38 Comments

The "low-hanging fruit" was picked some time ago with improved sanitation, vaccination, nutrition; and now we're faced with spending larger and larger amounts of money on interventions that add years, or months, to our life expectancy instead of decades. Even worse, our medical successes may be worsening our genetic fitness.

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That is the study I discuss in 3rd to last paragraph above.

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I don't remember if Robin responded to this story showing mortality benefits from healthcare coverage:https://statmodeling.stat.c...

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These results are not surprising. Medical advances are focused on treatment and patient feedback isn't applicable until the patient experiences conditions that put them in statistical categories like heart disease, cancer, high blood pressure, rare diseases, etc. Preventative medicine benefits everyone and could go far to increase the number of patients who look at medicine as useful in these studies, but when a medical system is driven by profit where is the incentive to focus on preventative medicine? Until physicians (and payors) make prevention a priority, the results won't change.

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I think you forgot to mention that you are talking about **marginal** health expenditure rather than **aggregate** while the typical american (after including employer sponsored health insurance as spending) spends an average of 12k/year on heath care, Medicaid patients spend 4k/year. (in california, including both gov/out of pocket expenses), The framing of this post seems to be talking about all 12k instead of the dubious say 8k/year. (while medicaid does cover some unnecessary stuff, it's the best I got as far as "low insurance"

Of course there's one caveat to this, a large amount of health expenses are about things which don't actually improve lifespan at all but do improve quality of life (mental health, pain management, broken bone fixing ect) since most of that seems to be covered by medicaid, let's just say this rounds to equality

I think you (unintentionally) are overstepping your bounds, there's good reason to believe in certain subsets of healthcare either A: not improving health but making life better or B: meaningfully improving health but not at the margin of insurance vs no insurance

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don't think he's disputing that there are some useful drugs, devices, operations, etc. Your surgery, Sovaldi, cisplatin, etc. Just that in the aggregate these benefits are potentially offset by medical harms - hospital acquired infections, medical error, etc. - and by useless or bad treatments - opioids, stents, etc. And potentially by behaviour modification i.e. if you think healthcare can swoop in and solve your problems, you may be less likely to solve them yourself. And by opportunity cost - if you had spent those dollars on other more impactful determinants of health...

It's quite surprising that we can't see a clear benefit given what we spend.

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Which editor? I think it would be good to include the editor name so that editors stop ghosting.

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Huge asymmetry in medical success. Mechanical interventions (operations eg) based on technology and accumulated doctors' skills are very impressive. General medicine (non acute degenerative) is not very good at all. Success of the former is easily and quickly identifiable but the latter is just promises and depressing evaluations of pathology. Is this a clue? Is it surprising?

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I'm not sure what you're trying to say.

Opioids are cheap (oxycodone costs about the same as aspirin). If people can afford to feed themselves, they shouldn't need insurance to pay for opioids.

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Has Medicaid Made the Opioid Epidemic Worse?

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heart surgery,

Bypass surgery belongs in the medical archives . . . No Western European nation has as high a rate of bypass surgery and angioplasty as we do—and they live longer

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Did you somehow miss the part at the very beginning where he says an EDITOR asked him to submit the article? Good grief...might want to consider deleting this embarrassing reply.

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Medical insurance is a way of paying for medicine. The "control" group also consumed medicine, so the study could only demonstrate whether the extra medicine that insured patients consume is valuable. If the non-insured patients had diabetes, I'll bet they found a way to pay for insulin.

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With insurance, it is quite common to split dental and optometry insurance off from the rest of medicine. While it is true that policy levers often bundle lots of medicine together, that's not the only perspective. People want to know how to fix themselves and their loved ones. They typically don't care about the status of medicine overall. They care about whether specific aspects of medicine work.

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Most of our policy discussions re medicine don't make such distinctions. Such as insurance, tax credits, regulation, professional licensing, sick days, medical privacy, etc.

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It seems as though what most people really want to know is which medicine is useful. We know that some medicine works. Broken bones, myopic treatments, IVF, filling cavities, etc. We also know that some medicine is net harmful. Addictive painkillers for example - see the opiate epidemic. Putting everything under the "medicine" umbrella in a study muddies the various effects together. Does that really help? IMO, we already know that medicine is a mixed bag - with some great therapies and some dangerous nonsense designed to enrich Big Pharma's shareholders.

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