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I can't quite understand why more people aren't interested in WHY the effect might be neutral - the best bet is probably that drugs are vastly more harmful in their long term effects than we now know (or could know.) But maybe Doctors also tend to inadvertently "approve" bad life style choices by the rude things they don't say. Or maybe we take better care of ourselves when we know others won't.

Of course, there could also be a rural effect - the farther you are from a health clinic, the farther you are from shift work or a bar.

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Let's call the mystery factor "more money for food"

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That was my first reaction, too.

Aren't there any studies that at least use QALYs instead of mortality?

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I'm not quite ready to buy Robin Hanson's whole "showing that youcare" theory, but it does explain a lot. Maybe someone can bepersuaded to do some fMRI. If the same parts of the brain lightup when people think about medicine as when they think aboutreligion, and they're different parts from what lights up whenpeople think about other health-related activities, that would besuggestive.

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What he said.

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First problem among both sides of the debate is the purposeful confusion between healthcare and health insurance.

Second, and probably more important is the false notion that a publicly funded healthcare system would provide the same level of healthcare that is available today in the semi-private system.

Any argument that does not first (and always) address this second issue is at best incomplete, and worst, just plain wrong if not deceitful.

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Robin's claim is far broader. As he put it: "For many decades health economists have known that the best available evidence shows little or no relation at the margin between med and health."

If true, that claim shouldn't be startling just to those who believe in medicine; it should be startling to those who believe in economics. Just about anyone who can afford it purchases health insurance and spends money at the margin for medical products and services. Neither signaling nor rational choice nor rational ignorance would seem to explain this behavior.

It's much easier to tell a rational choice or signaling story about health care denialism: isn't it startlingly clever? wouldn't it be economically rational for those who can already afford their own health insurance to lobby against measures that would tax their income for the benefit to others? Etc.

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I'll interpret your non sequitur to mean that you realize your study is inconclusive, but you do not wish to lose status by acknowledging it.

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The study doesn’t address the most common use of insurance, to treat non- fatal disease.Just as an example, my ophthalmologist couldn’t get a patient into the local nonprofit hospital to treat glaucoma as needed. So the guy will eventually go blind, but may live a long time. Being affluent and well insured, my friends are always going to the hospital for joint replacements, tests, cardiac stents, cataract or gallbladder surgery or to have some suspicious breast lump excised. All these things improve quality of life but don’t markedly extend it.

On the other hand, if a non insured person needs emergency treatment or just wants to visit a family doctor she doesn’t need health insurance.

If he gets cancer or some really bad chronic problem ,a person usually goes bankrupt and, gets on Medicaid and gets treated that way. So, all this study shows is that the system we have now is pretty good at keeping people alive. I doesn’t not show that it keeps people healthy.

There are several studies out there that show that people don’t prioritize their health when it comes to spending their dollar. If there are increased co-payments or lack of insurance coverage, they reduce their doctor’s visits. Thus, if preventive care is effective, it will be more effective if paid for by a third party. Then that leads to the question of a persons responsibility for their own welfare, and destiny, etc.

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Let's call the mystery factor Toothpaste.

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That paper is suggestive, but hardly conclusive.

It has a serious flaw in that they don't run the most basic possible check of methodology: run the same study, searching for a discontinuity at 64, 63 or 66 (and finding none). I don't see how the referee let them publish without this.

But lets assume the discontinuity exists and is robust. The discontinuity is more than 2x larger than could be reasonably explained by people shifting from uninsured to insured. This implies that in addition to insurance, there is also a mystery factor involved in the discontinuity.

To determine the effect of health insurance, we must figure out whether this mystery factor explains 50% or 100% of the discontinuity.

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Anonymous, the claim is not that medicine has no effect on health. The claim is that health insurance has no effect on health.

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It's a tempting offer. What are the odds that (1) I will come down with a serious health problem in the next 5 years; and (2) the problem is one which will respond well to medical treatment?

Maybe one in 10,000? I guess I prefer not to take that risk on a personal level. But I would think it's a pretty small risk.

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Megan has yet another post trying to explain what she means.

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And Medicare spending per capita is close to private per-capita spending, which suggests dramatically higher efficiency when you consider that it covers an older population that is, statistically, much sicker.

But there are limits to how efficient Medicare can be when the market in which it is buying services has been so heavily distorted by the irrationalities of the private health insurance market. You really have to look at countries that apply single-payer universally to see the full benefit.

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Here is Ezra Klein's reply. He says "At its base, [Megan McArdle's column] takes a methodological difficulty (it's hard to measure mortality) and blows it into something approximating a conclusion (insurance coverage has no effect on mortality)," and then reviews some evidence for the importance of insurance (including the QJE study mentioned by Bill).

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