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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?

To: Road Walker who wrote (3663)	1/9/2008 4:21:27 PM
From: Lane3	Read Replies (1) \| Respond to of 42652

"It is startling to see the US falling even farther behind on this crucial indicator of health system performance...other countries are reducing these preventable deaths more rapidly..." Misleading argument. Trailing in rate of change of some factor tells you nothing about quality. The center on my local high school basketball team is improving faster than, say, Shaq, but no one in his right mind would interpret that as meaning that the high school center is the better player.

To: Road Walker who wrote (3663)	1/9/2008 4:25:56 PM
From: TimF	Read Replies (2) \| Respond to of 42652

I wonder what criteria they use to consider a death one that could have been prevented. Also I wonder whether they are looking at the whole population, and taking the percentage that die from medical issues that "could have been prevented by timely and effective medical care", or looking at the population who has such issues and than taking the precentage. If the former, and if the US has more people with such issues, than our death rate will be higher whether our medical system is as good as other countries, better, or worse. If the later than they are close to actually measuring medical care (although there are still other factors besides the quality of care available and the insurance system to pay for the care). And it might be important to understand what conditions and circumstances they decide amount to conditions where death could be avoided and what conditions and circumstances don't fit that criteria. With the limited data you present I can't try to answer the questions, only raise them.

To: Road Walker who wrote (3663)	1/15/2008 5:47:34 PM
From: TimF	Read Replies (1) \| Respond to of 42652

"...If we put the partisanship aside, and view this as raw statistics, what lessons can be drawn? The biggest surprise is Japan -- a country whose health care institutions are not generally popular -- at number two. Spain and Italy and #4 and #5 are less extreme examples of the same point. Do the Germans and Danes really kill so many extra people through their health care systems? Would you really rather get sick in Greece? Nothing in this post is intended as apology for the United States health care system, but if we are going to look at the numbers let's consider all of them. If there is any lesson about the French -- who are a clear first -- it is that they do something right for health care apart from having so much government involvement. What might that be? What do we learn about what makes for a good health care system? Is there a correlation between health care performance and policy? I don't see it, maybe there is one, but I'm wondering if people are willing to draw lessons from this diagram consistently or not. I might add I find it easy to believe that American health care institutions make a disproportionate share of stupid errors, or are responsible for lots of patient mistreatments, so I am not trying to undo our presence on the right hand side of this graph. I do, however, walk away suspicious of the concept of "amenable" mortality..." marginalrevolution.com Unless I'm missing something this study is naive in the extreme. Let me enumerate a few ways it is deficient: 1) The study does not adjust for dietary differences. No, it is not the job of the health care system to force people to eat a Mediterranean diet. No, your doctor can't force you to lose weight. 2) The study does not adjust for geographical differences. In some places it is easier to get exercise all year around and get sun and therefore vitamin D all year around. That extends life. 3) The study doesn't adjust for population density. This has many longevity effects including distance to emergency room and likelihood of getting exercise. 4) The study doesn't adjust for lifestyle differences such as amount of exercise. 5) The study doesn't adjust for genetic differences. The racial and ethnic groups differ in their frequencies of alleles that affect risk of cancer, heart disease, Alzheimer's, and assorted other diseases. Also, skin color differences cause differences in vitamin D synthesis rates and folic acid destruction rates. Most of the ways that life expectancy differs are outside of the control of health care delivery systems. Until social scientists accept evolution and biology they are going to keep grinding out lots of crap studies. Posted by: Randall Parker at Jan 13, 2008 2:24:21 PM Randall Parker, Not to mention differences between countries in violent crime rates, differences in accident rates, differences in stress levels arising from differences in work patterns, family and community life, differences in pollution levels, differences in climate, differences in rates of smoking, alcohol and drug use, and so on. Each of these variables, and numerous others, may significantly affect mortality rates independently of any effects from the health care system. Posted by: Jason at Jan 13, 2008 3:17:42 PM Jason, Yes, it is extremely difficult to tease out causes for differences in mortality because there is such an incredibly long list of factors that influence longevity. This is an area where I read and blog about alot because I have a strong desire to not die. Studies done on longevity always end up having sources of error in them and successive studies contradict the results of earlier studies. I've been reading in this area for decades and I am not sure about the influence of many factors on longevity and I know there's a lot of uncertainty among many researchers who are focused on, say, dietary factors for example. These jokers come along and make some ridiculous simplifying assumptions and then draw equally ridiculous conclusions. I think these researchers are lightweights. This isn't easy stuff to tease apart. Look at the arbitrary assignment of lifestyle as the cause of half of heart disease. The average amount by which lifestyle impacts heart disease varies from country to country by a substantial amount. It gets even worse. People in different countries have different average genetic predispositions to heart disease. It gets even worse. If people eat a diet that, say, increases their risk of a certain kind of cancer they'll be less likely to get heart disease in the first place since they'll die sooner from cancer before getting heart disease. How to control for that? It is somewhere between very hard and impossible. Other researchers have approached international comparisons in relatively less naive ways such as to compare clinical outcomes once diagnosis has been made. But even comparisons between countries on survival rates of particular types of cancers are biased by whether diagnoses happen at earlier or later stages in some countries and by genetic factors that influence your odds. Heck, even diet influences survival odds once diagnosed. Do the heart disease patients change their diets in France or the US or Japan better once diagnosed? You'd have to find out before trying to compare quality of clinical care. Posted by: Randall Parker at Jan 13, 2008 4:29:58 PM

To: Road Walker who wrote (3663)	1/15/2008 5:50:38 PM
From: TimF	Respond to of 42652

Uncovering Some Really Bad Science Kevin Drum thinks he has a killer analysis supporting government health care. In a post he titles sarcastically "Best Healthcare In the World, Baby," Drum shares this chart: The implication is that the US has the worst healthcare system, because, according to this study, the US has the highest rates of "amenable mortality," defined as deaths that are "potentially preventable with timely and effective health care." I get caught from time to time linking to studies that turn out to have crappy methodology. However, I do try to do a little due diligence each time to at least look at their approach, particularly when the authors are claiming to measure something so non-objective as mortality that was "potentially preventable." So, when in doubt, let's look at what the author's have to say about their methodology. The press release is here, which gets us nowhere. From there, though, one can link to here and then download the article from Health Affairs via pdf (the site is gated but I found that if you go through the press release site you can get in for free). The wording of the study and the chart as quoted by Mr. Drum seem to imply that someone has gone through a sampling of medical histories to look at deaths to decide if they were preventable deaths. Some studies like this have been conducted. This is not one of them. The authors do not look at any patient data. Here is what they actually did: They arbitrarily defined a handful of conditions as "amenable" to care. These are: Ischemic Heart Disease (IHD) Other circulatory diseases Neoplasms (some cancers) Diabetes Respiratory diseases Surgical conditions and medical errors Infectious Diseases. Perinatal, congenital, and maternal conditions Other (very small) All the study does is show how many people died in each country from this set of diseases and conditions. Period. It doesn't determine if they got care or if they in particular could have been saved, but just that they died of one of the above list of conditions. This study was not an effort to identify people who died when their particular condition should have been preventable or amenable to care; all it measures is the number of people in each country who died from list of conditions. If Joe is talking to me and in the next second flops over instantly dead of a massive heart attack, the author's consider him to have died of a disease amenable to care. We can learn something by looking at the breakdown of the data. If you can't read the table below, click on it for a larger version Let's take the data for men. The study makes a big point of saying that France is much better than the US, so we will use those two countries. In 2003, France has an "amenable disease" death rate 56 points lower than the US. But we can see that almost this whole gap, or 42 points of it, comes from heart and circulatory diseases. The incidence of these diseases are highly related to diet and lifestyle. In fact, it is well established that the US has a comparatively high incidence rate of these diseases, much higher than France. This makes it entirely possible that this mortality difference is entirely due to lifestyle differences and disease incidence rates rather than the relative merits of health care systems. In fact, this study is close to meaningless. If they really wanted to make a point about the quality of health care systems, they would compare them on relative mortality with a denominator of the disease incidence rate, not a denominator of total population... coyoteblog.com