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

To: Brumar89 who wrote (22169)	8/18/2011 4:19:09 PM
From: Alastair McIntosh	1 Recommendation Read Replies (1) \| Respond to of 42652

don't know why lower extremity amputations from diabetes isn't cherry picking, but survival rates of major cancers* is.* we can argue whether our ability to extend the life of a relatively small number of people a short period of time is the true hallmark of quality, it’s our fixation on survival rates and not mortality rates that is telling. Mortality rates define the number of people who die of a certain cause in a year divided by the total number of people. For instance, the mortality rate for people with lung cancer in the United States is 53.4 per 100,000 people. Survival rates are something else entirely. They calculate the percentage of people with a disease who are still alive a set amount of time after diagnosis. The five year survival rate for people with lung cancer in the US is 15.6%. But here’s the thing. You can only decrease the mortality rate by preventing death, or curing the disease. That’s really it. That’s a cure or a life extension, and both are unequivocally good. Survival rate, however, can be increased by preventing death, curing the disease, or making the diagnosis earlier. And there’s the rub. Let’s say there’s a new cancer of the thumb killing people. From the time the first cancer cell appears, you have nine years to live, with chemo. From the time you can feel a lump, you have four years to live, with chemo. Let’s say we have no way to detect the disease until you feel a lump. The five year survival rate for this cancer is about 0, because within five years of detection, everyone dies, even on therapy. Now I invent a new scanner that can detect thumb cancer when only one cell is there. Because it’s the United States, we invest heavily in those scanners. Early detection is everything, right? We have protests and lawsuits and now everyone is getting scanned like crazy. Not only that, but people are getting chemo earlier and earlier for the cancer. Sure, the side effects are terrible, but we want to live. We made no improvements to the treatment. Everyone is still dying four years after they feel the lump. But since we are making the diagnosis five years earlier, our five year survival rate is now approaching 100%! Everyone is living nine years with the disease. Meanwhile, in England, they say that the scanner doesn’t extend life and won’t pay for it. Rationing! That’s why their five year survival rate is still 0%. The mortality rate is unchanged. The same number of people are dying every year. We have just moved the time of diagnosis up and subjected people to five more years of side-effects and reduced quality of life. We haven’t done any good at all. We haven’t extended life, we’ve just lengthened the time you have a diagnosis. Think this is far fetched? In England women are screened by mammography every three years starting at age 50, yet in the United States the American Cancer Society recommends women are screened by mammography every year starting at age 40. For a woman diagnosed with breast cancer in 2001, the five year survival rate in the US was 89.1%; in England it was 80.3%. The mortality rates? The American Cancer Society’s Cancer Facts & Figures 2009 reports it’s 25.0 per 100,000 women in the US and Cancer Research UK reports it’s 26.7 per 100,000 women in England. That’s not as big a difference. Hard to believe we’re spending almost two and a half times per person for health care what they do over there. theincidentaleconomist.com

To: Brumar89 who wrote (22169)	8/18/2011 4:27:40 PM
From: Alastair McIntosh	Read Replies (2) \| Respond to of 42652

'Cherry picked cancer?' Yes. You ignore lung cancer. Kills more people than all of the cancers you listed combined. ..................................... I’m going to be presenting you with a lot of charts today, because I want to cast a pretty wide net. All of these will be considering mortality rates, or how many people die each year from certain diseases. Before you start to talk about survival rates, go read this. It explains why I’m not going to use that misleading statistic. Let’s start with cancer. And, because I want to be fair, I’m going to go in alphabetical order for the different types of cancer. Here’s breast cancer mortality: Well, the good news is that we are among the best in the world when it comes to breast cancer mortality. We’re not the best, but we’ve been #2 in the G8 for a while. Japan however, seems to be doing much, much better than we are. Next up is cervical cancer mortality: Granted, cervical cancer is nowhere near as prevalent as breast cancer, so far fewer women die of it every year. But compared to comparable countries, I think it’s safe to say that we are middle of the pack in treating it. How about colon cancer? We are very good in treating colon cancer, with the lowest mortality rates when compared to comparable countries. A solid win for he US. The deadliest cancer, in terms of killing the largest number of people, is lung cancer. How do we stack up there? Shockingly bad. We’re dead last. And before you start blaming high smoking rates, remember that the US has some of the lowest rates of tobacco use of these countries. Let’s round things out with prostate cancer: Could be worse. We’re certainly not the worst, but nor are we the best. So, some good news and some bad news. How does this all combine in terms of our treatment of cancer overall? Not nearly where you’d like to see us. Because we don’t do as well with some of the more prevalent cancers, we wind up doing much worse overall when it comes to cancer mortality than you’d think. This is why, when some point to us having the “best” health care system, they focus on colon cancer or breast cancer, not on lung cancer. Overall, though, we’re near the worst. But that’s cancer. How do we do in treating respiratory diseases? Not so good. We beat the UK, but no one else. Less common than cancer, but still, a fair number of people die from these illnesses. How about deaths from heart attacks? Solid middle of the road again. I don’t want you to think I’m cherry picking diseases, though. Here’s how we stack up in mortality from all causes. Last place. Not where you’d expect to find the “best” health care system. Now I know a few of you are going to look at the list of “causes” I link to and take exception with some of them. I agree that deaths from assaults, suicides, falls, etc. can’t be blamed entirely on the health care system. But the number of deaths from the causes you are likely to complain about are small in relation to the total number of deaths. Moreover, were not the worst in death rates in all those “questionable” categories. So that’s not the answer. Plus, this is where we are supposed to shine. Preventing death is traditionally where we should feel safe in our skill. Unfortunately, we do well in some subsets, while middling or terrible in others. Overall, we’re in the bottom half when it comes to this category. theincidentaleconomist.com