

Health Care Doesn't Affect Health (on the margin) - yummyfajitas
http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/

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mattchew
A quote from one of my favorite books. The speaker is a poet from about 500
BC:

"Some of my best friends have been doctors, and excellent people they were,
most knowledgeable about the minds of men, whom they see when the poets do
not. But doctors are taught their laws, and they keep those laws if it kills
you. Some of them here in Sicily come asking how a wanderer like me has kept
such good health to past fourscore. I tell them this or that. It would be
uncivil to say that whenever in my travels I get a touch of fever, I go
quietly to bed and send for the local wise-woman."

Pretty good advice today, too.

I'd like to see Robin's point of view get a wide hearing. I'm afraid he's
trying to paddle against a powerful current the other direction, though.

~~~
kirubakaran
Is "local wise-woman" an euphemism for a woman of negotiable affections? I
don't understand how a woman possessing wisdom can help your fever.

~~~
MaysonL
Read "witch" or "herbalist" or "evidence-based medical practitioner unwilling
to go by fads and humours".

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ivankirigin
There are four levels of health: how healthy you are, how much health care
coverage you get, how much health care coverage insurance you have, and what
percentage of the population has insurance.

We've been arguing that increasing the percentage of those with a certain
level of health care coverage insurance would be good for aggregate health.

My intuition is that removing corn subsidies would have a greater effect - and
the aggregate health of the world would drastically increase if you consider
the African sugar farmer who can't sell to western markets because of
regulations and subsidies. Ohh, and it would make money, not cost money.

~~~
tjic
> My intuition is that removing corn subsidies

Heck, why not go ahead and remove _tobacco_ subsidies!

~~~
ivankirigin
Corn syrup isn't addictive. I think the cigarette market would be fine without
subsidies. Of course, I agree completely to remove those limits.

I find it's like solving global warming like painting a roof white, or working
from home - extremely cheap and obvious ways to change things. That
governments don't choose these options is likely because their goal is power,
not progress.

Removing subsidies, lowering regulation, legalizing pot, etc., would all be
revenue generators and add to the public good.

~~~
anamax
> I find it's like solving global warming like painting a roof white, or
> working from home - extremely cheap and obvious ways to change things.

Except for the part that they don't work. For example, painting your roof
white saves energy in some climates but not others.

> That governments don't choose these options is likely because their goal is
> power, not progress.

That's half correct. The goal is power but progress isn't something that govt
opposes, it's something that doesn't matter either way.

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sethg
It wouldn't surprise me if the health of the _average_ person is not
significantly affected by the amount spent on medical care. So what? The whole
point of insurance is to protect the policy-holder from the risk of outcomes
that are _much worse than average_.

My seven-year-old son has a friend with hemophilia; if he didn't get regular
infusions of clotting factor and similar treatments, he might live for another
ten years--fifteen, tops. The quality of his health coverage certainly has an
effect on _his_ health. And he is exactly the sort of patient that the
insurance companies will drop like a hot rock at the earliest excuse.

~~~
yummyfajitas
You are arguing against a point the article isn't making. There are two types
of treatments:

1\. Marginal treatments, or treatments you will not pay for out of pocket, but
will consume if they are free. These comprise 30% or more of treatments.

2\. Non-marginal treatments, which you will buy regardless of whether
insurance pays for them.

Your son's friend's hemophilia treatments sound like they fall into category
2. The article argues that category 1 treatments are useless (equally likely
to harm or help you).

~~~
mmt
This strikes me as a false dichotomy, especially since I believe the
hemophilia treatments fall into the first of two additional categories:

3\. Treatments you will pay as much _as possible_ for. This category may not
be distinct from category 2 for a single adult with no family.

4\. Treatments which have a high enough out-of-pocket cost, that it is a
factor in the consumption decision.

A personal example falls into category 4. Two migraine aborting treatments
work for me, rizatriptan in tablet form and sumatriptan in injection form. The
first requires about 3 hours for full effect, whereas the second takes under
an hour. The differences in cost between insurance an no insuranceare around
$25 and $100, respectively.

In the context of missing a full day of work, even the $100 falls into
category 2. However, during unemployment, on a weekend or an evening, even $25
is enough that it's not "free," but even the $100 isn't so much that I
wouldn't pay for it out of pocket, depending on the circumstances.

These treatments may well reduce my "health" by any objective measure,
including lifespan, but they certainly improve my productivity and quality of
life, something the article seems to ignore.

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Achorny
This article reminds me a lot of conspiracy theorists and their "anomaly
hunting" - throwing out as many anomalies as possible leaving little chance to
consider/rebut them before moving onto the next thing, and claiming victory
when no one bothers. I'm not an expert on many of the things listed, but many
stick out as just not making any sense:

First of all, holy special pleading batman! Pretty much right at the beginning
he redefines health care to exclude things he admits work - diet, exercise,
sleep, not smoking, etc. Who does he think figured out that smoking was bad?
Or how much exercise and sleep is enough, and how much is too much? Or what
foods are good for you and which are bad?

He also claims that there are "dozens of studies of the aggregate health
effects of medicine", but most of the studies he describes are very specific -
several only studying the last six months of people's lives, ignoring how many
cases of people living extra _years_ because of medicine? He also admits that
increased social status improves health while claiming that increased medical
spending does not. But it's well known that the rich can afford better health
care, and doesn't explain how to (or cite any papers that) control for this.

Lastly, he only considers length of life and totally ignores _quality of
life_. I take an antidepressant for my anxiety, and while it probably will not
affect the length of my life, it sure as hell is worth every penny in
improving the _quality_ of my life!

~~~
yummyfajitas
I strongly suggest you read the article before commenting.

 _Pretty much right at the beginning he redefines health care to exclude
things he admits work - diet, exercise, sleep, not smoking, etc._

No he doesn't. That was a bad choice of title on my part when I submitted the
article. I should have titled it "Medical Care Doesn't Affect Health (on the
margin)". But like most people, I use the terms "health care" and "medical
care" interchangeably.

The bigram "health care" does not appear once in the article.

 _He also admits that increased social status improves health while claiming
that increased medical spending does not. But it's well known that the rich
can afford better health care, and doesn't explain how to (or cite any papers
that) control for this._

This is simply not true. He cites a number of cross section studies which
compare rich/poor/etc people receiving more medicine to rich/poor/etc people
receiving less. He also cites the RAND experiment which was actually a
randomized trial addressing the same question.

 _Lastly, he only considers length of life and totally ignores quality of
life..._

False. The RAND experiment studied various health measures, not mortality.

~~~
mmt
> _Lastly, he only considers length of life and totally ignores quality of
> life..._ > >False. The RAND experiment studied various health measures, not
> mortality.

That may be the case, but the author makes it clear enough that, even in this
case, it is mortality with which he is concerned:

"The RAND experiment was not quite large enough to see mortality effects
directly, and so the plan was to track..."

I must agree that there is a distinct absence of focus on quality of life,
which I believe is the crux of the issue, especially at the expensive margins,
near the end of life.

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te_platt
Quick summary - from the article:

"If you would not pay for medicine out of your own pocket, then don’t bother
to go when others offer to pay."

Overall a well argued article.

~~~
jfornear
I would say the quick summary would be:

"In the aggregate, variations in medical spending usually show no
statistically significant medical effect on health."

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billswift
Robin's got a lot more on medical care at
<http://www.overcomingbias.com/tag/medicine> . You need to go back a few
months or more to get stuff like this essay though; most of his newer stuff is
on status signalling and medicine.

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silent_tone
Bad analogy. Most automotive defects lead to breakdowns, not serious crashes.
Most serious automotive crashes aren't caused by mechanical defects. When your
car DOES breakdown, you buy a new one. Preventative medicine and lifestyle
practices extends life in lieu of the option of replacing your body

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anamax
Indoor plumbing matters, as does garbage pickup and food and water safety.

