This blog continues my ongoing series of “mysteries of health economics.”
The mystery this week is “what is a life worth?” We cannot ignore this question because it seems unthinkable. As will discuss, coverage decisions by public and private insurers depend on the answer. Some payers are rather explicit about they think a life is worth.
Before I try to solve this mystery, let me acknowledge that we should not spend money on health services that are of zero value (or worse.) But what about expensive health services that might prove to be of some value? How much should we spend on these?
Let us accept the reality of insurance. When we “purchase” health care, someone else foots the bill. Perhaps insurance should contain big deductibles, but even big deductibles are quickly exhausted if we need surgery or have a chronic health problem. If we are pooling our resources to pay for medical care, then we will probably want to reach some sort of collective decision about what drugs and treatments we will pay for. The alternatives would be to invite massive moral hazard. (Let me repeat for those who bang the drum loudly for big deductibles – deductibles are quickly exhausted when serious illness strikes and moral hazard again rears its ugly head.)
Now imagine a new cancer drug that offers a small prospect of survival to patients who have no other choices. Suppose that on average, patients who receive this drug can expect to live about another three months and that there are no downsides to this drug. If the drug company offered to give the drug away for free we would surely want patients to have access to it. If the drug company asked $100 million a dose, we would probably agree to spend the money elsewhere.
There must be some price under $100 million that would cause us to stop and think this over. Should we pay for the drug if it costs $500 per patient? What if it cost $100,000?
At some point we must answer the unthinkable question. In this case, we must determine how much should we be willing to spend to offer individuals three more months of life? Regulators in many countries have already given their answer. For example, the UK recently refused to pay for the skin cancer drug ipilimubab because the cost per “quality adjusted life year” was between £54,000 and £70,000. The UK uses a threshold of about $100,000 per year of life, a threshold that is accepted in most developed countries. But is that really what a year of life is worth? By all accounts, this threshold is based on past spending norms, adjusted for inflation. What was once seat of the pants policy, driven purely by budgetary needs, has become the gold standard for measuring the value of a life.
This all seems rather ad hoc. Rather than accept a valuation that was seemingly pulled out of thin air, academics have sought to value life by looking at how people actually behave. Some researchers have asked people what their lives are worth. Carefully constructed surveys generate values for a year of life well in excess of $100,000.
Such surveys are notoriously unreliable. If we could observe people spending their own money on health services, then we would truly know what they think their lives are worth. But insurance means that we only see people spending someone else’s money. Here is where economists have gotten rather clever. Workers are often confronted with tradeoffs between relatively safe jobs and relatively riskier jobs that pay more money. (Controlling for skills and experience, the data definitely show that riskier jobs pay more.) Assuming that employers do not pay higher wages out of the goodness of their hearts, they must be paying higher wages in order to convince workers to take on more risk. Led by Harvard’s Kip Viscusi, economists have looked at the data and determined that workers can expect to get paid an extra $5000-$10,000 to take on a job that has a heightened mortality risk of 0.1 percent. This adds up to $5-10 million for every additional death, or well over $250,000 for every year of life lost. If workers insist on getting paid $250,000 extra to compensate for the prospect of losing a year of life, then they must hold their lives very dear.
So is a year of life worth $250,000 to the average worker? Many people criticize Viscusi’s work, in part because it makes strong assumptions about what workers know about job risk and about worker mobility. Some economists observe that these calculations do not take into consideration the importance of hope. But if we try to correct for any resulting biases, the value of a life would probably be even bigger! One bias might work in the opposite direction – we might insist on receiving a lot of money to take on additional risk, but be unwilling to give up the same amount of money to reduce risk.
My mother always told me that “if you don’t have your health, you don’t have anything.” She held life very dear. So do I and so do most people – more so than the UK and other regulators want to believe.
Everyone is concerned about rising medical costs, and for good reason. At some point we may spend so much on medical care that we will no longer be willing to give up so much money to live longer or better, preferring to spend the money on food and shelter. And in today’s tough economic environment, perhaps quite a few of us have reached that point. But in our zeal to cut spending, let’s not throw out the baby with the bath water. Effective medical care remains one of the greatest bargains, even when that means spending tens of thousands of dollars to save just one year of life.
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Indeed.
You mean the section 8 neighborood I live in? I don’t have enough rich friends paul? Your just pushing more BS and avoiding the facts. What income disqualifies someone for Medicaid? Once you establish that what percentage of people making more then the number you just determined have cell phones, cable TV, two cars, etc etc. Sometimes BS is BS and your spewing BS. We know 20% or more of the uninsured make over 75K per year, are you argueing someone making 75K is choosing between food and insurance?
The chief failue of liberals is rank stupidity and ignorance. No matter how clear the facts and how easy they are to obtain they push a narritive based purly on ideology.
“No matter how much insurance you have, it is possible for you to contract an illness which will exhaust it.”
How do you exhaust an unlimited policy? See above about ignorance and facts in regards to the left.
“Then they learn that suffering is not always the fault of the sufferer.”
And in those cases everything should be done to help those sufferers. The left on the other hand is hell bent on helping those that do not need help, at the expense of the true sufferers. People such as your self thrive on the action of assistance not the result. To you it does not matter of the person being helped is in need as you helped and that is all that matters, preferrably with someone else’s money as people like you love to talk about sacrafice but prefer it be born by the next man.
Lets look at the largest of failures Medicare, it was passed to assist the 13% of seniors that suffered yet as passed did not help them at all, in fact it grew the problem from 13% to 19%. As typical liberals you celebrated the action of medicare even though it failed.
>> I have never once meet a person that could not afford insurance, I have meet thousands that had other priorities. usually nice cars, new clothes, and comforts not needs.<<
You travel in the wrong circles, Nate.
The term B.S. is unfortunate, because it is often used to smear someone who espouses truths which are inconvenient. But if that term has to be used, it should be applied to the rants of ideologues like you, who would seem to take life and death issues and reduce them to ideological ones. It is interesting to note how the prejudices of people change when they discover that they are adversely affected by policies they once espoused. Then they learn that suffering is not always the fault of the sufferer.
In my view, the chief failing of conservatives is the failure of imagination. They suppose that "it can't happen to me." Well, Nate, I'm here to tell you that it can. No matter how much insurance you have, it is possible for you to contract an illness which will exhaust it. Sooner or later, Nate, we are forced to acknowledge that our share of the world is the same In the end — six feet. To acknowledge is sooner is the beginning of wisdom.
Sorry Paul but that is BS. Our poor live better then the middle class of almost every other nation in the world. When your talking about people buying policies your already excluding our poor becuase they have Medicaid, your talking about our middle class everyone of which has a fancy cell phone, cable TV, more house then they need, drinks and smokes etc etc. There is zero truth to any claim americans are choosing between food on their table and buying a good health insurance policy.
How many policies have you sold in your lifetime? A more acurate fact would be how many policies did I not sell becuase the person choose not to buy, sometimes claiming they could not afford it. I have never once meet a person that could not afford insurance, I have meet thousands that had other priorities. usually nice cars, new clothes, and comforts not needs.
Nate, you say “it was usually the greed of the individual that didn’t want to pay extra for a policy that covers the treatment they now wish they could get.” In my experience, those who avoid the “premium” health care policies do so because they cannot pay for it and still put food on the table and pay the rent. To say this decision is a result of “greed” is perverse.
I know someone whose favorite saying is “enough is as good as a feast.” The word greed, in my understanding, applies to people who already have enough. and want MORE. It doesn’t apply here.
Jeff –
That was a very interesting and informative comment. I also hope you heal quickly and suffered no permanent effects.
I think your emergency room experience with respect to both your own care and care administered to others reflects providers’ perception of our litigation environment and patient expectations plus a desire to generate revenue from well insured patients. As for cardiology related services, it seems that everyone wants to expand there because it pays well, even by Medicare.
I’ve long favored high deductible health plans as a good way to mitigate utilization of healthcare services. I know liberals claim that many people, not all of them low income, will forgo some necessary care and incur higher costs later when a minor problem develops into a major one. In other words, people cannot be trusted to act in their own best interests and government needs to protect them from themselves. I don’t buy it. High deductible plans should work fine for at least the upper half of the income distribution. For the lower half, doctors and hospitals could work with patients on payment terms and even write off the entire patient portion of the bill if circumstances warrant while setting fees sufficiently high to earn a respectable living net of uncompensated care.
I think Nate makes a fair point about people being less likely to scam someone who lives close by than a distant government entity. I also think it would be better if state and local government had a significantly higher taxing and spending responsibility as a percentage of total public sector spending. State and local government should probably be responsible for all education spending as well as transportation and finance Medicaid through a combination of state taxes and federal block grants. Benefits and eligibility criteria will not be uniform but they aren’t now either. States would capture all of the benefits from fraud mitigation strategies and would be free to use robust ID cards if they want to even if other states choose not to and there is no federal ID card.
is the dog remaining silent or talking about who put him up to it? Its a dog don’t beleive him if its naming names.
I’ll agree that means testing is needed, I would just hope for a drastic change in how and who does it. I would like to see an inversion of the responsibility pyramid. It seems responsibility starts at the federal government level then trickles down to the individual with the individual responsible for very little today.
If we flipped that and responsibility started with the individual then finally the federal government I feel it would solve many of these problems, including means testing. Its mush easier to scam someone far away that doesn’t care then someone that lives in the same town as you. Taxes should also be inverted with local taxes consisting of the vast majority and a small amount going off to the federal government.
I do feel sharing these stories is starting to pay off. When we do benefits meetings now and talk about the high cost of Rx or the cost of a hospital MRI versus freestanding center people are not only engaging with questions but followinbg through. One of my biggest concerns is now that we are finally making some head way reform will kill the movement.
Hope you get well soon and there is no cosmetic damage:)
Nate,
I wanted to get back to you all week. Unfortunately I had an embarrassing incident wherein I tripped while walking my dog. With both hands occupied I did the traditional face-plant onto the concrete. As my nose touched down a foul crack echoed through the neighborhood. All I could think was ****$$$%%% that hurt! Second thought, get out of here fast before someone sees your foolishness. I trotted down the hill with Bodi ; blood dripping everywhere; bag of dog poop in one hand and dog leash in other. This all culminated in 12 hours of ER evaluation with a final diagnosis of broken cartilage but all else in-tact. Of course I had the obligatory CT of my head. I even called my primary care doc before I left for the ER stating that all I cared about was whether or not I had any cranial fractures otherwise treatment would not be a concern until it all healed. Knowing I wanted a simple skull series of x-rays; I got the full-house. This of course was due to my Blue Cross.
While in the ER I watched the non-urgent bumped elbows, chronic knee pains and earaches come and go as three true rescues were attended to by full medical teams and in one case…a Chaplin. I kept asking myself why it hasn’t gotten any better with all of our efforts at managed care and now: Primary care Medical Homes.
When I managed Pulmonary Rehabilitation Programs I held to strict criteria that the tobacco addicts had to be free from all tobacco products and receive counseling as required. In ten years I discharged two patients early because they elected to smoke in the bathrooms. We had a 10 bed facility and I simply stated to the patients that we had a waiting list and needed commitment: In other words a zero tolerance contract. This was the ONLY time in my clinical work where the corporate administrators of any company allowed me to sacrifice revenue for health-beliefs.
In the early 1980’s ,my profession was blessed with all kinds of cool technologies: New high-resolution cardiac cath lab equipment, electrophysiology and 2 dimensional ultrasound. I had been hired to open a new diagnostic clinic in New Hampshire where we had three competing hospitals within 15 miles of each other. We were fortunate enough to hire the first cardiology group and I was hired from Los Angeles due to my cardiovascular skill set. Here is how we justified each purchase of new diagnostic equipment.
Population count X (prevalence +incidence rate) X Medicare MAC (it was lower than commercial so we hedged our bets)X estimate of cases expressed as a % of diseased population. Once I had the revenue I would simply divide it by the capital cost and incremental cost of operation to establish break-even. In most cases, break-even was less than 12 months. As long as costs were below $1M we did not need a certificate of need. Between 1981 and 1982 I became the instant hero at the hospital with the new revenue centers. The small community-funded hospital eventually sold to Hospital Corporation of America (I am sure you know their history), and I went on with my career chasing revenue center to revenue center as managed care established rules which simply required us to relocate the patient to a slightly lower cost of care facility. I could tell you some great stories from the road back then.
Within five years we had three hospitals with a combined 600 beds caring for 150,000 people: each with competing services including cardiovascular medicine and neurology.
As I sat in the ER the other day I thought of your comment on the era of cost-control in medicine: When we had no insurance and everyone self-insured: This resonated with me as ‘truth’. Of course, back then we were just starting to experiment with open heart surgery. But you nailed it brother. My reality is that with the exception of us folks that traverse the payer-provider line few really understand how the M1 works in healthcare. The escalation in cost through value added services and no requirement for us to have the vaguest idea how to read an EOB.
So my point all this time was that I actually agree with you on many points. For example I have what I call the Harris Index of Diagnostic Inefficiency. It is the ratio of MRI scanners to population where the USA is three times higher than other countries; and the Dartmouth Atlas linear regression of cardiac surgery rates to number of cardiothoracic surgeons per 100,000 persons. This is after correcting for illness burden of course.
One of the missions of my Blog is to bridge the gap between the lay-public and professionals and create parity of knowledge around cost benefit and cost efficiency. Kind of like when we learned that out cars didn’t need the $800 under treatment to prevent rust after paying for it for so many years.
So I want to thank you for putting me back in touch with a need to expose the shell game. Like you, I simply have no short term solution so want to leave blame out of my discussion other than pointing to a system run-amuck with overpriced services, too many inflationary steps in the value chain and too many people on public subsidy. I will continue to argue for some form of provision of healthcare services for those who do not have the ability to pay. But…due to our conversation and my soul searching and my trip to the ER and the 33 years of saying to myself “this doesn’t make sense” : I will push for a better mechanism for means-testing and a time limited resource to slow down our social Darwinism …perhaps.
Let’s stay in touch as your perspective is a critical lens that needs to be added to the ‘big picture’.
Take care,
Jeff
You can reach me on Twitter: @untangledhealth
” I believe that society must reach agreement on how to help those who can’t help themselves.”
Haven’t we tried this and it failed miserably? I don’t see how this can ever work but on paper when we allow those that can’t help themselves to self identify and those seeking assistance are given power of taxation and regualtion over those with the ability to assist.
Is it still help/assistance when its confiscated against the will of those that have it?
“in a free market with no cost control”
The most efficient we ever were and the most effective cost control in the world was when people paid for their own healthcare totally or paid then seeked reimbursement. The lack of cost control is a perception when in fact the implementation of managed care under the guise of cost control increased cost. ACA is a recent example, whats affordable about it? What did manage care manage?
“Medicare/Medicaid landed on the seen far too late in my opinion: Then we passed the ACA hybrid”
Whole lot of failed reform skipped over here.
no need to apologize its going to take some nasty fights and maybe even worse to break through 60 years of lies and misinformation. I strongly agree with the need for an informed public, i just disagree on how we fix it. You appear to gravitate to the educated and polite method of teaching. I prefer to call an idiot an idiot and tell them to pull their head from their ass. Not so much so they change their mind and see the light, most people can’t admit when they are wrong to that level, more so other people see how wrong those people are and stop being influenced by them.
Thank you for the lively debate
Barry and Nate,
I certainly did not mean to be anonymous and thought I had posted my personal info earlier. I also agree with all of your observations Barry.
I have a consulting practice since 2007 that specifically focuses on local organizational needs when it comes to understanding and developing health care systems that will address the needs of the community, I address community health profiles, professional supply, and health belief culture and health information technology. I believe that health is a local phenomenon and that all citizens should take a role in defining their values, needs and ‘nice to haves’, My practice has taken me to regional health-plan and provider partnerships, hospitals, the CT Academy of Family Practice joint venture with Anthem Blue Cross, Federally Qualified Health Centers, and State Medicaid Programs. I started the consulting practice due to what I judge to be a lack of truthfulness in the industry.
My clinical training is in Respiratory Therapy and Cardiovascular Technology and Rehabilitation Medicine. I hold three Registry Credentials and one State License in Massachusetts. I have a BS in Business Economics which I used to brighten up my thick skull.
In 1997 I became very frustrated with hospital readmissions when patients leaked outside of our system of care and left my program management role to work in clinical informatics. I joined a start-up team formed by a physician-engineer, the CTO of Lotus Development and the former AI lead at Carnegie Melon. We went on to patent one of the first web-native, role based security care coordination platforms which applied geographically sensitive decision support rules to care plan generation. Ref: System for Managing Applied Knowledge and Workflow in multiple dimensions and contexts. United States Patent 6282531 June 12, 1998.
Suffice it to say, I have worked with many folks that are light years ahead of my intellectual capacity and have enjoyed the excitement in medicine in the last thirty years as we have tried to squeeze more and more blood from a turnip (or water balloon), From pre DRG to UR, to UM, to CM to DM, to PCCM; I have worked in all systems and believe we need to somehow create a clean slate that is based on the values and pocketbook of our democratic society,. I believe in Universal Coverage from the perspective of basic life sustaining and episodic curative procedures but not a continual stretching of the healthcare dollar to reach the theoretical longevity of 125 years,
On Politics: I trust NO-ONE. I call myself a communitarian capitalist as I believe that society must reach agreement on how to help those who can’t help themselves. This would include all ICDs and DSMs. I believe we should address the beginning and last two years of life and ask ourselves some serious questions on just how much society should pay when it comes to life sustaining procedures. I have an advance directive that specifically states my wishes. I have spent too many hours in the ICU listening to doctors and families hold on to the last few breaths of a person that my staff knew would be reaching their end 12 months ago. When it comes to the end, we all take it very personal and have a hard time reaching an agreement. I certainly do not believe in death panels but believe that evidence based medicine has its place in forming policy. For example: We know that without lung transplant a COPD patient has about a 10% probability of becoming ventilator free after three previous episodes of ventilatory failure. So who decides and who pays for the care of the patient after the fourth intubation. Should we have an end of life Medical Savings Account? And of course the same applies to neonates. Somehow, we need to understand that we can’t have everything, all of the time.
Yes, I am a healthcare reformer. But there is no such thing as Obama Care and never was. What we have is an interdependent supply chain of numerous value added companies in a free market with no cost control until Managed Care and Medicare/Medicaid landed on the seen far too late in my opinion: Then we passed the ACA hybrid with all of its negotiated points. All that has value to me is the fact that my State’s High Risk Pool can now insure me for $467 per month vs. $1100 (Diabetes for 45 years): And the inclusion of pay for performance. I believe most folk are stuck in an uninformed state, listening to sound bites that are taken out of context and used to prove or disprove the agenda of the sponsoring agent. We spend more time thinking about which LCD TV to purchase than our benefits programs.
I took 1000 hours off in 2008 to campaign for President Obama. Why???
I liked the Man but had no faith in the system until we get term limits: and now also recognize that President Obama was a bit new inside the beltway to take on the bandits attacking from all directions.
Well, I never thought his rhetoric or anyone else’s was the least bit achievable in a 4, 8 or 12 year time frame. But I wanted to make sure a fight got started that would force us to look at the aforementioned social issues. It is too easy to watch TV and head for the voting booth. This is why I champion for mutual respect and conversation. If I wind up with an overwhelming group of draconian folks then I will move elsewhere: Same for a Nation of Addicts seeking immortality.
I am very sad that our nation is so divided. I am an independent consultant because I see how folks twist data to prove points just as Nate described…causation vs. correlation…
I still hope for a solution to emerge from a group of adults who can objectively state the moral, spiritual, functional, social nature of medicine to the average citizen and a truly informed society then votes with a basis of knowledge.
Thanks for asking me who I am. I don’t have answers. Yes Nate, I do have training in statistics, probability theory, meaningful difference and central tendency. But as I just said: data and information can be manipulated to prove a point so I try to live with that knowledge and hold myself in integrity. My friends are all the same and we have a great time calling ourselves on our own BS as opposed to flogging one another. I was a bit mean in the last few posts so I apologize.
You can access my blog at http://www.untangledhealth.com
Thanks for calling me out with your diplomacy Barry.
Jeff
“One area where I certainly agree with you is on the disparity in prices per procedure and per brand name drug between the U.S. and Europe and Canada.”
Allow health plans to reimburse foreign sourced prescriptions and the price of brand name Rx will plummet. If an American can travel the world and buy Rx any place he wants along the way its redicilous to say he can’t be trusted to order from home.
The key factor here is not that American’s will actually buy their drugs from overseas, its the fact it will create awareness. Once people see the difference in cost between the same drug in Canada or India and the US they get engaged….that and a little enraged. Our governmental policies are just as much if not more responsible for our sheltered consumption as the FFS system we have. In fact these are symptoms of government regualtion not FFS.
Hospital charges are about to take a huge hit, 2012 might even be the year it all blows up for the good. The CA v MultiPlan & Sutter lawsuit plus a couple other things are going to get hospital bills more attention then they can withstand.
Untangled Healthcare –
Agree or not, at least Nate, I and several others use our real names when commenting. Our attitude is if it’s worth saying, it’s worth owning up to. You seem like a pretty smart and knowledgeable guy but we have no idea who you are or what you do. Are you a doctor, an academic, an insurance executive, health economists? A little more color there might better help us understand your perspective.
One area where I certainly agree with you is on the disparity in prices per procedure and per brand name drug between the U.S. and Europe and Canada. Standard chemical based drugs, as opposed to biologics, have an extremely low (often pennies) marginal cost to manufacture. Drug companies that go along with price controls in other countries add to their profits while, in effect, forcing Americans to shoulder the lion’s share of their R&D costs. I don’t support price controls, but I do support limited formularies and tiering which we have. Some 75% of prescriptions are already generics, which are actually cheaper it the U.S., and Lipitor, the biggest seller, is about to go off patent with Plavix the 2nd biggest seller losing patent protection in 2012.
Hospital charges are also much higher in the U.S. but so are their costs. The number of employees per licensed bed is considerably higher for reasons I don’t fully understand. Perhaps you could shed some light on that.
Doctors also earn considerably more in the U.S. vs. their European counterparts. Aside from the issue of medical school debt, the opportunity cost of earnings in other lucrative fields such as business and finance is much higher in the U.S. than in Europe. While many doctors may happily work for half what they could earn in the business and finance worlds, they won’t work for 10% or 20% as much.
I think we would be better served if we attack healthcare utilization through such as strategies as robust price and quality transparency tools, tiered insurance products, safe harbor protection from failure to diagnose lawsuits for doctors who follow evidence based guidelines where they exist, and a much more sensible approach to end of life care along the lines of the approach followed by the Gundersen Lutheran Health System based in LaCrosse, WI, A serious attack on fraud and fewer unnecessary back surgeries and cardiac stenting would also be helpful.
You can take a wealthy African American male and live his entire life in Japan he still won’t have Japanese genetics or life expectancy.
[comment: jeffrey harris] Actually his blood pressure will be quire lower and he won’t suffer the consequences of end organ damage from that disease.
BETHESDA, Md., Oct 28 2011– African-Americans with two copies of the APOL1 gene have about a 4 percent lifetime risk of developing a form of kidney disease, according to scientists at the National Institutes of Health. The finding brings scientists closer to understanding why African-Americans are four times more likely to develop kidney failure than whites, as they reported in the Oct. 13 online edition of the Journal of the American Society of Nephrology.
If the stroke doesn’t get ya the Kidney’s will, can’t run from your genetics. This sickle cell and numerous other race specific illnesses raise the question how can you compare life expectancy of Americans to Europeans and Asians and not adjust for race?
“I was referring to the fact that disparities research proves”
No, disparities research argues access to care relates to income which drives the majority of the loss in years of life. Its a theory like all the other bogus academic theories derived by academics who have never worked a day in the field in their life. Just because poor people suffer from X more does mean poverty causes X, all the disparity research in the world will never prove that.
“[comment: jeffrey harris] Um, I am referring to literature published by the NIH, UNC School of Public Health, Duke metabolism and nutrition program etc.”
This comment;
“I can’t believe someone would point to race and minority as an issue regarding our healthcare cost burden.”
Sure appears to dismiss genetics in favor of the poor oppresed masses 99% argument. Genetics matter far more then income and access to care.
“why would you bring them up to begin with if you had issues with their ability to fulfill commitments. ”
???? Um I didn’t bring them up.
” I fear that you may not believe in the holocaust.”
Thats a desperate attempt to save face when you have been terribly discredited. Name one fact I was wrong on. I can back up everything I said.
“But even this lower ratio continues to reflect the fact that the Census data’s top “quintile” is seriously overpopulated, while the bottom is underpopulated. Once the quintiles are adjusted to contain equal numbers of persons, the ratio of incomes of the top to the bottom quintile drops to $4.23 to $1.00 (as shown in Chart 4). Moreover, even this difference is due in large part to the fact that working age adults in the top quintile work twice as many hours as those in the bottom. If such adults worked the same number of hours, the income ratio would fall to around $3.07 to $1.00.”
http://www.physorg.com/news/2011-01-shorten-lifespans.html
Over the past 25 years, life expectancy after 50 has risen in the United States, but at a slower rate than in countries like Japan and Australia, said the National Academy of Sciences report.
The gap sounded the alarm among government researchers because the United States spends more on health care than any other country, said the study which examined mortality records in 21 countries.
Men in the US showed an increase in life expectancy of 5.5 five years between 1980 and 2006 for an average lifespan of 75.64 years, while US women’s lifespans expanded from 77.5 to 80.7 years.
“Three to five decades ago, smoking was much more widespread in the US than in Europe or Japan, and the health consequences are still playing out in today’s mortality rates,” said the report.
“Smoking appears to be responsible for a good deal of the differences in life expectancy, especially for women.”
Cigarette smoking also appears to have dented life expectancy in Denmark and the Netherlands, the report said, noting those two nations showed “lower life expectancy trends than comparable high-income countries.”
I’ll be embarrased when you find a single error in my post.
Thanks Bill, I agree with you. Actually their are some good examples of redesign. I point you to Ezekiel J. Emanuel (Author) Healthcare, Guaranteed: A Simple, Secure Solution for America available on Amazon or Kindle.
Certainly we are speaking of a social paradigm shift.
To start with physicians will be paid FFS and have a health outcome component as a kicker. See the NCQA Bridges to Excellence Program and CMS pay for performance models.
Unfortunately we still need to work on human motivation due to the tremendous issues with patient compliance.
It is heartening to hear your comment though.
Here is the new reply:
“I can’t believe someone would point to race and minority as an issue regarding our healthcare cost burden.” I can’t believe someone would pretend to have an intellectual conversation then jump up screaming as soon as the FACT that genetics matter in life expectancy.
[comment: jeffrey harris] I was not referring to genetics, I was referring to the fact that disparities research proves access to care and its attendant proportionality to quality adjusted life years relates to income regardless of race and ethnicity.
You can take a wealthy African American male and live his entire life in Japan he still won’t have Japanese genetics or life expectancy.
[comment: jeffrey harris] Actually his blood pressure will be quire lower and he won’t suffer the consequences of end organ damage from that disease.
This isn’t middle school science class, if you can’t accept the basic scientific fact that we are not all created equal genetically there is no sense trying to discuss this with you.
[comment: jeffrey harris] Um, I am referring to literature published by the NIH, UNC School of Public Health, Duke metabolism and nutrition program etc.
Shocker, races have different predispositions, certain Jewish heritages are prone to illness few others are, African Americans are predisposed to certain ailments. “I have personally met and presented to executives at Wellpoint and admire their commitment to prevention.” I bet you loved Obama and his ability to read off a teleprompter as well. Have you spoken to any of Wellpoint’s clients on how those commitments are manifesting?[
comment: jeffrey harris] Well Point has had significant changes in management leadership and why would you bring them up to begin with if you had issues with their ability to fulfill commitments.
“Not whether or not we have treatments. What we have is disparity in access to treatment as a result of unequal distribution of resources” This is present in every country and has very little impact on outcomes.
[comment: jeffrey harris] (Huh???)
Personal choices are far greater issue then unavailability. If we gave away free PSAs to everyman most would still not take it. Access is a red herring of those provoking government assumption of healthcare. “does that mean if you are in poverty you should die early?” That you should die early, no it does not. That you will likely die early, yes it does. Poverty is usually the result of poor decisions and those decisions are in financial matters as well as health.
[comment: jeffrey harris] I know like the legacy of dependency we have created with entitlements thereby creating a class of poverty.
“countries with equal access have better health outcomes regardless of economic status.” BS, not true in the macro at all.US leads the world in many health outcomes. Anyone claiming what you just did doesn’t understand proper scientific analysis, i.e. your bogus life expectancy claims. For more bogus beliefs I bet you subscribe to let’s talk premature births, that’s another red herring of those that don’t know how to properly present data or compare disparate systems. Every race of people lives as long or longer in the US then they would in their native country, our minorities far outlive their native life expectancy. “If you look at the same WHO tables referenced above you will see this represented by the fact that our premature birth rates are high” That is because the WHO are quack academist who use different measures in different nations and don’t adjust for it. FYI if you measure temp in celsius in Europe and Fahrenheit in the US and don’t adjust you have meaningless comparisons. Go back and use the same reporting standards then tell me what your WHO data says. “everyone stop smoking (we smoke less than comparison countries)” How sheltered are you? We smoke less? Now but not until 1980s. Damage from smoking doesn’t disappear, all those people that smoked for 20-30 years are in their Medicare period and incurring claims. Again you have to know how to use data and properly adjust. You can’t look at today’s smoking rate and ignore 40 years of prior smoking. “exercise daily and take care of their families while working two $10 per hour jobs.” More complete BS, today’s poor work fewer hours then any time in measured history. “Perhaps we just don’t care and will let the trend escalate as is now to a two tier system of haves (1-3%) and have-not groups (97-99%).” Our have nots live better then the haves in almost every other country in the world. Our poor live better then the middle class of Europe. Bigger homes, more personal property, more comfort items like AC and cable. Most of the world dreams of being poor in America. “All I asked for at the beginning was for a group of us angry, polarized people to sit down and discuss the real data, information, and consider a compromise that will create access for all.” Start with real data and throw out the propaganda, our system provides care equal to any other system in the world and unlike almost every other developed system ours is sustainable. Once you start with the facts the solution becomes much easier. “Man ,what has happened to us.” Lazy people telling lies looking for free handouts. Classic case of the “homeless” guy at the intersection begging money before he goes home to his nice house. If you were working 70 hours and trying to provide for yourself you wouldn’t be poor, if you were born poor and worked that hard you wouldn’t stay poor. If you were a lazy bum working 10 hours a week once or twice a month claiming to be working so hard then a life of poverty not only awaits you but is deserved by you. These pathetic attempts at class warfare are going to blow up in your face. Sooner than later those that actually work and provide are going to get feed up with the parasites demanding more for nothing and stop supporting them.[
comment: jeffrey harris] I can see that you have totally embarrassed yourself at this point so I don’t want to add any further comment on this post. I fear that you may not believe in the holocaust. Good luck in your life and I am sorry we couldn’t work through to an understanding.
Take care bro
All life is precious to the person but has a limited value to others. My biggest disappointment in all this is that no one is working on redesigning the model. We need to spin our thinking around to a place where health is the norm. As long as you keep paying while we are sick the incentive is to hold you between wellness and death. The perfect medicine could not be used in our society because it would end a large part of our healthcare industry and that tells me we have a deeper problem. The only solution I have ever heard was to pay the physicians or health professional when we are well and not pay them when we get sick then the motives are correct as they should be. That said there must be other ways or steps to accomplish this goal.
“I can’t believe someone would point to race and minority as an issue regarding our healthcare cost burden.”
I can’t believe someone would pretend to have an intellectual conversation then jump up screaming as soon as the FACT that genetics matter in life expectancy. You can take a wealthy African American male and live his entire life in Japan he still won’t have Japanese genetics or life expectancy. This isn’t middle school science class, if you can’t accept the basic scientific fact that we are not all created equal genetically there is no sense trying to discuss this with you. Shocker, races have different predispositions, certain Jewish heritages are prone to illness few others are, African Americans are predisposed to certain ailments.
“I have personally met and presented to executives at Wellpoint and admire their commitment to prevention.”
I bet you loved Obama and his ability to read off a teleprompter as well. Have you spoken to any of Wellpoint’s clients on how those commitments are manifesting?
“Not whether or not we have treatments. What we have is disparity in access to treatment as a result of unequal distribution of resources”
This is present in every country and has very little impact on outcomes. Personal choices are far greater issue then unavailability. If we gave away free PSAs to everyman most would still not take it. Access is a red herring of those provoking government assumption of healthcare.
“does that mean if you are in poverty you should die early?”
That you should die early, no it does not. That you will likely die early, yes it does. Poverty is usually the result of poor decisions and those decisions are in financial matters as well as health.
“countries with equal access have better health outcomes regardless of economic status.”
BS, not true in the macro at all. US leads the world in many health outcomes. Anyone claiming what you just did doesn’t understand proper scientific analysis, i.e. your bogus life expectancy claims. For more bogus beliefs I bet you subscribe to let’s talk premature births, that’s another red herring of those that don’t know how to properly present data or compare disparate systems.
Every race of people lives as long or longer in the US then they would in their native country, our minorities far outlive their native life expectancy.
“If you look at the same WHO tables referenced above you will see this represented by the fact that our premature birth rates are high”
That is because the WHO are quack academist who use different measures in different nations and don’t adjust for it. FYI if you measure temp in celsius in Europe and Fahrenheit in the US and don’t adjust you have meaningless comparisons. Go back and use the same reporting standards then tell me what your WHO data says.
“everyone stop smoking (we smoke less than comparison countries)”
How sheltered are you? We smoke less? Now but not until 1980s. Damage from smoking doesn’t disappear, all those people that smoked for 20-30 years are in their Medicare period and incurring claims. Again you have to know how to use data and properly adjust. You can’t look at today’s smoking rate and ignore 40 years of prior smoking.
“exercise daily and take care of their families while working two $10 per hour jobs.”
More complete BS, today’s poor work fewer hours then any time in measured history.
“Perhaps we just don’t care and will let the trend escalate as is now to a two tier system of haves (1-3%) and have-not groups (97-99%).”
Our have nots live better then the haves in almost every other country in the world. Our poor live better then the middle class of Europe. Bigger homes, more personal property, more comfort items like AC and cable. Most of the world dreams of being poor in America.
“All I asked for at the beginning was for a group of us angry, polarized people to sit down and discuss the real data, information, and consider a compromise that will create access for all.”
Start with real data and throw out the propaganda, our system provides care equal to any other system in the world and unlike almost every other developed system ours is sustainable. Once you start with the facts the solution becomes much easier.
“Man ,what has happened to us.”
Lazy people telling lies looking for free handouts. Classic case of the “homeless” guy at the intersection begging money before he goes home to his nice house. If you were working 70 hours and trying to provide for yourself you wouldn’t be poor, if you were born poor and worked that hard you wouldn’t stay poor. If you were a lazy bum working 10 hours a week once or twice a month claiming to be working so hard then a life of poverty not only awaits you but is deserved by you. These pathetic attempts at class warfare are going to blow up in your face. Sooner than later those that actually work and provide are going to get feed up with the parasites demanding more for nothing and stop supporting them.
1. I can’t believe someone would point to race and minority as an issue regarding our healthcare cost burden. Please research your literature on disparities in access to preventive medicine you will find that the determinant is income. Not race. And if you head down that path I will show you some pictures of diabetic feet in a foot clinic where access was unavailable due to a lack of sufficient funding for the given county.
2. I have personally met and presented to executives at Wellpoint and admire their commitment to prevention. Yes, chronic disease is to a large extent a result of secondary risk factors e.g. lifestyle. Not whether or not we have treatments. What we have is disparity in access to treatment as a result of unequal distribution of resources: More pictures and case studies if you want.
‘So we admit that socioeconomic factors are 20%, does that mean if you are in poverty you should die early?
The point here is this: In contrast to the US: countries with equal access have better health outcomes regardless of economic status. If you look at the same WHO tables referenced above you will see this represented by the fact that our premature birth rates are high and lost well life years are far worse than other countries at roughly double the cost. If you look at the Dartmouth Atlas you will find that the density of physician sub-specialty is proportionate to expensive procedures e.g. CABG even when compared to geographic populations with identical prevalence rates.
So here is the deal: You folks are correct: If we get rid of fast food, every one exercise 30 minutes per day at 80% of anaerobic threshold, everyone reduce LDL and eat whole foods, everyone stop smoking (we smoke less than comparison countries) our vital statistics will improve and procedures will decrease and less will be spent.
However, procedural cost will continue to be double what it is in other countries. Why…because we have become accustomed to multiple points of ‘mark-up’ in the supply chain.
Plans beat the heck out of providers for greater discounts and pass on their need for profit to employers who in exchange increase cost sharing to employees.
So: We have a country where the disadvantaged are asked to shop at whole foods market, exercise daily and take care of their families while working two $10 per hour jobs. Of course, I am sure you will point out that this is their choice after five generations of entitlements (I agree and believe we need to engineer a way out of this system).
So you see: Health is a combination of desire and ability to move into a higher socioeconomic status, reduce life style related risk factors and have the capacity to spend double the amount per invasive procedure as in any other country. Of course, now we have top executives going outside the US for these procedures to save $
IMHO (and I am sure you know I am a poor, misinformed humble soul) Healthcare Access and cost is a symptom of a nation whose markets have become far too uninformed to know what a good return on investment is and how to rate quality. Perhaps we just don’t care and will let the trend escalate as is now to a two tier system of haves (1-3%) and have-not groups (97-99%).
The result of complex reimbursement models and cost sharing is a shell game that is worse than looking at the window sticker on a car.
And, as long as we can find a scapegoat e.g. Democrats (which I am not), Presidents ‘Obama), Minorities as stated by Nate, we can refrain from truly understanding the problem ourselves and let industry white papers explain our truth for us.
Sad state for the fat, dumb and broke Americans that can not afford a movie let alone membership to a health club. And so the story goes at Animal Farm.
All I asked for at the beginning was for a group of us angry, polarized people to sit down and discuss the real data, information, and consider a compromise that will create access for all.
Our sick system of federal grants has created a dependency that need not be there to bring access to care to the masses. What is required is a factored analysis on cost benefit and cost effectiveness and what we consider as a society to be reasonable profit margins. No-one wants to go there as it means they might have to sacrifice something.
It is too easy to point fingers as opposed to assuming responsibility for a broken country.
Good luck to all: I am sure you can afford the best of care and will keep your elders tied to their ventilators while your families argue over their inheritance. Of course, those of you who have reproductive issues will certainly be able to afford your ‘in vitro’, select your genes and produce your stellar youth.
Meanwhile the rest of us will work our 70 hour work weeks attending to the antibiotic resistant staph infections in the foot wounds of diabetic workers that wash your cars in their second jobs. Who cares, they don’t add that much social value anyway since they didn’t graduate high-school.
So, what is a life worth?
Income production (for you)-cost of treatment- cost of treating illnesses that would have never been treated had we not extended the life of the person with the original treatments (original Joseph Opatz book on health promotion from 1986).
Suggested reading: Thomas Jefferson (any commentary on his concerns over industrial feudalism in America’s future.)
Compassion: Who needs it as long as I have a good life?
Man ,what has happened to us.
Every time I hear someone try to make a connection between life expectancy and the quality and efficiency of our healthcare system, I cringe. Leonard Schaefer, a healthcare expert and former CEO of Wellpoint, in his 2007 Shattuck Lecture, told us that our population’s health status is determined 40% by personal behavior, 30% by genetics, 20% by socioeconomic status and environmental factors and only 10% by the quality of healthcare than one has access to. Just because life expectancy is relatively easy to measure doesn’t mean it has much to do with how good or cost-effective our (or any other) healthcare system is.
http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers
Analysts often juxtapose the poor ranking of the United States in life expectancy and the very high percentage of its gross national product that is spent on health care. In 2007, the United States spent 16% of its GDP on health care, by far the highest fraction of any country (Congressional Budget Office 2007). The conclusion that is often drawn from this combination is that the United States’ health care system is extremely inefficient (e.g., Anderson and Frogner 2008).
One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD 2 countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston, Glei, and Wilmoth 2009). Recent trends in obesity are also more adverse in the United States
than in other developed countries (OECD 2008; Cutler, Glaeser, and Shapiro 2003).
What lens are you viewing PPACA, the massive failure to be through?
http://infoproc.blogspot.com/2009/04/us-human-development-indices.html
Asian females in the US have a life expectancy that is 3 y higher than that of females in Japan [34].
The gap between the life expectancy of the 3.4 million black males in high-risk urban areas in America 8 and the life expectancy for the 5.5 million Asian females in America 1 in 2001 was 20.7 y.
http://health.dailynewscentral.com/content/view/0002418/42/
The primary cause of the disparities between racial and geographic groups is early death from chronic disease and injuries, an analysis of data from the Census Bureau and the National Center for Health Statistics showed.
Asian-American women living in Bergen County, NJ, enjoy the greatest life expectancy in the US, at 91 years. American Indians in South Dakota have the worst, at 58 years.
The differences were attributed to a combination of injuries and such preventable risk factors as smoking, alcohol, obesity, high blood pressure, elevated cholesterol, diet and physical inactivity — particularly among people from 15 years to 59 years of age. They were not due to income, insurance, infant mortality, AIDS or violence, said the study’s lead investigator, Christopher J.L. Murray, director of the Harvard Initiative for Global Health.
Most public health initiatives target children and the elderly, he noted.
The study looked at life expectancy by geographical areas as well. Hawaii led the 50 states and Washington, DC, with an average life span of 80 years, while DC trailed at 72 years.
Personal choices could be more important than access to medical care in improving life expectancy, Dr. Murray noted. Half of the people who have high-blood pressure fail to get it controlled, two-thirds of those with high cholesterol do not get medication to lower it, and two-thirds of diabetics fail to manage the disease, in spite of the fact that 85 percent of the population overall has health insurance.
What does life expectancy have to do with healthcare? If you want longer life expectancy drive fewer miles in cars, change your diet, and get rid of the minorities. From your listed sources I’ll assume you have never seen an analysis of life expectancy broken down by race? An asain in america lives just as long as they do in asia. A white european lives as long as a european. The reason the US has a lower life expectancy then the other nations is because of our considerably larger minority make up. When you correctly adjust the numbers the difference disappears.
The % citizen vs % gov are just numbers, there is no point there. In an ideal world it would be 100% citizen and 0% government but I have a feeling thats not the point you were trying to make.
If we repeal ObamaCare our healthcare system, with all of its flaws will be the last one standing. Some people, those on the left, are all for stealing from future generations to live beyound our means today. That only ends one way, collapse of governments and civilizations. Why would we choose to go down the same path Greece and the other PIDS did 30-40+ years ago, you only need pick up a paper to see the outcome.
Or watch the OWS movement to see what failure will look like. Why choose a failed model?
Nate, I have read your entries on this topic and find that in most cases I agree with you.
I used the wrong descriptor when I said “address universal coverage”. If you check out my blog or slide share you will find a cause and effect diagram that points historical benchmarks when we did consider coverage e.g. WWII, Medicare/Medicaid in the 60s, The Nixon era, The Clinton era etc.
I do stay informed on international healthcare trends through sources such as Health Affairs, The RWJ Foundation, The NIH and the WHO. Most importantly I do not pick and choose from countries that are socialist, communist, have universal coverage or not as this makes it far too easy to push conservative and liberal buttons thereby loosing the attention of my audience.
I point to data so here are some examples:
Economic Analysis in Clinical Research from the Division of Cancer Control and Population Sciences by Martin Brown Ph.D has a wonderful model for looking at the multivariate approach needed to address the value of health interventions
The RWJ report Disparities in Health and Health Care among Medicare Beneficiaries A brief Report on the Dartmouth Atlas Project; authors Elliott S. Fisher, David C. Goodman and Amitach Chandra. .
The most recent WHO annual report where the following stats are recorded
Location Per capita cost % citizen cost % govt cost
Belgium $5104 32 68
Canada $4380 32 68
Japan $3321 20 80
Germany $4629 25 75
UK $3285 17 83
New Zealand $2634 20 80
USA $7410 52 48
By the way, we have lower life expectancy, lower functional status after 60
and higher mortality per 1000 between 15 and 65.
Our health reform act hits the benefits and insurance organizations hard. So if that is your lens I certainly understand.
Peace,
“If we look at the world we are the only society that did not address universal coverage in 1900.”
We are one of the few countries that didn’t try Communism/Socialism. Fascism either, are you suggesting we give those a try?
To correct your factual error yes we have addressed universal healthcare numerous times since 1900 and every time so far we as a nation decided we didn’t want such a system.
It’s one thing for someone to champion and push a bad idea like universal healthcare, but to champion an idea that is failing all over the world….I’ll let you pick the adjective. Have you not read the news to see what is happening in UK, Greece, Italy, Portugal, Ireland, Spain.
Once we get rid of Obama and undo his failed ideology history will show our lack of Universal Healthcare was one of the things that saved us from going to Slaughter like the PIGS.