Assorted links

by on July 8, 2009 at 7:38 am in Web/Tech | Permalink

1. Markets in everything: Do Stuff for Money.

2. Ezra Klein on administrative costs.

3. Jeff Friedman's Critical Review, special issue on the financial crisis, $$ but recommended; view the abstracts here.

4. Our culture of (pornographic) small bits (totally safe link).

5. Michael Lewis and derivatives and AIG.

6. Superb Dave Leonhardt column on health care and prostate cancer.

E. Barandiaran July 8, 2009 at 8:39 am

Tyler,
Please read again Leonhardt column. It’s terrible. I don’t know anything about treatments for prostate cancer but to call “watchful waiting” a treatment in the same category as the others is nonsense. I fully agree with Arnold Kling about the terrible incentives of the current system, but do you believe that doctors will recommend you any of the two most expensive treatments because some day you MAY have prostate cancer? Leonhardt thinks that we can determine which treatment is best; you should know how difficult it is to know which one is good. Since Arnold Kling has reading again Sowell’s A Conflict of Visions, I suggest you talk to Arnold about the relevance of Sowell’s ideas for this type of problem.

steve July 8, 2009 at 9:02 am

Leonhardt’s article is important for two reasons. It addresses the health care cost issue and it addresses the way we debate the issue.

In almost any debate about this issue, you get someone claiming our system is the best in the world. That is not what the data show. The one area where we might come out ahead, is in cancer, but that is difficult to judge by the way we compile data. If we diagnose prostate cancer in a 67 y/o, we treat it. If most other places find prostate cancer, they watch it. Both patients then live for 20 years. Prostate cancer is almost a slow, non-invasive cancer. Yet, our data showsa cancer patient with a 20 year survival.

E.B. Watchful waiting is not that uncommon, at least where I practice. Not just for prostate cancer, but for many illnesses. The idea is that you have a disease or process that does not immediately need surgery, and in fact, may never require surgery. So you watch and see if it does. Just as an example, if someone has an enlarged aortic, we will follow it until it hits a critical size, before considering replacement. Often it never reaches that size or the patient dies from other causes. The key here is that your not knowing anything about cancer treatments, seems to make you think it must be treated. Following it with serial exams and labs looking to see if it really does need surgery or radiation is also treatment. We just call it watching.

Leonhardt also points out that there is little incentive for treatment innovators or providers to do cost effectiveness research. At this point, I see no alternative to some governmental effort here.

Steve

josh July 8, 2009 at 9:21 am

Leonhardt’s column must be pretty awful if its keeping people from mentioning the latest from little Ezra.

Parke July 8, 2009 at 10:04 am

I thought the Leonhardt article was great. It left me 80% convinced that watchful waiting is wisest for prostate cancer, when costs are considered, and, importantly, the author only seemed to claim to be 80% sure on this point. Meanwhile, the author seemed 100% sure of what the prostate example illustrated — bloated, excessively expensive, an overly technological treatment in the United States — and I found that claim 100% convincing.

TA July 8, 2009 at 10:18 am

Let’s apply the Kinsley test to the prostate cancer treatment options: If Obama is diagnosed with it this year, what option is he going to get? That’s the one I want.

Andrew July 8, 2009 at 10:33 am

Steve,

What medical systems are superior that the US? I don’t mean more cost effective.

Ed July 8, 2009 at 11:18 am

One thing about health Americans in particular have a hard time grasping is that everyone will die of something. If you avoid dying from disease X, it just means you get to die from disease Y.

I don’t mean to be flippant. Y might take longer to kill you. X might leave you with a better quality of life while you suffer from it. But you don’t necessarily turn your life inside out or go in debt to fight one disease.

Life expectancy in the US is somewhere in the 70s. If prostrate cancer kills slowly, the odds of a 67 man not being killed by prostrate cancer because he get killed by something else are pretty good. That does not mean you don’t treat the cancer. It is an argument for waiting to see what happens.

Mark July 8, 2009 at 12:38 pm
Rama July 8, 2009 at 1:15 pm

Ezra Klein’s article is comprehensive. Guess a journalist generally has more time and resources than a blogger .

“The answers are that we do more stuff and have more technology….”

And its hard to do (or allow) cost-benefit analyses on seriously ill patients.

d.cous. July 8, 2009 at 2:55 pm

Wow. Seriously, nobody jumped at the opportunity to quote the Big Lebowski about standards falling in the adult entertainment industry? I don’t know whether I should be disappointed with the discussion above, or with myself for just snickering and thinking of the Big Lebowski.

Also, I love that Tyler and Alex just have to mention partisan politics, religion, or health care to really get the readers all hot and bothered.

Tom July 8, 2009 at 3:39 pm

“In almost any debate about this issue, you get someone claiming our system is the best in the world. That is not what the data show.”

Steve, even in the WHO report, where the US is 37th overall, we are #1 in outcomes.
It takes little time to tease out the facts about life expectancy, ect. This has been done ad nauseum.

Lets call it WHO’s Law. Whoever throws out how bad our system is automatically loses the argument.

runescape money July 8, 2009 at 9:06 pm

That’s about it. You can delete this article if you wish. Oh, and thank you for choosing runescape gold.

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