Category: Medicine

A Buckinghamshire man diagnosed with terminal
cancer is to collect a second winning payout of £5,000 after betting he
would stay alive.

Jon Matthews, 59, from Milton Keynes, was
diagnosed with mesothelioma, a cancer linked to asbestos, in 2006 and
told he had months to live.

He placed two bets, each with a £100 stake at odds of 50/1, that he would be alive in June 2008 and in June 2009.

A third wager will earn him a further £10,000 if he lives until 1 June 2010.

The full story is here and I thank Leonard Monasterio for the pointer.  Of course you are implicitly betting on your life each time you make an investment or a long-range plan.

In a 2003 study, another Dartmouth team, led by the internist
Elliott Fisher, examined the treatment received by a million elderly
Americans diagnosed with colon or rectal cancer, a hip fracture, or a
heart attack. They found that patients in higher-spending regions
received sixty per cent more care than elsewhere. They got more
frequent tests and procedures, more visits with specialists, and more
frequent admission to hospitals. Yet they did no better than other
patients, whether this was measured in terms of survival, their ability
to function, or satisfaction with the care they received. If anything,
they seemed to do worse.

That’s because nothing in medicine is
without risks. Complications can arise from hospital stays,
medications, procedures, and tests, and when these things are of
marginal value the harm can be greater than the benefits. In recent
years, we doctors have markedly increased the number of operations we
do, for instance. In 2006, doctors performed at least sixty million
surgical procedures, one for every five Americans. No other country
does anything like as many operations on its citizens. Are we better
off for it? No one knows for sure, but it seems highly unlikely. After
all, some hundred thousand people die each year from complications of
surgery—far more than die in car crashes.

To make matters worse,
Fisher found that patients in high-cost areas were actually less likely
to receive low-cost preventive services, such as flu and pneumonia
vaccines, faced longer waits at doctor and emergency-room visits, and
were less likely to have a primary-care physician. They got more of the
stuff that cost more, but not more of what they needed.

Let's start with a correct claim:

The fiscal outlook is grimmer than before, therefore we should spend less on health care reform than I used to think.

I'm willing to make a comparable admission when it comes to tax cuts, so will you sign on to this claim about health care and revise your policy prescriptions accordingly?  (Unless of course your previous estimate had forecast the current revenue situation; Nouriel Roubini could claim this.)

If you do not sign on to this claim, you are committing the third health care cost fallacy.  Note also that your support for non-revenue-intensive means of health care reform might well go up, for related reasons.

You will find fallacies one and two here and here.  Might there be TANSTAAFL deniers who commit all three?

Addendum: Megan McArdle offers some related sentences to ponder:

Conversely, if there is some political or institutional barrier which is preventing you from controlling Medicare cost inflation, than that barrier probably is not going away merely because the program covers more people.  Indeed, to the extent that seniors themselves are the people blocking change (as they often are), adding more users makes it harder, not easier, to get things done.

This comes from Robert Reich but you will find it all over the place:

Social Security is a tiny problem. Medicare is a terrible one, but the
problem is not really Medicare; it's quickly rising health-care costs.

You would think it is hard to resist the fiscal conservatives' core argument — X is slated to grow a lot in cost, therefore we have at least one reason to spend less on X — but such resistance is becoming a growth industry.

There are two simple points in response.  First, it matters whether a given expenditure shows up on the balance sheet of the government or not.  It matters for the incentives of our government, for its credit rating, for future marginal rates of taxation, and ultimately for the future of the health care (or other) sector.

Second, if Medicare were less generous, much less would be spent on health care.  Now you might think that would be a bad result and that of course a debate worth having.  But the mere fact that you favor some amount of Medicare does not lower the cost burden of the amount you favor.  If your preferred policy induces say "40 percent more of health care costs," you can't put all the blame on the preexisting level or path of health care costs.  You also have to accept responsibility for the 40 percent boost or whatever the increment is.

It's a common claim that health care would be more efficient and cheaper if not for third party payment.  Sometimes, yes, but often these claims are overstated, especially when the link between treatment and improvement is murky. 

To consider one example, for the most part autism-related services are not covered by private health insurance.  Government aid is often scarce as well.  Also in Canada medical benefits for autism-related services are quite limited.  So when it comes to autism, this is a fee for service setting for the most part.

And what does this world look like?

1. Services are not especially cheap nor do they seem to be falling in price. 

2. Market participants are not well informed about what works.  Many parents of autistic children pursue hopeless treatments or unvalidated or even refuted theories.  Some of the treatments, such as chelation, are harmful in many cases and yield no benefits.

3. There is lots of innovation — in terms of advertised methods of treatment — but it is unclear, to say the least, what percentage of these innovations succeeds.  Very often it is parents "buying hope."

The point is not that insurance coverage would solve all these problems.  Third party coverage would slant the relative prices toward more mainstream treatments and away from the fads; how good or bad this would be depends on your point of view as to what brings better (worse) outcomes. 

Overall I don't view the autism example as a good selling point for the view that third party payment is the basic problem behind U.S. health care.  Nor do I see critics of third party payment citing autism services as a model example for their ideas.  (By the way, it is an open question how much autism should be an education issue and how much it should be a health care issue; de facto it is often a health care issue but this should not be taken for granted.)

Another lesson is this: the more emotional the issue, the less effective any health care system will be.  Policy discussions of "health care" often require more disaggregation.

Addendum: There is, by the way, a movement afoot to require that private insurance cover some autism-related services, such as ABA.  Given the costs of the treatment, and the unclear link between treatment and results, I would be curious to hear if "universal coverage" advocates would include this in their ideal public policy.  I would say they should admit that any notion of "universal coverage" is value-laden rather than purely descriptive.

The Austrians need some good jokes if they're ever going to be taken seriously.

So writes to me one loyal MR reader.  He has a specific and indeed noble reason for wanting these jokes (someday I'll be able to explain but the best jokes will in fact be used publicly).  Although I've been connected to Austrian ideas for a long time, I don't know the jokes.  Nor does Google seem to yield much.

But surely MR readers can deliver in a pinch (Raivo?  Are you there?).  And note that simply listing the name of an Austrian economist you don't like isn't actually that funny.  It should have a punchline something like "I cut off their noses" or "I'm sick and tired of all this bickering about oatmeal," etc.  Puns and limericks are OK too.

I thank you all in advance.

Here is Revere at Effect Measure:

We currently have fewer staffed hospital beds per capita than we did in the last pandemic, 1968 (the "Hong Kong flu").

He offers further wise words and note that this hypothetical projection is one of the better case, mutation-free scenarios:

Now take a bad flu season and double it. To each individual it's the
same disease but now everybody is getting it at once, in every
community and all over the world. In terms of virulence, it's a mild
pandemic. It's not a lethal virus like 1918. But in terms of social
disruption it could be very bad. If twice as many people get sick, the
number of deaths could be 80,000 in the US instead of 40,000. Gurneys
would line the hallways of hospitals and clinics. And absenteeism
amongst health care workers would compound the problem. Infrastructure
would probably survive intact. No need to have your own water supply or
electricity generator. But it would be a very rough ride.

All of this could plausibly happen from this virus without it causing anything more than the usual case of influenza.

We've figured out how to do it.  Courtesy of La Gloria of course.

Why is the death rate higher in Mexico?  Maybe it isn't:

Of the 110 million people in Mexico, 1,600 cases have been reported, with about 100 deaths–suggesting a mortality rate of 6 percent. This is almost certainly bad math, as the total case count almost certainly ignores thousands or tens of thousands of other cases that have taken milder courses like those in the United States. It's perfectly conceivable Mexico has actually had 10,000 or 100,000 cases–or even 1 million cases. If so, then the kill rate would be not 6 percent but 0.1 percent (given 10,000 cases) or 0.01 percent (given 100,000 cases). If it's 1 million cases (quite possible if this thing really spreads easily) then the mortality rate is just 1 in 10,000. Meanwhile, because the United States is on high alert–and can take special note of people with recent travel to Mexico–it is probably picking up a fairly high percentage of its cases, including milder instances that would have gone unnoticed in Mexico a few weeks ago.

…For one thing, it's also possible that Mexico is missing, undercounting, or badly underreporting deaths. But if this virus really does spread rapidly, its kill rate is fairly low; and if its kill rate is anywhere near as high as the 100-out-of-1,600 suggests, then it doesn't spread very easily.

Here is the full article.

Addendum: Have the first U.S. deaths arrived?

Ever since the 2003 outbreak of SARS, or severe acute respiratory syndrome, Hong Kong has used infrared scanners to measure the facial temperatures of all arrivals at its airport and at its border crossings with mainland China.

It surprises me that no one has mentioned this, so i'll end years of
quietly lurking and say it myself: a possible explanation for the
difference in clinical picture here vs Mexico lies in the sample size
here. 8 of 8 confirmed "swine flu" cases here have not involved serious
lower respiratory infection or death. But about 60 of about 1,000
generally unconfirmed cases of "swine flu" in Mexico have. If those all
confirm, that's about a 6% CFR. From what i've read, we don't have data
yet on the CFR of confirmed cases in Mexico, and we don't have a
satistically significant sample here for measuring phenomena in the
single percentage digits.

This tells me that there is no confirmed or statistically
significant difference in the clinical picture between US & Mexico.

Of course Mexico is where most of the data points lie.  That's Suzanne Bunton.  Read the other comments too.  If the Obama administration believes in competent government, it would be nice if they would meet the public health standards currently practiced by the government in Mexico.  Even a completed fence would not stop a virus and there is otherwise no reason to wait.  Should we in the meantime count on a more favorable mutation to protect us?