Ezra Klein pinch hits for the med skeptics
File this one under "health care doesn’t work nearly as well as we’d like to believe." A group of researchers followed almost 15,000 initially healthy Canadians for more than 10 years to see whether universal access to health care meant that the rich and the poor were equally likely to stay healthy. The answer? Not even close.
. . .
The problem, the researchers say, is that the medical system just isn’t that good at keeping people from dying. "Health care services use by itself had little explanatory effect on the income-mortality association (4.3 percent) and no explanatory effect on the education-mortality association," they conclude.
Ezra seemed to backtrack a little in a later post but I can see he really wants to come over to the skeptical side. Don’t let Tim Carney’s abrasiveness scare you away. The skeptics really are a nice, internally consistent bunch.
I, for example, have never paid a dime of my own money for my own health insurance. I have always chosen the lowest quality health plan when rolled into my employment package and no health plan when not.
Really quickly I’d also just like to plant another seed. There are clear cases when medical care saves people’s lives. However, if access to more medical services isn’t associated with a longer life, then we have to take seriously the proposition that medical care is also causing a significant number of deaths. I’ll get into the life expectancy of Christian Scientists in another post.
All that having been said, what I really wanted to talk about the possibility of education improving health outcomes.
Ezra goes on
Rather, the best way to make people healthier would be to get health-care costs under control so there’s more money in the budget for things like early-childhood education and efforts to strip lead out of walls, both of which seem to have very large impacts on health even though we don’t think of them as health-care expenditures.
Arnold Kling cosigns on the general concept education for health
My guess is that if you want to improve health outcomes in the United States, ignore health insurance and focus on literacy. Even if it has nothing to do with whether or not they can follow a doctor’s written instructions, my guess is that better literacy has a positive impact on health outcomes.
I am skeptical about a fundamental link here. I suspect we have two things going on.
First, education confers status and status is related to health outcomes. For example Oscar winners live longer than those simply nominated. How this link occurs is not totally clear. It seems that the hormones associated with stress and disappointment – cortisol for example – reduce long run health. However, this may not be the mechanism. No one really knows at this point.
Second, for a long list of reasons there is correlation between education and physical attractiveness. Physical attractiveness is by evolutionary design a proxy for health. Which to say, healthier folks are more likely to become well educated.
This makes me doubt that power of health improvements from increasing education.
In general it is just damn hard to improve health outcomes. Our bodies are the product of about 4 billion years of evolution. Just making sense of how they work is hard enough. Making them work better is a herculean task.
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Wednesday ~ March 2nd, 2011 at 9:22 am
Annelid Gustator
“In general it is just damn hard to improve health outcomes. Our bodies are the product of about 4 billion years of evolution. Just making sense of how they work is hard enough. Making them work better is a herculean task.”
Yes, our bodies are such finely-tuned instruments. Please–it’s a collection of gimmicks and kludges that just *barely* get the job done. Improving its function is easy. Improving it a lot, not so much.
Wednesday ~ March 2nd, 2011 at 12:15 pm
Th
This study reinforces my preference for a universal but bare-bones public health system with private supplemental policies available. Similar to the Canadian system (or our Medicare) where basic (very basic) care is provided to everyone and we can choose to buy extras but without any government subsidies.
As for the magic bullet that evens the playing field, I suggest we find a way to adjust energy levels in people. This seems to me the most basic starting point for health, wealth, happiness, stress, etc.
Wednesday ~ March 2nd, 2011 at 1:25 pm
Jeff
I’m basically on board with all of this, but there are a few things to bear in mind here:
One, a lot of medicine does save lives in ways that aren’t likely to be captured by that study. For example, without modern medicine, approximately 1 in 30 women die in childbirth, but with modern medicine, about 1 in 10,000 do. There are other obvious examples like someone having a heart attack who’s life is saved in an emergency room. My guess is that in Canada, as in the US, even the uninsured poor had access to those services before reform. The issues in reform were about how that gets paid for (cost shifting, job lock, etc.).
Now it needs to be acknowledged that most of the medical care that attempts to extend life for the sake of extending life, without regard for cost, the probable length of life extension or the quality of that extra time, takes place among the elderly. Most of that, without question, is really waste.
But in acknowledging that only a fraction of medicine fits this description lies my second point: Most of contemporary medical care isn’t about “keeping people from dying”. So, assessing whether it does that is missing the point. As an example, I have a friend who’s jaw was not perfectly aligned. Eventually, he wore down his TM joint and had some low-level, but continual pain, especially if he had to really chew something. Sooner or later, without surgery, he would have been in constant, excruciating pain with difficulty talking and unable to eat practically anything other than applesauce. Of course, he got the surgery, which cost, I believe, in the tens of thousands. Did it save his life? No. But he’s certainly glad he was able to get that surgery, and I’m glad for him, too. I realize this is an anecdote, but I’m not sure how you could do a good job of capturing this sort of thing. Each case is fairly unique. After all, his condition is quite rare, but there are probably lots of other rare conditions that can be managed through non-life-saving medical care that does an enormous amount to improve quality of life. People like Tim Carney and Megan McArdle care a lot about this sort of thing, too, that’s why they spend so much of their money on their health insurance. They just don’t want other people to be able to buy comparable insurance on the individual market if it means either more government regulation or subsidies for the poor.
Wednesday ~ March 2nd, 2011 at 1:35 pm
Hal
I’m getting a little bit of cognitive dissonance vibe here. On the one hand, just a week ago you were boldly claiming that pretty soon IBM’s Watson technology was going make doctors n’ such obsolete. Now you’re throwing up your hands claiming that something perhaps less complicated than approximating human intelligence means that we can’t possibly draw conclusions.
But leaving that aside, let’s take up the issue of lead. The correct analogy is one where you have people trying to win a race when they have a 600 pound lead weight chained to their ankle. It is not the case that people trying to solve this problem are trying to make superhumans by making them “work better”. What they’re trying to do is simply remove the well known problems that lead causes that makes them perform worse.
One doesn’t have to delve into the infinite complexities of the wonder of biology to understand that if you repeatedly hit someone over the head with a baseball bat, that person isn’t going to perform well. Similarly, the deleterious effects of heavy metal poisoning isn’t – as they say – rocket science. I mean, the effects of lead on cognitive functions aren’t exactly a mystery. They’re well understood.
So, again, I’m left scratching my head. We might not be able to do much in the current system – or even in the Civ V system of the FUTURE – to improve health outcomes of people past the age of 12 or so. But we know for a fact that we can do a heck of a lot to improve the outcomes of infants, toddlers and children.
Will this lead us into utopia? Maybe not. Relieving people of the 600 pound lead weight that has been shackled to them since birth isn’t likely to turn them into world record setters. But it is a qualitative difference to their life. And not shackling the newborn with their own personalized 600 pound lead weight from the moment of conception due to pathetically poor nutrition and growing up with lot’s of lead in the environment is also not likely to turn them into world record setters.
But at least it will give them a fighting chance at living a normal, productive life. Something that is radically unlikely when you’re dragging that weight around.
Sorry, but this post sounds an awful lot like “because we can’t get perfection, we simply shouldn’t be doing the good we know we can do”
Wednesday ~ March 2nd, 2011 at 2:49 pm
David B
In reading the post I am not sure what the point is. Do we spend too much as a society on end of life care – probably. But what does this have to do with whether or not we have health insurance.
My friend had an accident while carving a pumpkin in the 6 months after college graduation but before his new job’s health insurance kicked in. The surgery to repair the tendons in his wrist cost upwards of $25,000. He and his wife eventually paid it off but it put him at a real disadvantage economically for years afterward – There was no reason they had to start off married life in this big economic hole.
What possible benefit was there for society as a whole by keeping him uninsured for 6 months? What would be the benefit for him losing the use of his left hand?
Friday ~ March 4th, 2011 at 10:28 pm
Would Universal Health-Care Coverage Actually Improve Health? - Christian Forums
[...] Improve Health? There is a debate going on in the blogosphere between Ezra Klein, Arnold Kling, Karl Smith, Tim Carney, and others about, to put it crudely, whether health care really affects health that [...]