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[deleted]

TheOtherHobbes 10y ago
The UK also has infinitely better healthcare-related bankruptcy statistics. I suspect it would be easier to improve the 5-year cancer survival rates in the UK than it would be to eliminate healthcare-related bankruptcies in the US. The NHS has also become increasingly inefficient over the last couple of decades, as managerialisation and stealth privatisation have diverted funds away from front-line patient care towards administration costs and third-party profits.
nkrisc 10y ago
How do those rates look when you account for income?
stephencanon 10y ago
> The UK also has dramatically worse 5-year cancer survival rates than the US - in some cases, almost half what the US provides[0][1]. 5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die.
- jessaustin 10y ago
  Stipulating that five years is the wrong period to use, what would the right period be? Intuitively, there must be some period of time over which different nations could be meaningfully compared on this basic health result.
  - wutbrodo 10y ago
    > Stipulating that five years is the wrong period to use, what would the right period be? The short answer: Whenever death rates plateau for the 99th (or whatever) percentile, relative to progression of the illness. If you wait XX years until the effect of moving around the diagnosis date is largely mitigated statistically, then the error begins to fade. The long answer: This isn't quite the right question to ask at all, because it assumes away the possibility that the naive "years from diagnosis" is a flawed metric in the first place. The point of the comment you're responding to is that "n-year survival rate (from diagnosis)" as measured is a flawed statistic in general, because the baseline from which the counting starts can be different for people with the exact same outcomes. An illustrative _reductio ad absurdum_ thought experiment here is that of taking two people with the exact same cancer, detecting one earlier, and giving both exactly no treatment (or treatment on the exact same schedule). Despite having identical quality of care and outcome, the person whose cancer was detected earlier will show up as having a better 5-year survival rate, simply because we started counting earlier and her 5-year mark came earlier in the progression of the disease. This can be mitigated to an extent by controlling for stage of cancer or whatever, and that's probably a good idea, but this is necessarily brittle and hard to scale and study.
    - jessaustin 10y ago
      You've proved too much. This same argument could be used to show that we can't decide e.g. which drugs or lifestyle choices make death due to cancer more or less likely, or indeed which behaviors make death due to any long-term illness more or less likely. Congratulations I guess, but you've just put a bunch of medical researchers out of a job. They had to study a long time to do that job!
      - Dylan16807 10y ago
        I don't see how you reach that conclusion. If your detection is the same, it's easy to see which treatments or lifestyles work better or worse. This seems to me to be a problem unique to measuring the value of different kinds of detection.
        jessaustin 10y ago
        If the argument is that detecting cancer at year four isn't worse than detecting that cancer at year zero, then could we specify a year at which it would be worse to detect cancer? It's a deadly disease, so presumably if you wait too long the patient will have died already? If I've misunderstood this complex and sophisticated argument and we're all ready to admit that detecting cancer later is worse, then the original point that USA is better than UK in this one tiny respect stands.
        Dylan16807 10y ago
        The argument is that while detecting cancer earlier is usually a good thing, you have to be careful how you measure the effects. Looking at survival X years from detection can give you false positives about what is best. - I'll lay out a particular scenario where this happens: Currently we detect a cancer moderately far along, and aggressively treat it. The five year survival rate is 50%. We figure out how to detect it two years earlier. We use the same aggressive treatments, and the five year survival rate is now 70%. Hooray! But looking closer, if we wait another two years to correct for the early detection, the survival rate is only 45%. Only some of those tumors would have continued growing. Of those, attacking early is only marginally helpful. In others, the tumor wouldn't have killed the patient, but the radio/chemotherapy killed a quarter of them. In this case, we magically know we detected everything two years earlier, so we could look at the seven year survival rate instead of five year. But the real world is not so clean. It's very hard to figure out a timescale and normalize everyone to it. - Catching cancer earlier screws up your ability to measure survival. A naive analysis will see higher survival rates when smaller/earlier tumors are detected. A sophisticated analysis that corrects for this is actually hard to do. Even when you do save lives by treating earlier, it's very hard to figure out how many lives are saved, and how much of a confounding factor your detection method is.
- TearsInTheRain 10y ago
  I feel like it is trivial to account for this difference by using something like the stage the cancer was caught in, type/size of mass etc
  - stephencanon 10y ago
    It's extremely difficult to do this without running up against Simpson's paradox (which doesn't stop lots of people from trying, of course).
- ptaipale 10y ago
  >5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die. This does not make sense. The earlier you detect cancer, the higher is the likelihood that treatment is effective. 5-year survival rate absolutely correlates with 10-year survival rate and 30-year survival rate. Though it is undoubtedly true that in the long term, we're all dead. That is however not a meaningful indicator of health care system effectiveness.
  - danielweber 10y ago
    If you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better. So you can't just look at cancer survival rates. I meant what I said about AND CHANGE NOTHING ELSE but experience tells me I have to repeat it. Merely detecting it earlier, BUT DOING NOTHING ABOUT IT, will improve your cancer survival stats.
    - DrScump 10y ago
      <If you detect cancer earlier AND CHANGE NOTHING ELSE...> That is a meaningless population unless you are suggesting that providers are working hard to detect cancer and then, having found cancer, choose to not treat it at all.
      - danielweber 10y ago
        Ugh, no, I'm not using that as a population to compare to. Here, let me put it into a story. We're comparing the health care of two countries, A & B. The survival rates of cancer are better in country A. So researchers study what country A does to get better results. They find that it has a system of early detection followed by slathering people with chicken blood. Well, you aren't sure if the chicken blood is the right thing, but surely the early detection means people are healthier, right? No, because . . . ahem, "if you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better." In fact, country A and country B may be exactly the same when it comes to treating cancer. But because of very real statistical artifacts like https://en.wikipedia.org/wiki/Will_Rogers_phenomenon https://en.wikipedia.org/wiki/Will_Rogers_phenomenon, it leads to statistics showing the country A is better when people have the exact same outcomes. Perhaps you think that rubbing with chicken blood is an unfair comparison of the US health care system, because it uses science-y stuff. But measuring outcomes is hard. Lots of things that people naturally assume improve health outcomes (see other discussion on this page about annual checkups) don't. Some things that we assume improve health care outcomes actually worsen outcomes. Radical chemotherapy is the go-to example. And insurance companies were required to pay for it, too, following expensive court cases. (Health care costs were held nearly flat in the US under HMOs, which put a lid of costs but had no noticeable negative impact on outcomes. This pretty much broke their cost containment. They were also unpopular because they said no a lot.) So figuring out if the US has better cancer outcomes is hard, because the US really puts a big emphasis on early detection, but it might be just early detection which makes the stats look good. I'm not trying to push a narrative right here. There are a bunch of different health care systems in the world, and the one thing we know about the US system is that it costs more. This is not necessarily a bad thing, because it's possible we are getting more benefit (by pushing new treatments) but it's also something that the US has not explicitly decided to do, neither by policy nor by the invisible hand of a bunch of individual actors in the market.
wk_end 10y ago
You're cherry picking. You've presented one stat where the US system comes out well ahead of the UK system (which is far from the only socialized health care system). But so what? It's true that the American health care system is not literally the worst at everything. But yes, when all is said and done, if you look at the data in aggregate [0], socialized medicine provides far more bang for the buck than the American system does. [0] https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... The US usually does quite well: often times somewhat better than some countries with socialized health care, usually somewhat worse than some others; it's rare that there's a dramatic difference between it and other first world countries. But, of course, where there is a dramatic difference is in costs: the US often spends twice as much per capita [1]. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Moreover, the way those costs are distributed is socially destructive in the US in a way that they simply aren't in any other country. No one in Canada goes bankrupt due to medical bills; in the US, roughly 2 million people do a year, and another 56 million struggle to pay their bills [2]. [2] http://www.cnbc.com/id/100840148 http://www.cnbc.com/id/100840148 And again, all this is for what is, in aggregate, roughly the same quality of care.
- CWuestefeld 10y ago
  in the US, roughly 2 million people do [bankrupt due to medical bills] a year, and another 56 million struggle to pay their bills This is misinterpreting the data. The vast majority of this is the problems caused by lost income - an inability to work while ill, not because of the medical bills themselves. EDIT: remove repeated phrase
  - wk_end 10y ago
    The press release for the original study this article is based on claims they've accounted for this: "NerdWallet Health chose to include only bankruptcy explicitly tied to medical bills, excluding indirect reasons like lost work opportunities." [0] https://www.nerdwallet.com/blog/health/managing-medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/ https://www.nerdwallet.com/blog/health/managing-medical-bill...

[deleted]

The UK also has infinitely better healthcare-related bankruptcy statistics. I suspect it would be easier to improve the 5-year cancer survival rates in the UK than it would be to eliminate healthcare-related bankruptcies in the US. The NHS has also become increasingly inefficient over the last couple of decades, as managerialisation and stealth privatisation have diverted funds away from front-line patient care towards administration costs and third-party profits.

nkrisc 10y ago

How do those rates look when you account for income?

stephencanon 10y ago

> The UK also has dramatically worse 5-year cancer survival rates than the US - in some cases, almost half what the US provides[0][1]. 5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die.

jessaustin 10y ago
Stipulating that five years is the wrong period to use, what would the right period be? Intuitively, there must be some period of time over which different nations could be meaningfully compared on this basic health result.
- wutbrodo 10y ago
  > Stipulating that five years is the wrong period to use, what would the right period be? The short answer: Whenever death rates plateau for the 99th (or whatever) percentile, relative to progression of the illness. If you wait XX years until the effect of moving around the diagnosis date is largely mitigated statistically, then the error begins to fade. The long answer: This isn't quite the right question to ask at all, because it assumes away the possibility that the naive "years from diagnosis" is a flawed metric in the first place. The point of the comment you're responding to is that "n-year survival rate (from diagnosis)" as measured is a flawed statistic in general, because the baseline from which the counting starts can be different for people with the exact same outcomes. An illustrative _reductio ad absurdum_ thought experiment here is that of taking two people with the exact same cancer, detecting one earlier, and giving both exactly no treatment (or treatment on the exact same schedule). Despite having identical quality of care and outcome, the person whose cancer was detected earlier will show up as having a better 5-year survival rate, simply because we started counting earlier and her 5-year mark came earlier in the progression of the disease. This can be mitigated to an extent by controlling for stage of cancer or whatever, and that's probably a good idea, but this is necessarily brittle and hard to scale and study.
  - jessaustin 10y ago
    You've proved too much. This same argument could be used to show that we can't decide e.g. which drugs or lifestyle choices make death due to cancer more or less likely, or indeed which behaviors make death due to any long-term illness more or less likely. Congratulations I guess, but you've just put a bunch of medical researchers out of a job. They had to study a long time to do that job!
    - Dylan16807 10y ago
      I don't see how you reach that conclusion. If your detection is the same, it's easy to see which treatments or lifestyles work better or worse. This seems to me to be a problem unique to measuring the value of different kinds of detection.
      - jessaustin 10y ago
        If the argument is that detecting cancer at year four isn't worse than detecting that cancer at year zero, then could we specify a year at which it would be worse to detect cancer? It's a deadly disease, so presumably if you wait too long the patient will have died already? If I've misunderstood this complex and sophisticated argument and we're all ready to admit that detecting cancer later is worse, then the original point that USA is better than UK in this one tiny respect stands.
        Dylan16807 10y ago
        The argument is that while detecting cancer earlier is usually a good thing, you have to be careful how you measure the effects. Looking at survival X years from detection can give you false positives about what is best. - I'll lay out a particular scenario where this happens: Currently we detect a cancer moderately far along, and aggressively treat it. The five year survival rate is 50%. We figure out how to detect it two years earlier. We use the same aggressive treatments, and the five year survival rate is now 70%. Hooray! But looking closer, if we wait another two years to correct for the early detection, the survival rate is only 45%. Only some of those tumors would have continued growing. Of those, attacking early is only marginally helpful. In others, the tumor wouldn't have killed the patient, but the radio/chemotherapy killed a quarter of them. In this case, we magically know we detected everything two years earlier, so we could look at the seven year survival rate instead of five year. But the real world is not so clean. It's very hard to figure out a timescale and normalize everyone to it. - Catching cancer earlier screws up your ability to measure survival. A naive analysis will see higher survival rates when smaller/earlier tumors are detected. A sophisticated analysis that corrects for this is actually hard to do. Even when you do save lives by treating earlier, it's very hard to figure out how many lives are saved, and how much of a confounding factor your detection method is.
TearsInTheRain 10y ago
I feel like it is trivial to account for this difference by using something like the stage the cancer was caught in, type/size of mass etc
- stephencanon 10y ago
  It's extremely difficult to do this without running up against Simpson's paradox (which doesn't stop lots of people from trying, of course).
ptaipale 10y ago
>5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die. This does not make sense. The earlier you detect cancer, the higher is the likelihood that treatment is effective. 5-year survival rate absolutely correlates with 10-year survival rate and 30-year survival rate. Though it is undoubtedly true that in the long term, we're all dead. That is however not a meaningful indicator of health care system effectiveness.
- danielweber 10y ago
  If you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better. So you can't just look at cancer survival rates. I meant what I said about AND CHANGE NOTHING ELSE but experience tells me I have to repeat it. Merely detecting it earlier, BUT DOING NOTHING ABOUT IT, will improve your cancer survival stats.
  - DrScump 10y ago
    <If you detect cancer earlier AND CHANGE NOTHING ELSE...> That is a meaningless population unless you are suggesting that providers are working hard to detect cancer and then, having found cancer, choose to not treat it at all.
    - danielweber 10y ago
      Ugh, no, I'm not using that as a population to compare to. Here, let me put it into a story. We're comparing the health care of two countries, A & B. The survival rates of cancer are better in country A. So researchers study what country A does to get better results. They find that it has a system of early detection followed by slathering people with chicken blood. Well, you aren't sure if the chicken blood is the right thing, but surely the early detection means people are healthier, right? No, because . . . ahem, "if you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better." In fact, country A and country B may be exactly the same when it comes to treating cancer. But because of very real statistical artifacts like https://en.wikipedia.org/wiki/Will_Rogers_phenomenon https://en.wikipedia.org/wiki/Will_Rogers_phenomenon, it leads to statistics showing the country A is better when people have the exact same outcomes. Perhaps you think that rubbing with chicken blood is an unfair comparison of the US health care system, because it uses science-y stuff. But measuring outcomes is hard. Lots of things that people naturally assume improve health outcomes (see other discussion on this page about annual checkups) don't. Some things that we assume improve health care outcomes actually worsen outcomes. Radical chemotherapy is the go-to example. And insurance companies were required to pay for it, too, following expensive court cases. (Health care costs were held nearly flat in the US under HMOs, which put a lid of costs but had no noticeable negative impact on outcomes. This pretty much broke their cost containment. They were also unpopular because they said no a lot.) So figuring out if the US has better cancer outcomes is hard, because the US really puts a big emphasis on early detection, but it might be just early detection which makes the stats look good. I'm not trying to push a narrative right here. There are a bunch of different health care systems in the world, and the one thing we know about the US system is that it costs more. This is not necessarily a bad thing, because it's possible we are getting more benefit (by pushing new treatments) but it's also something that the US has not explicitly decided to do, neither by policy nor by the invisible hand of a bunch of individual actors in the market.

wk_end 10y ago

You're cherry picking. You've presented one stat where the US system comes out well ahead of the UK system (which is far from the only socialized health care system). But so what? It's true that the American health care system is not literally the worst at everything. But yes, when all is said and done, if you look at the data in aggregate [0], socialized medicine provides far more bang for the buck than the American system does. [0] https://en.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... The US usually does quite well: often times somewhat better than some countries with socialized health care, usually somewhat worse than some others; it's rare that there's a dramatic difference between it and other first world countries. But, of course, where there is a dramatic difference is in costs: the US often spends twice as much per capita [1]. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Moreover, the way those costs are distributed is socially destructive in the US in a way that they simply aren't in any other country. No one in Canada goes bankrupt due to medical bills; in the US, roughly 2 million people do a year, and another 56 million struggle to pay their bills [2]. [2] http://www.cnbc.com/id/100840148 http://www.cnbc.com/id/100840148 And again, all this is for what is, in aggregate, roughly the same quality of care.

CWuestefeld 10y ago
in the US, roughly 2 million people do [bankrupt due to medical bills] a year, and another 56 million struggle to pay their bills This is misinterpreting the data. The vast majority of this is the problems caused by lost income - an inability to work while ill, not because of the medical bills themselves. EDIT: remove repeated phrase
- wk_end 10y ago
  The press release for the original study this article is based on claims they've accounted for this: "NerdWallet Health chose to include only bankruptcy explicitly tied to medical bills, excluding indirect reasons like lost work opportunities." [0] https://www.nerdwallet.com/blog/health/managing-medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013/ https://www.nerdwallet.com/blog/health/managing-medical-bill...