7 ms·

I found this to be an extremely interesting point: >In the short term, less smoking would lead to decreased spending because of reductions in health care spend

by Dwolb 9y ago

I found this to be an extremely interesting point: >In the short term, less smoking would lead to decreased spending because of reductions in health care spending for those who had smoked. >In the long run, all of those people living longer would lead to increases in spending in many programs, including health care. The more people who quit smoking, the higher the deficit from health care — barely offset by the revenue from taxing cigarettes. So yes, if our goal is to “reduce healthcare spending” letting people die younger, faster would indeed do this. However if our goal is to “improve quality of life for people at the lowest possible cost” we most likely need to invest in preventative care. I would like to hear more from the authors on their synthesis.

mjw1007 9y ago
Similarly from the linked Robert Wood Johnson Foundation report: «Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.» Perhaps a useful way of looking at things would be to imagine we had access to a graph of the function from (preventative health care, emergency health care) → life expectancy, and see what it looks like for constant life expectancy. If you could increase the preventative part by less than you decrease the emergency part, then I think in one sense it's fair to say that preventative care saves money.
robkop 9y ago
Letting people die younger, faster makes sense that it would reduce healthcare spending but what doesn't make sense to me is that you loose all future productivity and value that these people create. They say that the costs are barely offset by cigarette tax revenue but that doesn't take into account all future tax revenue that would be generated by letting these people live.
- scarface74 9y ago
  I hate to sound callous, but on average, how productive are older people? Living longer doesn't necessarily imply working longer. It could just lead to costing more in treating chronic conditions.
  - ineedasername 9y ago
    It doesn't matter how productive they are if the savings are being equally cancelled out: the health cost issue is then zero-sum, but that means any productivity that wouldn't have occured without preventative care is a positive gain. And even without economic benefit one way or the other, I figure most people wouldn't mind having a healthier mom around a little longer. You cant narrowly focus on only economic benefits, and then narrowly only on the most obvious and easiest to calculate, and expect to arrive at anything like a coherent and inteligent point of view.
  - madengr 9y ago
    Though who says you have to be productive? If I have a few $M in retirement saved up. I could care less about being productive. Productive is all relative. If no one pays you to dig holes and fill them in again, then the productivity is infinite. Building ships in bottles is futile to most, but productive to an old man.
    - scarface74 9y ago
      No one, my parents retired at 55 and haven't been "productive" in the GDP sense for over 20 years. The original post that I replied to said but what doesn't make sense to me is that you loose all future productivity and value that these people create.
      - ineedasername 9y ago
        And yet how much may they have indirectly boosted the GDP by being of value to the family and friends around them, subtly adding to the support network that allows others to contribute more directly ti the GDP. And besides, who is insane enough to so narrowly define existential worth solely as a function and GDP contribution? A good healthcare system might greatly help such a person avoid those negative and irrational patterns of thouht.
        scarface74 9y ago
        That's true. Most of my cousins -- all female - stayed in my home town because it really helps having their parents around so they can work and not have to worry about childcare because they have their parents. When I was growing up, my grandfather or aunts would come pick me up if I was sick, take me to doctors appointments, etc. My dad worked in a factory and it was harder for him to get off of work in the spur of the moment and my mom could not just take time off in the middle of the day as a teacher. I've been married for a little while and have a teenage step son. We never really had extended family that lived around. We had to arrange our lifestyles to give us the maximum flexibility. My wife got a job that would allow here to be on the school system schedule and I have a flexible job that allows me to me work from home, work odd hours if I need to, etc. We also are fortunate enough to have teenage sons. When we really just can't get to our son in time to pick him up or take him somewhere we just tell him to order an Uber. I wouldn't do that if I had a daughter. I do see people in similar situations to ours who aren't so fortunate, when they need to take time off of work to deal with family issues, they have to use vacation or sick time or even worse take unpaid time off. If they had their parents around and healthy, it would make their life easier.
soVeryTired 9y ago
Let old people die faster? It sounds callous to frame it in terms of dollars and cents, but allowing people to choose to end their own lives might lift some of the burden on our healthcare systems. I'm still on the fence about the issue of euthanasia, but I think the Overton window is shifting. In time, I think that debate will make the debate on abortion look cordial.
- IIIIIIIIIIIIIII 9y ago
  Logan's Run [0] (still a great movie even watching it today - especially the cats [1] :-) ) - that society sure had the lowest health care expenses on the entire planet in its fictional universe of a future earth (a statement even more true since it probably was the only one, haha). By the way, if we want to "cut costs" we could just blow up the planet and be done with it. No more "costs". What bizarre discussions we are having these days. "Cost cutting" makes sense in narrow(er) contexts, when the goal is clear and various paths to get there are explored, but for societal meaning-of-everything goal setting? If we didn't have health care we would not need to pay for it. That's true for everything ever made by humans. On this planet one person's cost is another persons's income, until we find aliens to trade with. People already exist (and in huge numbers!) - what do we do with them? They may as well work as doctors and nurses and in the many industries supplying the health care sector. Or they could just hang around and play games, produce meme videos for Youtube, or become insurance agents or financial advisers (but of course, without "costs" somewhere there is not much to invest in... unless we become more of a "virtual society" and just have "money" building and feeding on itself without actual real-world connection). [0] http://www.imdb.com/title/tt0074812/ http://www.imdb.com/title/tt0074812/ [1] https://youtu.be/sax6J8n1AiE https://youtu.be/sax6J8n1AiE . PS: Completely unrelated issue, just for fun search for "Logan's run" on Youtube, filter by "length > 20 minutes", and check out a few of the many results. You can do that for lots of movies, especially popular older ones. Does it seem like Youtube is overrun by millions (must be millions overall, for all kinds of movies) of fake "movies", hours-long fake movies? Doesn't that waste huge amounts of Youtube storage? Why does Google not do anything about it, ML algorithms should have an easy time finding most of those uploads?
  - 9y ago
windexh8er 9y ago
The assumption that living longer costs more is just that. If Western culture focused more on nutrition and moved away from the Standard American Diet longevity and health would have positive outcomes in the long run. Preventative health care isn't prescribed by a Doctor in a world not driven by insurance and pharma.
- danmaz74 9y ago
  I'll break some good news to you: Western culture has never been tied to the Standard American Diet. Unless if by "Western" you meant Western US :)
  - windexh8er 9y ago
    Western culture is often defined by Christian following. So, yes - many Christian prevalent nations have been influenced by the standard American Diet, which continues to fuel its healthcare/pharma addiction. Diebetic? Take a pill. Depressed? Take a pill. There are very few doctors who have background in nutritional education, and instead focus on prescribing something as a fix. There is plenty of research showcasing how poor nutrition is systemic in the general health of populations. Western map for edification: https://en.m.wikipedia.org/wiki/Western_culture#/media/File%3AClash_of_Civilizations_map.png https://en.m.wikipedia.org/wiki/Western_culture#/media/File%...
ComputerGuru 9y ago
You missed this part, though: Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained. They’re not against paying for things, just not paying uncapped amounts. It does sound barbaric, but just take it to the extreme. Is, say, $4M of federal taxpayer money for one quality-adjusted year of life gained a good trade off? Someone has to make that call.
- gumby 9y ago
  It's not barbaric, but what I find interesting is different regulatory agencies (e.g. Transportation vs Health vs Defense) assign different economic values to human life.
ineedasername 9y ago
Also, from a view of net economic gain, healthier people are more productive for a longer period of time. So health cost savings may cancel out but the individual's contribution to the economy is higher.
- Dwolb 9y ago
  Agreed here. Thinking the authors should be rolling up a better view of “health dollars spent per year”.
anon04532 9y ago
Yet it is quite different to spend 6 months in a hospital when your kids are 3 and 5, compared to spending the same money and time in hospital when it is your grand children who are 3 and 5. You cannot put a pricetag on ones health when other lives depend on it.

by Dwolb 9y ago

mjw1007 9y ago

Similarly from the linked Robert Wood Johnson Foundation report: «Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.» Perhaps a useful way of looking at things would be to imagine we had access to a graph of the function from (preventative health care, emergency health care) → life expectancy, and see what it looks like for constant life expectancy. If you could increase the preventative part by less than you decrease the emergency part, then I think in one sense it's fair to say that preventative care saves money.

robkop 9y ago

Letting people die younger, faster makes sense that it would reduce healthcare spending but what doesn't make sense to me is that you loose all future productivity and value that these people create. They say that the costs are barely offset by cigarette tax revenue but that doesn't take into account all future tax revenue that would be generated by letting these people live.

scarface74 9y ago
I hate to sound callous, but on average, how productive are older people? Living longer doesn't necessarily imply working longer. It could just lead to costing more in treating chronic conditions.
- ineedasername 9y ago
  It doesn't matter how productive they are if the savings are being equally cancelled out: the health cost issue is then zero-sum, but that means any productivity that wouldn't have occured without preventative care is a positive gain. And even without economic benefit one way or the other, I figure most people wouldn't mind having a healthier mom around a little longer. You cant narrowly focus on only economic benefits, and then narrowly only on the most obvious and easiest to calculate, and expect to arrive at anything like a coherent and inteligent point of view.
- madengr 9y ago
  Though who says you have to be productive? If I have a few $M in retirement saved up. I could care less about being productive. Productive is all relative. If no one pays you to dig holes and fill them in again, then the productivity is infinite. Building ships in bottles is futile to most, but productive to an old man.
  - scarface74 9y ago
    No one, my parents retired at 55 and haven't been "productive" in the GDP sense for over 20 years. The original post that I replied to said but what doesn't make sense to me is that you loose all future productivity and value that these people create.
    - ineedasername 9y ago
      And yet how much may they have indirectly boosted the GDP by being of value to the family and friends around them, subtly adding to the support network that allows others to contribute more directly ti the GDP. And besides, who is insane enough to so narrowly define existential worth solely as a function and GDP contribution? A good healthcare system might greatly help such a person avoid those negative and irrational patterns of thouht.
      - scarface74 9y ago
        That's true. Most of my cousins -- all female - stayed in my home town because it really helps having their parents around so they can work and not have to worry about childcare because they have their parents. When I was growing up, my grandfather or aunts would come pick me up if I was sick, take me to doctors appointments, etc. My dad worked in a factory and it was harder for him to get off of work in the spur of the moment and my mom could not just take time off in the middle of the day as a teacher. I've been married for a little while and have a teenage step son. We never really had extended family that lived around. We had to arrange our lifestyles to give us the maximum flexibility. My wife got a job that would allow here to be on the school system schedule and I have a flexible job that allows me to me work from home, work odd hours if I need to, etc. We also are fortunate enough to have teenage sons. When we really just can't get to our son in time to pick him up or take him somewhere we just tell him to order an Uber. I wouldn't do that if I had a daughter. I do see people in similar situations to ours who aren't so fortunate, when they need to take time off of work to deal with family issues, they have to use vacation or sick time or even worse take unpaid time off. If they had their parents around and healthy, it would make their life easier.

soVeryTired 9y ago

Let old people die faster? It sounds callous to frame it in terms of dollars and cents, but allowing people to choose to end their own lives might lift some of the burden on our healthcare systems. I'm still on the fence about the issue of euthanasia, but I think the Overton window is shifting. In time, I think that debate will make the debate on abortion look cordial.

IIIIIIIIIIIIIII 9y ago
Logan's Run [0] (still a great movie even watching it today - especially the cats [1] :-) ) - that society sure had the lowest health care expenses on the entire planet in its fictional universe of a future earth (a statement even more true since it probably was the only one, haha). By the way, if we want to "cut costs" we could just blow up the planet and be done with it. No more "costs". What bizarre discussions we are having these days. "Cost cutting" makes sense in narrow(er) contexts, when the goal is clear and various paths to get there are explored, but for societal meaning-of-everything goal setting? If we didn't have health care we would not need to pay for it. That's true for everything ever made by humans. On this planet one person's cost is another persons's income, until we find aliens to trade with. People already exist (and in huge numbers!) - what do we do with them? They may as well work as doctors and nurses and in the many industries supplying the health care sector. Or they could just hang around and play games, produce meme videos for Youtube, or become insurance agents or financial advisers (but of course, without "costs" somewhere there is not much to invest in... unless we become more of a "virtual society" and just have "money" building and feeding on itself without actual real-world connection). [0] http://www.imdb.com/title/tt0074812/ http://www.imdb.com/title/tt0074812/ [1] https://youtu.be/sax6J8n1AiE https://youtu.be/sax6J8n1AiE . PS: Completely unrelated issue, just for fun search for "Logan's run" on Youtube, filter by "length > 20 minutes", and check out a few of the many results. You can do that for lots of movies, especially popular older ones. Does it seem like Youtube is overrun by millions (must be millions overall, for all kinds of movies) of fake "movies", hours-long fake movies? Doesn't that waste huge amounts of Youtube storage? Why does Google not do anything about it, ML algorithms should have an easy time finding most of those uploads?
- 9y ago

windexh8er 9y ago

The assumption that living longer costs more is just that. If Western culture focused more on nutrition and moved away from the Standard American Diet longevity and health would have positive outcomes in the long run. Preventative health care isn't prescribed by a Doctor in a world not driven by insurance and pharma.

danmaz74 9y ago
I'll break some good news to you: Western culture has never been tied to the Standard American Diet. Unless if by "Western" you meant Western US :)
- windexh8er 9y ago
  Western culture is often defined by Christian following. So, yes - many Christian prevalent nations have been influenced by the standard American Diet, which continues to fuel its healthcare/pharma addiction. Diebetic? Take a pill. Depressed? Take a pill. There are very few doctors who have background in nutritional education, and instead focus on prescribing something as a fix. There is plenty of research showcasing how poor nutrition is systemic in the general health of populations. Western map for edification: https://en.m.wikipedia.org/wiki/Western_culture#/media/File%3AClash_of_Civilizations_map.png https://en.m.wikipedia.org/wiki/Western_culture#/media/File%...

ComputerGuru 9y ago

You missed this part, though: Of all the interventions they looked at, only two were truly cost-saving: childhood immunizations (a no-brainer) and the counseling of adults on the use of low-dose aspirin. An additional 15 preventive services were cost-effective, meaning that they cost less than $50,000 to $100,000 per quality adjusted life-year gained. They’re not against paying for things, just not paying uncapped amounts. It does sound barbaric, but just take it to the extreme. Is, say, $4M of federal taxpayer money for one quality-adjusted year of life gained a good trade off? Someone has to make that call.

gumby 9y ago
It's not barbaric, but what I find interesting is different regulatory agencies (e.g. Transportation vs Health vs Defense) assign different economic values to human life.

ineedasername 9y ago

Also, from a view of net economic gain, healthier people are more productive for a longer period of time. So health cost savings may cancel out but the individual's contribution to the economy is higher.

Dwolb 9y ago
Agreed here. Thinking the authors should be rolling up a better view of “health dollars spent per year”.

anon04532 9y ago

Yet it is quite different to spend 6 months in a hospital when your kids are 3 and 5, compared to spending the same money and time in hospital when it is your grand children who are 3 and 5. You cannot put a pricetag on ones health when other lives depend on it.