6 ms·

On one hand you are suggesting "we can't know anything, let's not bother" but on the other hand you are saying "let's talk about things we should actually do".

On one hand you are suggesting "we can't know anything, let's not bother" but on the other hand you are saying "let's talk about things we should actually do". Ok! I moved to Canada (Quebec) from the US. The healthcare system is overloaded, there are weird things like a) it's extremely hard to get a family doctor, b) you have to go to a clinic early in the morning to get a number + time of day and then come back at that time to be seen, and c) you still need to pay your own way (or get insurance) for dental / vision. You have to wait weeks/months to have a surgery, but you have to do that in the US and then promptly file for personal bankruptcy. That's still a whole hell of a lot better than a random unexpected illness or injury sending an employed, insured person into bankruptcy. Seeing a doctor is now a possibility instead of a dangerous worst-case scenario that could ruin my life. No more hoping the pain/infection/whatever just goes away on its own. Thus, I still think moving towards a government program / single payer / whatever you want to call it system is the best idea. Now, I based this all on personal anecdotal experience and not statistics, so I wonder if anyone will actually agree with me. :)

yummyfajitas 16y ago
That's still a whole hell of a lot better than a random unexpected illness or injury sending an employed, insured person into bankruptcy. Do you have any evidence that this occurs much in the US?
- 27182818284 16y ago
  Harvard published a paper in the American Journal of Medicine in 2007 on the subject. It was also a big talking point by all US candidates and pundits that year. http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm http://www.businessweek.com/bwdaily/dnflash/content/jun2009/...
  - yummyfajitas 16y ago
    Go read the actual study rather than a press release about it. It's deeply flawed, both for methodology (it has no control group) and for basic definitions. Basic definitions: a bankruptcy with $1001 or more in medical spending in the previous 2 years is a "medical bankruptcy". By this criteria, Michael Vick's bankruptcy was medical, even though any sane person would realize there were other causes [1]. Also, "uncontrolled gambling", "drug abuse" and "adoption/birth" are medical causes of bankruptcy, by the definition of that study. If we adopted the criteria of that study, we would discover that nearly every bankruptcy has "major tax cause", for example. By the way, a slightly less misleading way to phrase the conclusions of that study would be "medical bankruptcies drop by 33%, even while medical costs increase." Luckily, the language of the study hid that from lazy reporters. See this explanation: http://www.theatlantic.com/business/archive/2009/06/elizabeth-warren-and-the-terrible-horrible-no-good-very-bad-utterly-misleading-bankruptcy-study/18826/ http://www.theatlantic.com/business/archive/2009/06/elizabet... Try again. [1] Getting arrested for dogfighting and losing his job in the NFL, for example. While he certainly spent a few grand on doctors, he also owed about $600k in back taxes. [edit: oops, linked to the debunking, forgot to link to the actual study. http://pnhp.org/new_bankruptcy_study/ http://pnhp.org/new_bankruptcy_study/ Thanks floor(e x 10^10).]
    - anamax 16y ago
      > ... and losing his job is the biggest factor in "medical bankruptcies". If you can't work because you're sick, you're going to have financial problems because the "cost of life" bills (food, shelter, transportation, heat/cooling) still come in. Healthcare doesn't address this, so it's absurd to bring up "medical bankruptcies" as an argument wrt healthcare.
    - 27182818284 16y ago
      I link to some website instead of the study >Go read the actual study rather than a press release about it. you link to another website instead of the study >http://www.theatlantic.com/business/archive/2009/06/elizabeth-warren-and-the-terrible-horrible-no-good-very-bad-utterly-misleading-bankruptcy-study/18826/ http://www.theatlantic.com/business/archive/2009/06/elizabet... reminds me of the old Marx joke "I would never join any club that would accept me as a member"
    - fluidcruft 16y ago
      > It's deeply flawed, both for methodology (it has no control group) Why do you require a control group for observational data?
      - yummyfajitas 16y ago
        To answer the question of how many bankruptcies are caused by medical bills, you must compare a group of people with medical bills in excess of $1001 (or perhaps a gambling problem) to a similar group of people without medical bills/gambling problems/birth/adoption. If, (for instance), 50% of the first group and 49% of the second group goes bankrupt, then only 2% of bankruptcies are caused by medical bills. Without the control group, you have literally no idea.
        fluidcruft 16y ago
        You don't need to find oaks that don't produce acorns in order to measure how many acorns an oak produces. And, yes, if you measure 1000 acorns on a tree, you actually do have an idea how many acorns are on that tree.
matwood 16y ago
You have to wait weeks/months to have a surgery, but you have to do that in the US There are many things messed up about healthcare in the US, but I've never had to wait for it. I had an emergency appendicitis surgery and from when I went to the doctor to when I was put under was about 2 hours. I've also had a non-emergency knee surgery (replaced ACL). I went to the doctor one day and had an MRI that same day. I had to wait 2 days for the MRI results, but when they came back positive for an ACL tear I had the option of surgery 2 days later. I opted for 2 weeks later so I could get work all set up for me to be out a couple weeks. Now, I have insurance and paid a bit here and there out of pocket, but waiting for care is one thing I didn't do.
- yummyfajitas 16y ago
  According to the WHO, the US is #1 in the world in terms of health care responsiveness. http://www.who.int/whr/2000/en/whr00_en.pdf http://www.who.int/whr/2000/en/whr00_en.pdf
- michaelchisari 16y ago
  Now, I have insurance and paid a bit here and there out of pocket, but waiting for care is one thing I didn't do. I think that may be key. I had insurance and appendicitis, and waited around 12 hours before surgery, but my brother was in a car accident without insurance, and was almost sent home. Luckily, a family member who is a nurse caused enough of a storm that he received the proper care. Not having insurance is what really skews the statistics in the U.S. Cook County hospital is an example of a hospital which provides care for the uninsured, and the wait times are significant. I haven't seen it, but I'd be interested to see the statistics on health care in the United States for the uninsured versus the insured: Wait times, costs, quality of care, quality of life, and life span.
DanielBMarkham 16y ago
You're arguing for some sort of political change -- in this case health care reform -- based on statistics and personal experience. Yes, personal experience and statistics are very important in setting public policy. And heck, make the government do anything you want it to do. But that's not what I'm talking about. Let's say you run a company with ten thousand workers. But they seem unhappy. One day a VP comes in and tells you that 30% of the workers are not able to read as much as they would like to stay current with their job. So you, wise person that you are, implement a free book program. The next month the number hasn't changed much. So querying further, you find out that folks don't have enough time to read the books -- it's not that they can't afford them. So you implement extra time off on Fridays so folks can read. Months later, no change. This time you bring in a comittee of experts. After much investigation, they find out that folks would rather play golf than read, and the extra time has just been spent on leisure activities instead of the reading. So you implement a program where folks can read at work on Friday afternoons. Months later, no change. This time it turns out that the books they are reading are not job-related. So, after bringing in an expensive outside consulting team, you decide to put video cameras in the office... What's happening? Are these people just lazy or what? Is management stupid? How many times do we have to set up the conditions where more reading can take place? Two things have happened. First, you've confused the statistic with the individuals. The 30% who want to read more aren't necessarily the same as the ones playing golf, which aren't necessarily the same as the ones reading other books. But in your mind they're all the same. You see, all you have is a metric, an aggregation of data. It's not like there's any one universal person out there -- everybody is unique. The system is made up of great variations in motives, ability, and circumstances. Teams of people work because they are all different, not because they are all the same. But you'll keep on measuring, and keep on poking around, and the numbers will never do what you want them to do. Why? Because top-down, statistics-based reactive management is full of shit. Doesn't work for your company, doesn't work for other companies, doesn't work for the government. That's not a political statement -- vote for your guys and do whatever you want to with the world. Lots of things need fixing. Let's go fix them. This has nothing to do with wanting less or more government. It's a statement on how systems of people operate. People either understand that concept or they don't. And if they don't, they're always looking at aggregate numbers instead of system constraints. It's just a futile and endlessly spiraling methodology to fix any problem of any system of interacting people. It continues to fail over and over again, yet we keep framing the discussion this way. Probably because we have a vast lack of education in economics. The final thing that's happened -- and this is the worst of all -- is that you've lost track of the goal for the metric. Somewhere along the way you're chasing percentages of folks reading books. What you really want is people leading happy and fulfilling work lives. But the minute you put a number on that, your abstraction starts carrying you away from your real goal. I've seen this happen over and over again, and I've never seen anybody go back to the original problem. These are just stupid people tricks. All I'm saying is that we have to be aware of them to keep from repeating yet again for the hundredth time. In reality, if you want to make people's lives better, you need to deal with one person and the thousand parameters around his or her life. Then you can make a difference. But once you start averaging -- even in groups as small as ten or so -- you've gone off the rails and into the weeds.

yummyfajitas 16y ago

That's still a whole hell of a lot better than a random unexpected illness or injury sending an employed, insured person into bankruptcy. Do you have any evidence that this occurs much in the US?

27182818284 16y ago
Harvard published a paper in the American Journal of Medicine in 2007 on the subject. It was also a big talking point by all US candidates and pundits that year. http://www.businessweek.com/bwdaily/dnflash/content/jun2009/db2009064_666715.htm http://www.businessweek.com/bwdaily/dnflash/content/jun2009/...
- yummyfajitas 16y ago
  Go read the actual study rather than a press release about it. It's deeply flawed, both for methodology (it has no control group) and for basic definitions. Basic definitions: a bankruptcy with $1001 or more in medical spending in the previous 2 years is a "medical bankruptcy". By this criteria, Michael Vick's bankruptcy was medical, even though any sane person would realize there were other causes [1]. Also, "uncontrolled gambling", "drug abuse" and "adoption/birth" are medical causes of bankruptcy, by the definition of that study. If we adopted the criteria of that study, we would discover that nearly every bankruptcy has "major tax cause", for example. By the way, a slightly less misleading way to phrase the conclusions of that study would be "medical bankruptcies drop by 33%, even while medical costs increase." Luckily, the language of the study hid that from lazy reporters. See this explanation: http://www.theatlantic.com/business/archive/2009/06/elizabeth-warren-and-the-terrible-horrible-no-good-very-bad-utterly-misleading-bankruptcy-study/18826/ http://www.theatlantic.com/business/archive/2009/06/elizabet... Try again. [1] Getting arrested for dogfighting and losing his job in the NFL, for example. While he certainly spent a few grand on doctors, he also owed about $600k in back taxes. [edit: oops, linked to the debunking, forgot to link to the actual study. http://pnhp.org/new_bankruptcy_study/ http://pnhp.org/new_bankruptcy_study/ Thanks floor(e x 10^10).]
  - anamax 16y ago
    > ... and losing his job is the biggest factor in "medical bankruptcies". If you can't work because you're sick, you're going to have financial problems because the "cost of life" bills (food, shelter, transportation, heat/cooling) still come in. Healthcare doesn't address this, so it's absurd to bring up "medical bankruptcies" as an argument wrt healthcare.
  - 27182818284 16y ago
    I link to some website instead of the study >Go read the actual study rather than a press release about it. you link to another website instead of the study >http://www.theatlantic.com/business/archive/2009/06/elizabeth-warren-and-the-terrible-horrible-no-good-very-bad-utterly-misleading-bankruptcy-study/18826/ http://www.theatlantic.com/business/archive/2009/06/elizabet... reminds me of the old Marx joke "I would never join any club that would accept me as a member"
  - fluidcruft 16y ago
    > It's deeply flawed, both for methodology (it has no control group) Why do you require a control group for observational data?
    - yummyfajitas 16y ago
      To answer the question of how many bankruptcies are caused by medical bills, you must compare a group of people with medical bills in excess of $1001 (or perhaps a gambling problem) to a similar group of people without medical bills/gambling problems/birth/adoption. If, (for instance), 50% of the first group and 49% of the second group goes bankrupt, then only 2% of bankruptcies are caused by medical bills. Without the control group, you have literally no idea.
      - fluidcruft 16y ago
        You don't need to find oaks that don't produce acorns in order to measure how many acorns an oak produces. And, yes, if you measure 1000 acorns on a tree, you actually do have an idea how many acorns are on that tree.

matwood 16y ago

You have to wait weeks/months to have a surgery, but you have to do that in the US There are many things messed up about healthcare in the US, but I've never had to wait for it. I had an emergency appendicitis surgery and from when I went to the doctor to when I was put under was about 2 hours. I've also had a non-emergency knee surgery (replaced ACL). I went to the doctor one day and had an MRI that same day. I had to wait 2 days for the MRI results, but when they came back positive for an ACL tear I had the option of surgery 2 days later. I opted for 2 weeks later so I could get work all set up for me to be out a couple weeks. Now, I have insurance and paid a bit here and there out of pocket, but waiting for care is one thing I didn't do.

yummyfajitas 16y ago
According to the WHO, the US is #1 in the world in terms of health care responsiveness. http://www.who.int/whr/2000/en/whr00_en.pdf http://www.who.int/whr/2000/en/whr00_en.pdf
michaelchisari 16y ago
Now, I have insurance and paid a bit here and there out of pocket, but waiting for care is one thing I didn't do. I think that may be key. I had insurance and appendicitis, and waited around 12 hours before surgery, but my brother was in a car accident without insurance, and was almost sent home. Luckily, a family member who is a nurse caused enough of a storm that he received the proper care. Not having insurance is what really skews the statistics in the U.S. Cook County hospital is an example of a hospital which provides care for the uninsured, and the wait times are significant. I haven't seen it, but I'd be interested to see the statistics on health care in the United States for the uninsured versus the insured: Wait times, costs, quality of care, quality of life, and life span.

DanielBMarkham 16y ago

You're arguing for some sort of political change -- in this case health care reform -- based on statistics and personal experience. Yes, personal experience and statistics are very important in setting public policy. And heck, make the government do anything you want it to do. But that's not what I'm talking about. Let's say you run a company with ten thousand workers. But they seem unhappy. One day a VP comes in and tells you that 30% of the workers are not able to read as much as they would like to stay current with their job. So you, wise person that you are, implement a free book program. The next month the number hasn't changed much. So querying further, you find out that folks don't have enough time to read the books -- it's not that they can't afford them. So you implement extra time off on Fridays so folks can read. Months later, no change. This time you bring in a comittee of experts. After much investigation, they find out that folks would rather play golf than read, and the extra time has just been spent on leisure activities instead of the reading. So you implement a program where folks can read at work on Friday afternoons. Months later, no change. This time it turns out that the books they are reading are not job-related. So, after bringing in an expensive outside consulting team, you decide to put video cameras in the office... What's happening? Are these people just lazy or what? Is management stupid? How many times do we have to set up the conditions where more reading can take place? Two things have happened. First, you've confused the statistic with the individuals. The 30% who want to read more aren't necessarily the same as the ones playing golf, which aren't necessarily the same as the ones reading other books. But in your mind they're all the same. You see, all you have is a metric, an aggregation of data. It's not like there's any one universal person out there -- everybody is unique. The system is made up of great variations in motives, ability, and circumstances. Teams of people work because they are all different, not because they are all the same. But you'll keep on measuring, and keep on poking around, and the numbers will never do what you want them to do. Why? Because top-down, statistics-based reactive management is full of shit. Doesn't work for your company, doesn't work for other companies, doesn't work for the government. That's not a political statement -- vote for your guys and do whatever you want to with the world. Lots of things need fixing. Let's go fix them. This has nothing to do with wanting less or more government. It's a statement on how systems of people operate. People either understand that concept or they don't. And if they don't, they're always looking at aggregate numbers instead of system constraints. It's just a futile and endlessly spiraling methodology to fix any problem of any system of interacting people. It continues to fail over and over again, yet we keep framing the discussion this way. Probably because we have a vast lack of education in economics. The final thing that's happened -- and this is the worst of all -- is that you've lost track of the goal for the metric. Somewhere along the way you're chasing percentages of folks reading books. What you really want is people leading happy and fulfilling work lives. But the minute you put a number on that, your abstraction starts carrying you away from your real goal. I've seen this happen over and over again, and I've never seen anybody go back to the original problem. These are just stupid people tricks. All I'm saying is that we have to be aware of them to keep from repeating yet again for the hundredth time. In reality, if you want to make people's lives better, you need to deal with one person and the thousand parameters around his or her life. Then you can make a difference. But once you start averaging -- even in groups as small as ten or so -- you've gone off the rails and into the weeds.