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The United States currently has the highest 5 year survival rate for all cancers combined. I think it's a fair question to ask if that would continue to be the

The United States currently has the highest 5 year survival rate for all cancers combined. I think it's a fair question to ask if that would continue to be the case in a MFA system for 300 million patients. Considering what a disaster the insurance marketplace was, I'm very skeptical. Edit: what I mean by "disaster": when it launched, the site completely crashed for over a month and then, when it finally came back up, the policies offered weren't accepted by most doctors, because they had crazy restrictions.

deleted 8y ago
[deleted]
dontreact 8y ago
The U.S. actually has worse health outcomes overall than Japan and France who both have universal coverage (through different systems)
- 5trokerac3 8y ago
  What are "health outcomes"? "5 year cancer survival" is a definable metric. "Health outcomes" is very vague. Is there a scoring system? Are different illnesses/conditions ranked?
  - dontreact 8y ago
    Lifespan Deaths due to preventable causes On both of these the US is somewhere in the 30s in terms of rank among countries. But we are #1 in terms of cost per capita :) 5 year cancer is too low level in my opinion to give an overall picture
    - 5trokerac3 8y ago
      And how much of that is due to the obesity epidemic in the US and has nothing to do with the healthcare system?
      - dontreact 8y ago
        I don’t know for sure what the breakdown is. Right now our overall system does little to discourage the obesity epidemic, but in a universal coverage system there would be massive financial incentive to fight it (either the government or insurance companies being forced to provide coverage for all)
        5trokerac3 8y ago
        Is there perhaps a better way to use resources to fight the obesity epidemic, and massively impact "health outcomes", than a ~$40 trillion complete overhaul of the medical system and hoping that the epidemic is solved by proxy?
        dontreact 8y ago
        I don't know where you get 40 trillion from. As I mentioned, our costs are significantly higher and our outcomes are worse than 30 other countries who have universal coverage. We should be learning something from the systems in place in other countries. I think you are focusing too narrowly on obesity in particular, when there are many reasons why this is happening. I would suggest reading this book: https://www.amazon.com/Getting-Health-Reform-Right-Performance/dp/019537150X https://www.amazon.com/Getting-Health-Reform-Right-Performan... It was written by William Hsiao, who was hired by the Taiwanese government to advise them on modernizing/reforming their health care system. It does a lot to compare health systems in various countries. I think one underlying thread is how much health systems improve once there is a commitment to universal coverage. I work in this space and am trying to see what can be done about changing behaviors to make people healthier but it is incredibly difficult, especially when there is so much financial incentive in getting people to behave in unhealthy ways.
  - cfmcdonald 8y ago
    "5 year cancer survival" is unfortunately a very weak metric. Consider this easy way to boost 5 year cancer survival rates - do prostate screening tests for everyone in the country every year. You will undoubtedly detect more cancers and thus increase 5 year survival rates, but this is also undoubtedly a net negative for society.
Sahhaese 8y ago
I wonder how much of that is down to better/earlier diagnosis \* ? My experience with the NHS is that diagnostics in general isn't great because it's essentially a money-sink, you have to push very hard for a diagnosis a lot of people get a diagnosis privately before going back to the NHS for treatment. Once diagnosed however I've never had any problem getting top quality treatment. This is an anecdote, of course, so I'd be interested to see the statistics. \* Or even over-diagnosis? It's "easy" to have a high 5-year survival rate if you push removal of tumors that may well have been benign.
burkaman 8y ago
That's a cherry-picked stat. Most health outcomes are worse in the US than other rich countries with universal healthcare. There are many studies and charts you can search for, here's one: https://jamanetwork.com/journals/jama/article-abstract/2674671 https://jamanetwork.com/journals/jama/article-abstract/26746...
- 5trokerac3 8y ago
  1. This entire article and thread is about cancer, so I'm not cherry picking. If anything the broad "health outcomes" is a diversion from the main subject. 2. What percentage of poorer "health outcomes" are due to the US's ~33% obesity rate and overall horrid diet and have nothing to do with care or access?
  - burkaman 8y ago
    You're right about 1, sorry. Obesity and diet are very much related to care and access. If you can't afford to go to the doctor unless you're dying, nobody is going to tell you when your cholesterol is getting too high and you should adjust your diet, or your blood sugar is getting into the warning zone, or whatever. We have such high obesity because we don't focus enough on preventative care, and lots of people can't afford preventative care even if they want it.
    - 5trokerac3 8y ago
      Thanks for acknowledging that. It's not something you commonly see in forums. I have a hard time swallowing the idea that obesity and diet are related to access to medical care. Our great great grandparents undoubtedly had far less access to healthcare than even the average lower class, modern American, and yet obesity was almost non-existent for their generation. Occam's razor would say that an epidemic of diet related illness is caused by a societal shift in diet. The simplistic boiling down of the complex answer from nutrition experts is that the massive increase in processed foods in the American diet, post WWII, along with the insane increase in sugar consumption, have led to the obesity and diabetes epidemics (and increasingly believed to be one of the main causes of cancer). IMHO we could do exponentially more for the life expectancy of poor Americans by solving the problem of food deserts than by upending the entire medical system, that is functional for the majority, for a wholly bureaucratically controlled system - which, by the way, will eventually have to include decisions on which people do not get access to treatment.
bryanlarsen 8y ago
5 year survival rate is poorly correlated with treatment efficacy. It's mostly correlated with how early a cancer is diagnosed. In most cases it's a good thing to detect cancers early, but saying a country is good at detecting cancers is not near as strong of a statement as saying that a country is good at treating cancers. And this gets complicated by prostrate cancer -- many would argue that mass screening for prostrate cancer causes more pain and suffering than it prevents.
- 5trokerac3 8y ago
  So then it can be argued that, due to long wait times in MFA, the cancer survival rate would go down due to later diagnosis.
  - cannonedhamster 8y ago
    Nope, the reason it's diagnosed late is often due to many cancers being asymptomatic and aggressive. Your immune system literally cannot recognize the bad cells because of checkpoint inhibitors among other things.
emddudley 8y ago
It sounds like you are implying that cancer survival rates are affected by the way Americans pay for healthcare. What specific mechanisms do you think are the cause? Total spending, ability to see doctors, insurance company approval of certain treatments...? Or something else?
- cannonedhamster 8y ago
  There is actually evidence to show that while the coastal blue states and Texas have better (not great but better) survival outcomes, the ability to get diagnosed earlier is tied to access to preventative healthcare because if you have good health insurance and money you're more likely to go to the doctor if something doesn't seem severe, like most initial cancer symptoms, this causes patients to only go to the emergency room for health care which is often too late for a surgical option as the cancer has metastasized to your lymph nodes, which generally means it's in your other organs as well. This leaves chemotherapy and radiation as the resulting therapies, which while these can be effective, it's basically only life prolonging as radiation has a limit on how much you can due and damages other healthy tissue in the area and chemotherapy comes with side effects, organ damage, etc. and the cancer will eventually mutate, or the treatment could only slow the cancer or do nothing. Unfortunately doctors mostly don't know why the same treatment that works for the most patients doesn't work for all patients. Other treatments such as clinical trials can be either, unavailable for patients due to distance, trial rules, or a lack of expression of the marker that the medicine is hoping to exploit. While these are typically of no cost to the patient, it still means you have to be lucky enough to be near the location, be able to have the time off from work for the treatments which can take half a day at a time, and be able to have reliable transportation that isn't you driving yourself as the treatments can cause unpredictable side effects.
cannonedhamster 8y ago
As a person with cancer going through treatment, even with fully paid for by my employer healthcare and making a good amount of money, this is super expensive and if I didn't have a job where I could work remote, I'd probably be bankrupt by now with all the time I have to spend in treatment and the initial surgeries. 5 year survival rates vary by the type of cancer, while cancers like leukemia, prostate, and breast cancer have made progress, most of those survival rate numbers are based on catching the cancer early, which, unfortunately most aren't caught early leading to a poor prognosis, my prognosis for example is 5% overall survival for 5 years with a significant drop off after 3 years. The survival rate is also heavily dependent on comorbidities, or other things that impact your health, this can leave things like surgery off the table. Another fun fact is that we really still suck at cancer treatment because we don't know how it functions, and as previously stated there's over 100 different types of cancer, each with their own mechanisms and subtypes. So to your main point, no unless there's some massive breakthrough in immunotherapy that's pan-cancer responsive for most patients (right now immunotherapy only works for roughly 20-30% of patients), the costs aren't going to go up dramatically as the primary option is surgery if it's early and if it's late you're probably still going to be dead within 5 years. The number of patients surviving each year only goes up by about roughly 2% per year.

deleted 8y ago

[deleted]

dontreact 8y ago

The U.S. actually has worse health outcomes overall than Japan and France who both have universal coverage (through different systems)

5trokerac3 8y ago
What are "health outcomes"? "5 year cancer survival" is a definable metric. "Health outcomes" is very vague. Is there a scoring system? Are different illnesses/conditions ranked?
- dontreact 8y ago
  Lifespan Deaths due to preventable causes On both of these the US is somewhere in the 30s in terms of rank among countries. But we are #1 in terms of cost per capita :) 5 year cancer is too low level in my opinion to give an overall picture
  - 5trokerac3 8y ago
    And how much of that is due to the obesity epidemic in the US and has nothing to do with the healthcare system?
    - dontreact 8y ago
      I don’t know for sure what the breakdown is. Right now our overall system does little to discourage the obesity epidemic, but in a universal coverage system there would be massive financial incentive to fight it (either the government or insurance companies being forced to provide coverage for all)
      - 5trokerac3 8y ago
        Is there perhaps a better way to use resources to fight the obesity epidemic, and massively impact "health outcomes", than a ~$40 trillion complete overhaul of the medical system and hoping that the epidemic is solved by proxy?
        dontreact 8y ago
        I don't know where you get 40 trillion from. As I mentioned, our costs are significantly higher and our outcomes are worse than 30 other countries who have universal coverage. We should be learning something from the systems in place in other countries. I think you are focusing too narrowly on obesity in particular, when there are many reasons why this is happening. I would suggest reading this book: https://www.amazon.com/Getting-Health-Reform-Right-Performance/dp/019537150X https://www.amazon.com/Getting-Health-Reform-Right-Performan... It was written by William Hsiao, who was hired by the Taiwanese government to advise them on modernizing/reforming their health care system. It does a lot to compare health systems in various countries. I think one underlying thread is how much health systems improve once there is a commitment to universal coverage. I work in this space and am trying to see what can be done about changing behaviors to make people healthier but it is incredibly difficult, especially when there is so much financial incentive in getting people to behave in unhealthy ways.
- cfmcdonald 8y ago
  "5 year cancer survival" is unfortunately a very weak metric. Consider this easy way to boost 5 year cancer survival rates - do prostate screening tests for everyone in the country every year. You will undoubtedly detect more cancers and thus increase 5 year survival rates, but this is also undoubtedly a net negative for society.

Sahhaese 8y ago

I wonder how much of that is down to better/earlier diagnosis \* ? My experience with the NHS is that diagnostics in general isn't great because it's essentially a money-sink, you have to push very hard for a diagnosis a lot of people get a diagnosis privately before going back to the NHS for treatment. Once diagnosed however I've never had any problem getting top quality treatment. This is an anecdote, of course, so I'd be interested to see the statistics. \* Or even over-diagnosis? It's "easy" to have a high 5-year survival rate if you push removal of tumors that may well have been benign.

burkaman 8y ago

That's a cherry-picked stat. Most health outcomes are worse in the US than other rich countries with universal healthcare. There are many studies and charts you can search for, here's one: https://jamanetwork.com/journals/jama/article-abstract/2674671 https://jamanetwork.com/journals/jama/article-abstract/26746...

5trokerac3 8y ago
1. This entire article and thread is about cancer, so I'm not cherry picking. If anything the broad "health outcomes" is a diversion from the main subject. 2. What percentage of poorer "health outcomes" are due to the US's ~33% obesity rate and overall horrid diet and have nothing to do with care or access?
- burkaman 8y ago
  You're right about 1, sorry. Obesity and diet are very much related to care and access. If you can't afford to go to the doctor unless you're dying, nobody is going to tell you when your cholesterol is getting too high and you should adjust your diet, or your blood sugar is getting into the warning zone, or whatever. We have such high obesity because we don't focus enough on preventative care, and lots of people can't afford preventative care even if they want it.
  - 5trokerac3 8y ago
    Thanks for acknowledging that. It's not something you commonly see in forums. I have a hard time swallowing the idea that obesity and diet are related to access to medical care. Our great great grandparents undoubtedly had far less access to healthcare than even the average lower class, modern American, and yet obesity was almost non-existent for their generation. Occam's razor would say that an epidemic of diet related illness is caused by a societal shift in diet. The simplistic boiling down of the complex answer from nutrition experts is that the massive increase in processed foods in the American diet, post WWII, along with the insane increase in sugar consumption, have led to the obesity and diabetes epidemics (and increasingly believed to be one of the main causes of cancer). IMHO we could do exponentially more for the life expectancy of poor Americans by solving the problem of food deserts than by upending the entire medical system, that is functional for the majority, for a wholly bureaucratically controlled system - which, by the way, will eventually have to include decisions on which people do not get access to treatment.

bryanlarsen 8y ago

5 year survival rate is poorly correlated with treatment efficacy. It's mostly correlated with how early a cancer is diagnosed. In most cases it's a good thing to detect cancers early, but saying a country is good at detecting cancers is not near as strong of a statement as saying that a country is good at treating cancers. And this gets complicated by prostrate cancer -- many would argue that mass screening for prostrate cancer causes more pain and suffering than it prevents.

5trokerac3 8y ago
So then it can be argued that, due to long wait times in MFA, the cancer survival rate would go down due to later diagnosis.
- cannonedhamster 8y ago
  Nope, the reason it's diagnosed late is often due to many cancers being asymptomatic and aggressive. Your immune system literally cannot recognize the bad cells because of checkpoint inhibitors among other things.

emddudley 8y ago

It sounds like you are implying that cancer survival rates are affected by the way Americans pay for healthcare. What specific mechanisms do you think are the cause? Total spending, ability to see doctors, insurance company approval of certain treatments...? Or something else?

cannonedhamster 8y ago
There is actually evidence to show that while the coastal blue states and Texas have better (not great but better) survival outcomes, the ability to get diagnosed earlier is tied to access to preventative healthcare because if you have good health insurance and money you're more likely to go to the doctor if something doesn't seem severe, like most initial cancer symptoms, this causes patients to only go to the emergency room for health care which is often too late for a surgical option as the cancer has metastasized to your lymph nodes, which generally means it's in your other organs as well. This leaves chemotherapy and radiation as the resulting therapies, which while these can be effective, it's basically only life prolonging as radiation has a limit on how much you can due and damages other healthy tissue in the area and chemotherapy comes with side effects, organ damage, etc. and the cancer will eventually mutate, or the treatment could only slow the cancer or do nothing. Unfortunately doctors mostly don't know why the same treatment that works for the most patients doesn't work for all patients. Other treatments such as clinical trials can be either, unavailable for patients due to distance, trial rules, or a lack of expression of the marker that the medicine is hoping to exploit. While these are typically of no cost to the patient, it still means you have to be lucky enough to be near the location, be able to have the time off from work for the treatments which can take half a day at a time, and be able to have reliable transportation that isn't you driving yourself as the treatments can cause unpredictable side effects.

cannonedhamster 8y ago

As a person with cancer going through treatment, even with fully paid for by my employer healthcare and making a good amount of money, this is super expensive and if I didn't have a job where I could work remote, I'd probably be bankrupt by now with all the time I have to spend in treatment and the initial surgeries. 5 year survival rates vary by the type of cancer, while cancers like leukemia, prostate, and breast cancer have made progress, most of those survival rate numbers are based on catching the cancer early, which, unfortunately most aren't caught early leading to a poor prognosis, my prognosis for example is 5% overall survival for 5 years with a significant drop off after 3 years. The survival rate is also heavily dependent on comorbidities, or other things that impact your health, this can leave things like surgery off the table. Another fun fact is that we really still suck at cancer treatment because we don't know how it functions, and as previously stated there's over 100 different types of cancer, each with their own mechanisms and subtypes. So to your main point, no unless there's some massive breakthrough in immunotherapy that's pan-cancer responsive for most patients (right now immunotherapy only works for roughly 20-30% of patients), the costs aren't going to go up dramatically as the primary option is surgery if it's early and if it's late you're probably still going to be dead within 5 years. The number of patients surviving each year only goes up by about roughly 2% per year.