3 ms·

In that hypothetical world, life expectancy would be rising. In fact, it is falling.

roenxi 7y ago
I promise I'll stop being argumentative after this, but in the meantime - not necessarily. Simpson's Paradox might get triggered where better healthcare encourages more marginal people to have children/migrate to the better healthcare/whatever. There is no single statistic or even a small batch that is safe to make uninformed decisions on. This is optimising a complex system. It needs to be done slowly, holistically and with statistics and science. Just because one part is failing doesn't mean that the system is out of control. It might be out of control, but the evidence needs to be quite deep to conclude that because the system is very complicated. A response powered by emotions, anecdotes or silver bullet stats probably feels right but is likely to do more damage than good. This is a field where high-functioning sociopaths should be given a lot of room to make decisions; they are the ones who can make hard decisions and get to a greatest-good-greatest-number style outcomes despite that fact that gut-wrenchingly unfair and tragic thing happen every day in the world of healthcare. What it comes down to is people die and often suffer. The fact that people are observed to die in the hospital system is not evidence. Even aggregate stats getting worse is not necessarily a problem. Arguments have to talk thoroughly about what the costs and benefits of any change is likely to be and we have to accept that death is a cost that the healthcare system is going to pay whether we like it or not; because that really is an elephant in the room with these sort of decisions.
- leereeves 7y ago
  What I don't understand is why you'd want to shut down the discussion. Why object, not merely to a specific statement a "medical conservative" made, but to their very existence? Why should we trust the system to high-functioning sociopaths, as you said, and not listen to both sides and have a vigorous and ongoing debate? You're right that people die, and will continue to die, in medical care. And it's a difficult and emotional subject. And people don't always make the best decisions. But I'd still rather have public discussion about every little detail rather than trust insiders (with their own, sometimes perverse, motivations) implicitly.
  - DoreenMichele 7y ago
    I don't want to debate it with you because you led with stating that your grandmother died. You made it emotional and personal from the very first sentence and in a manner such that arguing with you looks like emotional cruelty. Nothing can bring your grandmother back. The closure you desire is unlikely to be found in trying to protect others from her fate. I have a form of cystic fibrosis, as does my oldest son. It's just as personal for me as it is for you. No good ever comes from trying to argue whose hurt feelings or personal suffering trumps the other's. I've been talking about medical stuff a long time. I sometimes make comments that do decently well. I also still make comments that bomb, such as this one from this same discussion that was quickly downvoted to the negatives and still remains there: https://news.ycombinator.com/item?id=22042276 https://news.ycombinator.com/item?id=22042276 I'm only responding now to this comment of yours because it makes me completely crazy when I can't get engagement, I get downvotes and the silent treatment and people act like I'm too emotionally fragile to have a reasoned discussion with. I'm responding in hopes that something I say will help you more effectively find your way forward in future discussions. I still have zero plans to debate you in this one.
    - leereeves 7y ago
      I apologize for making it emotional. I didn't mean to; I only offered my grandmother's story as a cautionary anecdote. The truth is, it happened a long time ago and I've already found closure. I hope you find medications that help you.

I promise I'll stop being argumentative after this, but in the meantime - not necessarily. Simpson's Paradox might get triggered where better healthcare encourages more marginal people to have children/migrate to the better healthcare/whatever. There is no single statistic or even a small batch that is safe to make uninformed decisions on. This is optimising a complex system. It needs to be done slowly, holistically and with statistics and science. Just because one part is failing doesn't mean that the system is out of control. It might be out of control, but the evidence needs to be quite deep to conclude that because the system is very complicated. A response powered by emotions, anecdotes or silver bullet stats probably feels right but is likely to do more damage than good. This is a field where high-functioning sociopaths should be given a lot of room to make decisions; they are the ones who can make hard decisions and get to a greatest-good-greatest-number style outcomes despite that fact that gut-wrenchingly unfair and tragic thing happen every day in the world of healthcare. What it comes down to is people die and often suffer. The fact that people are observed to die in the hospital system is not evidence. Even aggregate stats getting worse is not necessarily a problem. Arguments have to talk thoroughly about what the costs and benefits of any change is likely to be and we have to accept that death is a cost that the healthcare system is going to pay whether we like it or not; because that really is an elephant in the room with these sort of decisions.

leereeves 7y ago
What I don't understand is why you'd want to shut down the discussion. Why object, not merely to a specific statement a "medical conservative" made, but to their very existence? Why should we trust the system to high-functioning sociopaths, as you said, and not listen to both sides and have a vigorous and ongoing debate? You're right that people die, and will continue to die, in medical care. And it's a difficult and emotional subject. And people don't always make the best decisions. But I'd still rather have public discussion about every little detail rather than trust insiders (with their own, sometimes perverse, motivations) implicitly.
- DoreenMichele 7y ago
  I don't want to debate it with you because you led with stating that your grandmother died. You made it emotional and personal from the very first sentence and in a manner such that arguing with you looks like emotional cruelty. Nothing can bring your grandmother back. The closure you desire is unlikely to be found in trying to protect others from her fate. I have a form of cystic fibrosis, as does my oldest son. It's just as personal for me as it is for you. No good ever comes from trying to argue whose hurt feelings or personal suffering trumps the other's. I've been talking about medical stuff a long time. I sometimes make comments that do decently well. I also still make comments that bomb, such as this one from this same discussion that was quickly downvoted to the negatives and still remains there: https://news.ycombinator.com/item?id=22042276 https://news.ycombinator.com/item?id=22042276 I'm only responding now to this comment of yours because it makes me completely crazy when I can't get engagement, I get downvotes and the silent treatment and people act like I'm too emotionally fragile to have a reasoned discussion with. I'm responding in hopes that something I say will help you more effectively find your way forward in future discussions. I still have zero plans to debate you in this one.
  - leereeves 7y ago
    I apologize for making it emotional. I didn't mean to; I only offered my grandmother's story as a cautionary anecdote. The truth is, it happened a long time ago and I've already found closure. I hope you find medications that help you.