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Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confound

by bhupy 6y ago

Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised. All that being said, if we were to use this metric, for the sake of argument...these charts are quite illuminating, but not for the reasons you think. If you plot them on a graph, you'll find that the most efficient healthcare system is actually one closer to the "idealized market"...in Singapore[1]. Also the comment to which you are replying is strictly talking about "government insurance". "Government insurance" is not the only way to deliver universal healthcare. Germany, Switzerland, Netherlands, Singapore all have thriving multi-payer systems. In Switzerland and the Netherlands, ALL insurance is private. In Singapore, while the government covers catastrophic care, 70% of total health expenditures are private. Singapore's approach is actually the closest to what a system might look like if you replaced healthcare-specific targeted subsidies with a UBI — most health expenditure is through compulsory health savings accounts. The common theme is that there is some degree of government intervention/regulation and subsidy. Having the government be the sole payer is definitely an approach, but it's by no means the only approach, nor even the best approach. "Universal healthcare" just means that everyone has healthcare, it doesn't necessarily mean that the government provides it for everyone. We have pretty close to "universal food" in most of the developed world, and the vast majority of the food system is delivered through the open market. [1] https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.html https://www.bloomberg.com/graphics/infographics/most-efficie...

BasedCode 6y ago
>"Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised." A socialised healthcare system forces government and the healthcare service to write and maintain policies that consider the health of the nation. Where as a private insurance based service doesn't. The US opoid crisis is a perfect example of this. Many of those addicts in the US moved on from prescription opoids that they had been prescribed unnecessarily to streets heroin because there was little concern of the wider public health implications. In the UK getting a prescription for addictive strength opoid pain killers has long been near impossible because the healthcare system has to be careful not to create another problem in trying to fix the first one because it's their responsibility to fix it which also means Doctors are not motivated to meet the patients wants (e.g pain free) and only fulfil their healthcare needs. This is why the UK didn't go through the same crisis So I say that life expectancy is a good measure of healthcare systems because it forces policy makers at all levels to consider the wider impact of public policy on public health.
- bhupy 6y ago
  Again, it's debatable, but as I continued in my comment, even when charitably accepting your premise, your argument loses its strength. A fully socialized healthcare system is one of many implementations of universal healthcare in the developed world today, and you'll have to find an answer for why the most efficient system in the world is the one that just happens to rely the most on consumer-driven market mechanisms.
  - BasedCode 6y ago
    Perhaps but then you also have to consider that Singapore is such an outlier that maybe comparing with them is overlooking what universal healthcare system is more likely to really be possible to politically implement. Chasing that vision of efficency that Singapore shines a light on likely only serves to distract from other universal systems that are more commonly provided that are more realistically achievable. Singapore is so far off the scale close to Hong Kong that it suggests they have political, social, geographical conditions that can not be replicated. Don't let the perfect be the enemy of the good.
    - bhupy 6y ago
      That’s not what “outlier” means. If every country attempted to implement Singapore’s system, and only Singapore succeeded, then you would be correct that it is an outlier. Instead, other nations settled for different systems and are generally satisfied. There lacks a political will to move out of the local optima. Singapore’s path to its current system wasn’t by accident. It tried an NHS style system, which failed due to overuse, then tried a US-style system, which failed for obvious reasons, and then settled onto the system it has today. The US is in the unique position that someone else has tried this model and we have enough data to prove its superiority. There also appears to be enough political will to reform the current system. There’s no point in settling for local optima when we have more than enough information to be able to go all the way... There’s actually no evidence whatsoever that it “cannot be replicated”, there is little about Singapore, geographically that uniquely lends it to such a system. Suggesting otherwise is just ignoring an inconvenient data point. You’re also conveniently ignoring Switzerland, the Netherlands, and Germany which have a significant degree of privatization in their healthcare systems. Pure socialization isn’t the only way, it’s not even the best way.

by bhupy 6y ago

BasedCode 6y ago

>"Average life expectancy is a really flawed metric to measure the effectiveness of healthcare systems, because there are a ton of non-healthcare related confounding variables that impact average life expectancy. Anyone that dies early brings down the average life expectancy, and that includes suicides, homicides, drug overdoses, and car accidents. The US has more traffic fatalities per capita than any other Western European nation. The US has more opioid deaths per capita than any other Western European nation. The US has more gun-deaths per capita than any other Western European nation. While each of those problems have their own political causes...none of them have much to do with the underlying healthcare system, so using it as a metric to measure the quality of the healthcare system in question is ill-advised." A socialised healthcare system forces government and the healthcare service to write and maintain policies that consider the health of the nation. Where as a private insurance based service doesn't. The US opoid crisis is a perfect example of this. Many of those addicts in the US moved on from prescription opoids that they had been prescribed unnecessarily to streets heroin because there was little concern of the wider public health implications. In the UK getting a prescription for addictive strength opoid pain killers has long been near impossible because the healthcare system has to be careful not to create another problem in trying to fix the first one because it's their responsibility to fix it which also means Doctors are not motivated to meet the patients wants (e.g pain free) and only fulfil their healthcare needs. This is why the UK didn't go through the same crisis So I say that life expectancy is a good measure of healthcare systems because it forces policy makers at all levels to consider the wider impact of public policy on public health.

bhupy 6y ago
Again, it's debatable, but as I continued in my comment, even when charitably accepting your premise, your argument loses its strength. A fully socialized healthcare system is one of many implementations of universal healthcare in the developed world today, and you'll have to find an answer for why the most efficient system in the world is the one that just happens to rely the most on consumer-driven market mechanisms.
- BasedCode 6y ago
  Perhaps but then you also have to consider that Singapore is such an outlier that maybe comparing with them is overlooking what universal healthcare system is more likely to really be possible to politically implement. Chasing that vision of efficency that Singapore shines a light on likely only serves to distract from other universal systems that are more commonly provided that are more realistically achievable. Singapore is so far off the scale close to Hong Kong that it suggests they have political, social, geographical conditions that can not be replicated. Don't let the perfect be the enemy of the good.
  - bhupy 6y ago
    That’s not what “outlier” means. If every country attempted to implement Singapore’s system, and only Singapore succeeded, then you would be correct that it is an outlier. Instead, other nations settled for different systems and are generally satisfied. There lacks a political will to move out of the local optima. Singapore’s path to its current system wasn’t by accident. It tried an NHS style system, which failed due to overuse, then tried a US-style system, which failed for obvious reasons, and then settled onto the system it has today. The US is in the unique position that someone else has tried this model and we have enough data to prove its superiority. There also appears to be enough political will to reform the current system. There’s no point in settling for local optima when we have more than enough information to be able to go all the way... There’s actually no evidence whatsoever that it “cannot be replicated”, there is little about Singapore, geographically that uniquely lends it to such a system. Suggesting otherwise is just ignoring an inconvenient data point. You’re also conveniently ignoring Switzerland, the Netherlands, and Germany which have a significant degree of privatization in their healthcare systems. Pure socialization isn’t the only way, it’s not even the best way.