8 ms·

In the USA since 1960, healthcare has gone from 5% of GDP to nearly 20% of GDP, something I would consider a crisis. If you think of the enormous amount of mone

In the USA since 1960, healthcare has gone from 5% of GDP to nearly 20% of GDP, something I would consider a crisis. If you think of the enormous amount of money that’s being spent, and then ask if we’re really living better or longer lives, I would disagree. Some might argue that the average lifespan has gone up a 8-10 years, but take out infant mortality, account for improvements in vehicular safety, the fact that most people no longer smoke cigarettes, and improvements in workplace, food and drug safety, and what are you actually left with? I would say most dollars in healthcare are selfishly spent squeezing a year or two of extra time in the twilight of most peoples’ lives, while destroying our society in the process.

colechristensen 4y ago
It is an American problem, we must do something. Which leads to antibiotics being over prescribed because parents don’t want to leave the doctors office without something to do afterwards. Life is worth living well, but it’s also worth accepting the end, something to which many people are openly hostile.
- cs137 4y ago
  Which leads to antibiotics being over prescribed because parents don’t want to leave the doctors office without something to do afterwards. You're not wrong, but sometimes this is purely preemptive and might still be a sound decision. For example, influenza almost never directly kills anyone--the monster flu in 1918 is an exception--whereas secondary bacterial infections (leading to pneumonia) can and do. Antibiotics are often prescribed as an extra precaution; given the atrocious financial resources of most Americans, most doctors know that they only get one shot with most patients, because they can't afford the copays or get the time off work, and that if they under-prescribe and are read to have missed something, they'll face malpractice suits from the desperate. So, they err on the side of immediate caution, since antibiotic resistance is one of those diffuse long-term problems. Life is worth living well, but it’s also worth accepting the end, something to which many people are openly hostile. Part of the problem is that capitalism creates a collapse of trust from which there is no recovery. Is the hospital denying or rationing care based on sound medical reasoning (i.e., that the requested procedures won't work, and will divert resources away from people who need them) or because they don't think the patient will be able to pay? Is the doctor performing a surgery because it will improve the patient's quality of life, or because he needs to generate fees? I'm sure most doctors are ethical and try to make the best decisions for the patients--I imagine, at least 90 percent of them do--but, as soon as the profit motive gets involved, distrust becomes endemic and personally mandatory. Medicine is, to put it bluntly and factually, too important to trust to the profit motive and capitalism.
  - ghufran_syed 4y ago
    Are you sure it was "capitalism" that led to the "collapse of trust"? Did Soviet citizens trust the local healthcare system when the quality of care you received depended on your party rank? From a Wikipedia article on the Soviet healthcare system[1] "Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training. Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but one still often below Western standards" I think the problem more generally is that of adverse incentives, whether in "capitalist" or "socialist" systems. I worked in the UK National Health Service which is "free at the point of use" which often results in rationing via waiting list. In my experience, many patients believe that their GP is inappropriately limiting their treatment to save money, particularly with respect to limiting testing, which is unsurprising because "gatekeeping" is often an explicit responsibility for general practitioners in the NHS [2][3] [1] https://en.m.wikipedia.org/wiki/Healthcare_in_Russia#Early_Soviet_period https://en.m.wikipedia.org/wiki/Healthcare_in_Russia#Early_S... [2] https://www.theguardian.com/society/2001/sep/15/NHS https://www.theguardian.com/society/2001/sep/15/NHS [3] https://bjgp.org/content/69/681/e224 https://bjgp.org/content/69/681/e224
    - cs137 4y ago
      Everything you're saying about the Soviet health system is true of capitalism's health system now. The difference is that, in the US, we go into debt for our mediocre care. The main reason for the discrepancy in care quality during the midcentury is... drumroll please... that the Soviet Union was poor, due to initial conditions. It encompassed countries that had long been impoverished. The US had a middle class to build on; the USSR did not. It built a middle class where none had ever existed. Not to mention, the US was in the historically rare situation of winning a war (since, in economic and humanitarian terms, wars are negative-sum and most often only have losers). The USSR, on the other hand, consisted of nations that had taken a beating in World War II. If you compare Kyrgyzstan to Alabama, the Soviet Union looks bad, but that's not really a fair comparison. Capitalism, as a sea empire, could dominate people from afar and keep them in nominally separate nations while exacting tribute; the Soviet system, as a land empire, could not. It had to integrate them. That's a harder problem. If you make a fairer comparison--say, if you compare Kyrgyzstan to Honduras or Haiti, the picture lines up a lot better. I imagine the quality of healthcare in the poorest countries under capitalism's thumb is even worse than it was in the poorest SSRs as of 1989. This isn't to say the USSR was great. It was an authoritarian regime, and it launched some really ugly wars (such as the one in Afghanistan). It remained poor (relative to the West) throughout its lifespan because, ultimately, there is no magical economic system that guarantees 12% annual GDP growth--doesn't exist, never has. Socialism solves one set of problems--and a big set of very ugly problems--that capitalism lets fester, but does it automatically bring about utopia? No, not even close. On the other hand, socialism iterates toward a better standard of living for the common people; capitalism, unless heavily checked (as it was in the Cold War) iterates toward a worsening standard of living. So, on that dimension alone, capitalism loses. Everything said above about shortages and nosocomial infections and substandard care applies to capitalism's medical system today.
jlawson 4y ago
I think it's not that everyone is chasing their extra 1.5 years at the end. People always did that as much as they could. A massive portion of healthcare spending (50%) goes to a tiny percentage of the population (<2%). We've grown that population and increased our spending on them in various ways. Back in the day, many issues would not have arisen because the way people lived prevented them, or they would have not been acknowledged as matters for healthcare at all. - Many kinds of drug addiction basically didn't exist, due to lower availability and a very different social environment. - Diseases of affluence like obesity and its endless related problems. - People would deal with their mental health issues on their own, or with their family. - Many things back then didn't have treatments, which now do have treatments - often expensive ones. Life was both harsher on individuals and less corrupted by illnesses that come from technology, affluence, and worldly connections. People's every mental and physical issue wasn't held up as a thing for sociotechnological treatment, and they were left on their own, but this also made people have more inner strength and not fall into a pit of helpless victim mentality. We've gained a tremendous wealth surplus since then, and it seems to be a law of societies that industrial surplus mostly gets consumed by concurrent bio-social deterioration. We coddle and support people who would have been told to deal with their own issues, or just laughed out of the doctor's office back then. For better or worse. Society is also lower in trust and less homogenous. Because of concerns about discrimination, decisions that would have been made cheaply and informally on the spot now have to be formalized and done through rubrics which give suboptimal answers because they lack human judgment and also consume more resources. Society is way more litigious and doctors have to spend a lot more time and effort covering their asses from lawsuits and accusations of all kinds. It's a complex issue with a lot of causes. I suspect Scott Alexander has some good writings on this.
- chrismartin 4y ago
  If by "back in the day" you mean the half-century following WWII, the USA had it uncommonly good: dirt-cheap post-secondary education, increasing upward mobility for everyone, low cost of living relative to income, and pensions. That's 3 of the 5 Social Determinants of Health, arguably better on average throughout the 1950s-1990s than post-2008. To the extent there is a wealth surplus now, it hasn't reached most people. Some of our current situation (including what you call diseases of affluence) feels linked to increasingly insecure prospects of housing, income, and retirement for the people who our increasingly labor-automated economy is leaving behind.
hallway_monitor 4y ago
Brutal take. Squeezing hundreds of thousands of dollars out of patients/insurance for maybe a few extra months is immoral imo
- wutbrodo 4y ago
  And months that often aren't a great quality of life and are questionably in the patients' interest. It made a huge impression on me as a kid when my greataunt, a physician, decided that she didn't want to be treated for her leukemia diagnosis. She died within a month (I assume it was late-stage). (IIRC, better end-of-life counseling is what the Obamacare "death panels" kerfuffle was in reference to)
pessimizer 4y ago
> Some might argue that the average lifespan has gone up a 8-10 years I don't think anyone would argue that's what we're getting for the quadrupling in cost, because nobody else spends half as much as we do and they all live longer than we do. Cubans, Panamanians, Albanians, and the Lebanese have longer life expectancies.
- nine_k 4y ago
  Many of these countries are such that I'd not be very-very certain about their statistics reports.
  - linschn 4y ago
    Cuba's health statistics are backed by the WHO. They were the first, for instance, to prevent mother-infant AIDS transmission.
  - Gordonjcp 4y ago
    In the UK healthcare costs about half as much (and you the consumer don't pay any of that out-of-pocket), and the average life expectancy is about three years longer here.
- ghufran_syed 4y ago
  When doing these kind of comparisons, I feel we should separate out deaths from "excess" (drugs / alcohol / cigarettes) - or at least control for differing levels of use in the various countries. I suspect differing incidence of young people dying of drug overdoses makes a big difference to average lifespan, but it seems to me that's more reflective of a society's regulatory and legal environment than a reflection of healthcare
lettergram 4y ago
Medicare is what pays for that btw. Dialysis is covered, as is any life saving treatment (like heart attack). What ends up happening is hospitals then charge others to cover their costs (hence high rates). Granted hospitals do take a bigger cut imo than they deserve, as do pharma, doctors, etc. Let’s not forget the number of doctors is intentionally restricted. They also seem to have a political bias imo (how much volunteer work and what kind you’ve done). Then you have regulations around drugs (FDA), hospitals / practice insurance, etc Combined, the entire industry is over regulated and captured effectively by cartels (what is Johnson and Johnson but a legal cartel). You can’t even sue for vaccine (any vaccine) injury. Think about that for a moment and explain it. Fixing the medical industry can only be done by deregulating it. I don’t think it would even be that hard; but people would lose their minds. I’ve spent a lot of time in one of the largest medical billing companies in the US. My family worked in this space for decades. The issue is really just fear. Regulatory / legislative changes: 1. Remove any protections pharma has against lawsuits 2. Remove bloated credentialing for doctors, instead have an apprenticeship program (at least for military and gov doctors) 3. phase out Medicare, no one under 60 will ever receive it again. 4. Completely defund the FDA 5. Remove much of the requirements around drugs. Enable easy purchasing of medication. Could just be consultation with pharmacist. Or maybe nurse. Or no one. Do that and overnight the cost of medicine would drop massively. The medical costs in the US would be less than Mexico.
- hattmall 4y ago
  It's not fear, it's money. All of those unnecessary things are huge profit centers for certain people. Health care is middle-manned to death, and not just insurance. There are loads of other middle men at every step.
  - lettergram 4y ago
    I mean fear of deregulation. The truth is that we push politicians to do what we want. As it stands, people are afraid to completely deregulate healthcare. Funny enough, even though imo it is the only way. I do think money would stop it from becoming a movement. When’s the last time you saw a leader stand up and say “let’s dissolve XXX three letter agency!”? You don’t see it. Wonder why? Last one I recall was Trump. Media did a number on him, so much so we can’t even discuss him without worrying about being attacked. Isn’t that something?
usrn 4y ago
A lot as gotten considerably worse since the 60s. Pointing out why gets you flagged though.
greg7gkb 4y ago
Just happened to read a report on this exact topic last week: https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low
bergenty 4y ago
The insurance middle man takes a huge slice too without offering much in return. But I do agree with you. What’s the solution though? How do you decide when to let people die?
- cfn 4y ago
  I think this is a bit of a fallacy (the decision to let people die). Do we know that all this money and processes (as described in the article) has led to better outcomes? Has the impact of the current methodology been objectively evaluated after excluding all other variables?
junofan 4y ago
> I would say most dollars in healthcare are selfishly spent squeezing a year or two of extra time in the twilight of most peoples’ lives, while destroying our society in the process. The vast majority of spend is on chronic disease patients in the 50–85 age range.
wbl 4y ago
In 1960 if you had a heart attack and collapsed in a mall things weren't going to go well. Today you'll get CPR from a bystander, an AED shock from an EMT, stenting in an interventional radiology lab, and statins to reduce cardiac risk. All of this adds cost but can add a few decades of life.
- raverbashing 4y ago
  There are several layers to this story If you collapsed in a mall in the 1960 your chance of having died on the spot from a preventable cause were much higher (like smoking, or a non-diagnosed heart problem) Today, that chance is also smaller. Defibrillators help but not in all cases.
- Gordonjcp 4y ago
  > an AED shock from an EMT, Not if you're having a heart attack. That's a mechanical problem - your heart is gunked up with fatty crud and cannot pump blood. The symptoms are chest pain, sudden weakness, and shortness of breath. *Usually* you don't just drop to the floor clutching your chest. You're thinking of a cardiac arrest, which is an electrical problem - your heart is not getting the right pulses to generate the right muscle contractions to pump. An AED will absolutely help here and you should not wait to start using it. Just grab the AED that's right there and open the lid, switch it on, and wait for it to start telling you what to do. It's very unlikely it could ever shock a patient who wasn't actually having a cardiac arrest because they detect the heart's electrical signals and look for a "shockable rhythm". If the rhythm looks normal, or looks like one that won't be improved by a quick zap, it won't do it. Even so, never stick the pads on someone who isn't actually in cardiac arrest because if it gets it wrong it probably *would* drop them into cardiac arrest. Pretty much every public space has a defib now. Often they're in a box with a locked door which you can get the code for from the emergency services operator. You're going to need to ring for an ambulance anyway so this doesn't waste time. The main thing though is just start CPR and get someone to call an ambulance. You might just save someone's life with that, maybe even today.
  - deleted 4y ago
    [deleted]

colechristensen 4y ago

It is an American problem, we must do something. Which leads to antibiotics being over prescribed because parents don’t want to leave the doctors office without something to do afterwards. Life is worth living well, but it’s also worth accepting the end, something to which many people are openly hostile.

cs137 4y ago
Which leads to antibiotics being over prescribed because parents don’t want to leave the doctors office without something to do afterwards. You're not wrong, but sometimes this is purely preemptive and might still be a sound decision. For example, influenza almost never directly kills anyone--the monster flu in 1918 is an exception--whereas secondary bacterial infections (leading to pneumonia) can and do. Antibiotics are often prescribed as an extra precaution; given the atrocious financial resources of most Americans, most doctors know that they only get one shot with most patients, because they can't afford the copays or get the time off work, and that if they under-prescribe and are read to have missed something, they'll face malpractice suits from the desperate. So, they err on the side of immediate caution, since antibiotic resistance is one of those diffuse long-term problems. Life is worth living well, but it’s also worth accepting the end, something to which many people are openly hostile. Part of the problem is that capitalism creates a collapse of trust from which there is no recovery. Is the hospital denying or rationing care based on sound medical reasoning (i.e., that the requested procedures won't work, and will divert resources away from people who need them) or because they don't think the patient will be able to pay? Is the doctor performing a surgery because it will improve the patient's quality of life, or because he needs to generate fees? I'm sure most doctors are ethical and try to make the best decisions for the patients--I imagine, at least 90 percent of them do--but, as soon as the profit motive gets involved, distrust becomes endemic and personally mandatory. Medicine is, to put it bluntly and factually, too important to trust to the profit motive and capitalism.
- ghufran_syed 4y ago
  Are you sure it was "capitalism" that led to the "collapse of trust"? Did Soviet citizens trust the local healthcare system when the quality of care you received depended on your party rank? From a Wikipedia article on the Soviet healthcare system[1] "Many medical treatments and diagnoses were unsophisticated and substandard (with doctors often making diagnoses by interviewing patients without conducting any medical tests), the standard of care provided by healthcare providers was poor, and there was a high risk of infection from surgery. The Soviet healthcare system was plagued by shortages of medical equipment, drugs, and diagnostic chemicals, and lacked many medications and medical technologies available in the Western world. Its facilities had low technical standards, and medical personnel underwent mediocre training. Soviet hospitals also offered poor hotel amenities such as food and linen. Special hospitals and clinics existed for the nomenklatura which offered a higher standard of care, but one still often below Western standards" I think the problem more generally is that of adverse incentives, whether in "capitalist" or "socialist" systems. I worked in the UK National Health Service which is "free at the point of use" which often results in rationing via waiting list. In my experience, many patients believe that their GP is inappropriately limiting their treatment to save money, particularly with respect to limiting testing, which is unsurprising because "gatekeeping" is often an explicit responsibility for general practitioners in the NHS [2][3] [1] https://en.m.wikipedia.org/wiki/Healthcare_in_Russia#Early_Soviet_period https://en.m.wikipedia.org/wiki/Healthcare_in_Russia#Early_S... [2] https://www.theguardian.com/society/2001/sep/15/NHS https://www.theguardian.com/society/2001/sep/15/NHS [3] https://bjgp.org/content/69/681/e224 https://bjgp.org/content/69/681/e224
  - cs137 4y ago
    Everything you're saying about the Soviet health system is true of capitalism's health system now. The difference is that, in the US, we go into debt for our mediocre care. The main reason for the discrepancy in care quality during the midcentury is... drumroll please... that the Soviet Union was poor, due to initial conditions. It encompassed countries that had long been impoverished. The US had a middle class to build on; the USSR did not. It built a middle class where none had ever existed. Not to mention, the US was in the historically rare situation of winning a war (since, in economic and humanitarian terms, wars are negative-sum and most often only have losers). The USSR, on the other hand, consisted of nations that had taken a beating in World War II. If you compare Kyrgyzstan to Alabama, the Soviet Union looks bad, but that's not really a fair comparison. Capitalism, as a sea empire, could dominate people from afar and keep them in nominally separate nations while exacting tribute; the Soviet system, as a land empire, could not. It had to integrate them. That's a harder problem. If you make a fairer comparison--say, if you compare Kyrgyzstan to Honduras or Haiti, the picture lines up a lot better. I imagine the quality of healthcare in the poorest countries under capitalism's thumb is even worse than it was in the poorest SSRs as of 1989. This isn't to say the USSR was great. It was an authoritarian regime, and it launched some really ugly wars (such as the one in Afghanistan). It remained poor (relative to the West) throughout its lifespan because, ultimately, there is no magical economic system that guarantees 12% annual GDP growth--doesn't exist, never has. Socialism solves one set of problems--and a big set of very ugly problems--that capitalism lets fester, but does it automatically bring about utopia? No, not even close. On the other hand, socialism iterates toward a better standard of living for the common people; capitalism, unless heavily checked (as it was in the Cold War) iterates toward a worsening standard of living. So, on that dimension alone, capitalism loses. Everything said above about shortages and nosocomial infections and substandard care applies to capitalism's medical system today.

jlawson 4y ago

I think it's not that everyone is chasing their extra 1.5 years at the end. People always did that as much as they could. A massive portion of healthcare spending (50%) goes to a tiny percentage of the population (<2%). We've grown that population and increased our spending on them in various ways. Back in the day, many issues would not have arisen because the way people lived prevented them, or they would have not been acknowledged as matters for healthcare at all. - Many kinds of drug addiction basically didn't exist, due to lower availability and a very different social environment. - Diseases of affluence like obesity and its endless related problems. - People would deal with their mental health issues on their own, or with their family. - Many things back then didn't have treatments, which now do have treatments - often expensive ones. Life was both harsher on individuals and less corrupted by illnesses that come from technology, affluence, and worldly connections. People's every mental and physical issue wasn't held up as a thing for sociotechnological treatment, and they were left on their own, but this also made people have more inner strength and not fall into a pit of helpless victim mentality. We've gained a tremendous wealth surplus since then, and it seems to be a law of societies that industrial surplus mostly gets consumed by concurrent bio-social deterioration. We coddle and support people who would have been told to deal with their own issues, or just laughed out of the doctor's office back then. For better or worse. Society is also lower in trust and less homogenous. Because of concerns about discrimination, decisions that would have been made cheaply and informally on the spot now have to be formalized and done through rubrics which give suboptimal answers because they lack human judgment and also consume more resources. Society is way more litigious and doctors have to spend a lot more time and effort covering their asses from lawsuits and accusations of all kinds. It's a complex issue with a lot of causes. I suspect Scott Alexander has some good writings on this.

chrismartin 4y ago
If by "back in the day" you mean the half-century following WWII, the USA had it uncommonly good: dirt-cheap post-secondary education, increasing upward mobility for everyone, low cost of living relative to income, and pensions. That's 3 of the 5 Social Determinants of Health, arguably better on average throughout the 1950s-1990s than post-2008. To the extent there is a wealth surplus now, it hasn't reached most people. Some of our current situation (including what you call diseases of affluence) feels linked to increasingly insecure prospects of housing, income, and retirement for the people who our increasingly labor-automated economy is leaving behind.

hallway_monitor 4y ago

Brutal take. Squeezing hundreds of thousands of dollars out of patients/insurance for maybe a few extra months is immoral imo

wutbrodo 4y ago
And months that often aren't a great quality of life and are questionably in the patients' interest. It made a huge impression on me as a kid when my greataunt, a physician, decided that she didn't want to be treated for her leukemia diagnosis. She died within a month (I assume it was late-stage). (IIRC, better end-of-life counseling is what the Obamacare "death panels" kerfuffle was in reference to)

pessimizer 4y ago

> Some might argue that the average lifespan has gone up a 8-10 years I don't think anyone would argue that's what we're getting for the quadrupling in cost, because nobody else spends half as much as we do and they all live longer than we do. Cubans, Panamanians, Albanians, and the Lebanese have longer life expectancies.

nine_k 4y ago
Many of these countries are such that I'd not be very-very certain about their statistics reports.
- linschn 4y ago
  Cuba's health statistics are backed by the WHO. They were the first, for instance, to prevent mother-infant AIDS transmission.
- Gordonjcp 4y ago
  In the UK healthcare costs about half as much (and you the consumer don't pay any of that out-of-pocket), and the average life expectancy is about three years longer here.
ghufran_syed 4y ago
When doing these kind of comparisons, I feel we should separate out deaths from "excess" (drugs / alcohol / cigarettes) - or at least control for differing levels of use in the various countries. I suspect differing incidence of young people dying of drug overdoses makes a big difference to average lifespan, but it seems to me that's more reflective of a society's regulatory and legal environment than a reflection of healthcare

lettergram 4y ago

Medicare is what pays for that btw. Dialysis is covered, as is any life saving treatment (like heart attack). What ends up happening is hospitals then charge others to cover their costs (hence high rates). Granted hospitals do take a bigger cut imo than they deserve, as do pharma, doctors, etc. Let’s not forget the number of doctors is intentionally restricted. They also seem to have a political bias imo (how much volunteer work and what kind you’ve done). Then you have regulations around drugs (FDA), hospitals / practice insurance, etc Combined, the entire industry is over regulated and captured effectively by cartels (what is Johnson and Johnson but a legal cartel). You can’t even sue for vaccine (any vaccine) injury. Think about that for a moment and explain it. Fixing the medical industry can only be done by deregulating it. I don’t think it would even be that hard; but people would lose their minds. I’ve spent a lot of time in one of the largest medical billing companies in the US. My family worked in this space for decades. The issue is really just fear. Regulatory / legislative changes: 1. Remove any protections pharma has against lawsuits 2. Remove bloated credentialing for doctors, instead have an apprenticeship program (at least for military and gov doctors) 3. phase out Medicare, no one under 60 will ever receive it again. 4. Completely defund the FDA 5. Remove much of the requirements around drugs. Enable easy purchasing of medication. Could just be consultation with pharmacist. Or maybe nurse. Or no one. Do that and overnight the cost of medicine would drop massively. The medical costs in the US would be less than Mexico.

hattmall 4y ago
It's not fear, it's money. All of those unnecessary things are huge profit centers for certain people. Health care is middle-manned to death, and not just insurance. There are loads of other middle men at every step.
- lettergram 4y ago
  I mean fear of deregulation. The truth is that we push politicians to do what we want. As it stands, people are afraid to completely deregulate healthcare. Funny enough, even though imo it is the only way. I do think money would stop it from becoming a movement. When’s the last time you saw a leader stand up and say “let’s dissolve XXX three letter agency!”? You don’t see it. Wonder why? Last one I recall was Trump. Media did a number on him, so much so we can’t even discuss him without worrying about being attacked. Isn’t that something?

usrn 4y ago

A lot as gotten considerably worse since the 60s. Pointing out why gets you flagged though.

greg7gkb 4y ago

Just happened to read a report on this exact topic last week: https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low

bergenty 4y ago

The insurance middle man takes a huge slice too without offering much in return. But I do agree with you. What’s the solution though? How do you decide when to let people die?

cfn 4y ago
I think this is a bit of a fallacy (the decision to let people die). Do we know that all this money and processes (as described in the article) has led to better outcomes? Has the impact of the current methodology been objectively evaluated after excluding all other variables?

junofan 4y ago

> I would say most dollars in healthcare are selfishly spent squeezing a year or two of extra time in the twilight of most peoples’ lives, while destroying our society in the process. The vast majority of spend is on chronic disease patients in the 50–85 age range.

wbl 4y ago

In 1960 if you had a heart attack and collapsed in a mall things weren't going to go well. Today you'll get CPR from a bystander, an AED shock from an EMT, stenting in an interventional radiology lab, and statins to reduce cardiac risk. All of this adds cost but can add a few decades of life.

raverbashing 4y ago
There are several layers to this story If you collapsed in a mall in the 1960 your chance of having died on the spot from a preventable cause were much higher (like smoking, or a non-diagnosed heart problem) Today, that chance is also smaller. Defibrillators help but not in all cases.
Gordonjcp 4y ago
> an AED shock from an EMT, Not if you're having a heart attack. That's a mechanical problem - your heart is gunked up with fatty crud and cannot pump blood. The symptoms are chest pain, sudden weakness, and shortness of breath. *Usually* you don't just drop to the floor clutching your chest. You're thinking of a cardiac arrest, which is an electrical problem - your heart is not getting the right pulses to generate the right muscle contractions to pump. An AED will absolutely help here and you should not wait to start using it. Just grab the AED that's right there and open the lid, switch it on, and wait for it to start telling you what to do. It's very unlikely it could ever shock a patient who wasn't actually having a cardiac arrest because they detect the heart's electrical signals and look for a "shockable rhythm". If the rhythm looks normal, or looks like one that won't be improved by a quick zap, it won't do it. Even so, never stick the pads on someone who isn't actually in cardiac arrest because if it gets it wrong it probably *would* drop them into cardiac arrest. Pretty much every public space has a defib now. Often they're in a box with a locked door which you can get the code for from the emergency services operator. You're going to need to ring for an ambulance anyway so this doesn't waste time. The main thing though is just start CPR and get someone to call an ambulance. You might just save someone's life with that, maybe even today.
- deleted 4y ago
  [deleted]