5 ms·

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 spend

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.
pessimizer 4y ago
This is all nonsense. Other affluent countries spend much much less, live much much longer, and don't practice eugenics.
- lettergram 4y ago
  “Much much longer” Imo all western countries are within the margin of error. The real truth is that the US subsidizes the medical fields of Europe. The US provides protection; which means the EU doesn’t have to pay for military and they dedicated funds to healthcare. Further, all the drug revenue for R&D recovery comes from the US market. With the countries of Europe gearing up for war. I’m curious if they’ll keep paying for the medical treatments of everyone.
  - diffeomorphism 4y ago
    That makes no sense. The point is that those countries spend way less money for better outcomes and your "rebutal" is that they have more money to spend? And pharmaceutical companies just charge less in these countries because of the kindness on their hearts? Eventhough they supposedly could charge much more than the US because Europeans have money left over?
    - Auracle 4y ago
      They charge less because those countries would simply go “no, we’re not going to offer that drug for that price” if the manufacturers ask for too much. If insurers did that here people would be upset, and with their revenue tied to how much they pay out they don’t have much of a reason to. All that leads to them making up the difference in the US market.
  - deleted 4y ago
    [deleted]
- zeckalpha 4y ago
  If you look at the US state by state you would see similar outcomes.

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.

pessimizer 4y ago

This is all nonsense. Other affluent countries spend much much less, live much much longer, and don't practice eugenics.

lettergram 4y ago
“Much much longer” Imo all western countries are within the margin of error. The real truth is that the US subsidizes the medical fields of Europe. The US provides protection; which means the EU doesn’t have to pay for military and they dedicated funds to healthcare. Further, all the drug revenue for R&D recovery comes from the US market. With the countries of Europe gearing up for war. I’m curious if they’ll keep paying for the medical treatments of everyone.
- diffeomorphism 4y ago
  That makes no sense. The point is that those countries spend way less money for better outcomes and your "rebutal" is that they have more money to spend? And pharmaceutical companies just charge less in these countries because of the kindness on their hearts? Eventhough they supposedly could charge much more than the US because Europeans have money left over?
  - Auracle 4y ago
    They charge less because those countries would simply go “no, we’re not going to offer that drug for that price” if the manufacturers ask for too much. If insurers did that here people would be upset, and with their revenue tied to how much they pay out they don’t have much of a reason to. All that leads to them making up the difference in the US market.
- deleted 4y ago
  [deleted]
zeckalpha 4y ago
If you look at the US state by state you would see similar outcomes.