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While this is a great and heartbreaking story that makes me proud to be an active member of HN it's also a symptom of the totally broken US healthcare system.

by mixmax 13y ago

While this is a great and heartbreaking story that makes me proud to be an active member of HN it's also a symptom of the totally broken US healthcare system. From wikipedia: The United States life expectancy of 78.4 years at birth, up from 75.2 years in 1990, ranks it 50th among 221 nations, and 27th out of the 34 industrialized OECD countries, down from 20th in 1990. Of 17 high-income countries studied by the National Institutes of Health in 2013, the United States had the highest or near-highest prevalence of infant mortality, heart and lung disease, sexually transmitted infections, adolescent pregnancies, injuries, homicides, and disability. Together, such issues place the U.S. at the bottom of the list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country. According to the World Health Organization (WHO), the United States spent more on health care per capita ($8,608), and more on health care as percentage of its GDP (17.9%), than any other nation in 2011. The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most. http://en.wikipedia.org/wiki/Health_care_in_the_United_States http://en.wikipedia.org/wiki/Health_care_in_the_United_State...

dantheman 13y ago
Damn lies and statistics - it's very difficult to compare countries on Infant Mortality because they have different definitions of alive. From wikipedia: The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[24] In Germany and Australia, requirements for live birth are even higher.[25][26] https://en.wikipedia.org/wiki/Infant_mortality https://en.wikipedia.org/wiki/Infant_mortality Not to say there aren't problems with the US healthcare system, but we need to stop these comparisons that are just not relevant.
- ewoodrich 13y ago
  From your article: "However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[34][35][dead link][36] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[36]" Your argument, will perhaps partially correct, fails to properly explain the disparity in infant mortality (mostly due to unnecessary premature births) between the US and similar industrial countries.
  - dantheman 13y ago
    Yes it doesn't explain it away, there are other problems too that aren't related to health care: More teenage pregnancies (higher likely hood of low birth weight), more single mother pregnancies, more obese pregnancies). These are underlying cultural issues that while related to healthcare are different. In no way am I trying to blame the victim or excuse a bad system. I'm only pointing out that these comparisons are very hard to do correctly and can be misleading. We have an urge to compare so that we can make better decisions, but it can be tough to do this. From the stats originally posted it could be argued that we need to spend more money on the healthcare system, when in reality we just need to educate people to wait to have kids. Researchers from the NCHS found that low birthweight and short gestational age births—a leading cause of infant death internationally were more common in the United States than in Europe. Although outcomes for these births were similar, they found that the U.S. rate of low birthweight and short gestational age births was double that of Finland and Sweden.29 After adjusting for potential recording differences by excluding very short gestational age births, they found that the U.S. IMR would be 3.9 if the United States had the same rate of low birthweight and short gestational age births as Sweden. https://www.fas.org/sgp/crs/misc/R41378.pdf
- krrrh 13y ago
  In addition, if you limit the data to single child births, eliminating twins and other multiple births, the US actually ranks number one for child mortality. Multiple child births are inherently more risky, as are births to women over the age of 30. Due to wealth, cultural, and lifestyle factors the number of multiple-child pregnancies in the US is much much higher than in other countries. More American women choose to have children later in life and sometimes this includes fertility drugs which results in more riskier twin pregnancies. When you remove car accidents and suicides from the death rates, factors that are largely independent from the health care system, the US actually has the highest life expectancy in the world. A good source of info on this is the work of Scott Atlas. This econtalk includes a good look at the statistical biases in the micro rankings that get so much undue attention in the media. http://www.econtalk.org/archives/2012/07/scott_atlas_on.html http://www.econtalk.org/archives/2012/07/scott_atlas_on.html
  - moocowduckquack 13y ago
    I am not sure that suicide rates are particularly independent of health care provision, especially suicides in the elderly, which is where there has been a massive increase.
lifeisstillgood 13y ago
Edit: It has been (correctly) pointed out downthread that I have helped hijacking a very personal post for political point scoring - which I think is fair. However we lack a decent history function in HN so I leave it here otherwise the thread will read strangely. Thank you - as a Brit I read this too. I cycled through emotions - fear and sympathy for the diagnosis, hope as some of our best professionals consider new options, and then. WTF describes it best. Americas attitude toward health care is odd from our perspective - not mismatched socks odd but like a Collegue suddenly announcing that aliens are real, they look very talk and thin and one is living in his attic That kind of odd (I am glad that the OP has recovered, heartened by every success medicine has against this disease. Just ... It's odd how nearly this was a different story) May you have a long and happy life.
- tptacek 13y ago
  The UK has notoriously poor cancer outcomes. http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-sur...
  - DanBC 13y ago
    You understand we've done a lot since 2007, right? EDIT: specifically, "survival rate" is just "how many people lived for 5 years after diagnosis". Thus, you detect a lot of slow growing prostate cancer and your survival rates go up, even though nothing has been done to reduce the incidence of cancer, or stop any more people from dying of cancer. When you look at US cancer mortality rates they look pretty good, until you restrict the numbers to the under-65s, when suddenly the numbers look pretty average. This might be because poor americans don't get access to treatment until they're 65 and qualify for some aid.
    - dfc 13y ago
      Dan I am not challenging your statement I am just curious if you have seen any figures about the new outcomes. I did a quick look at the UK Cancer research page and it does not look like many of the statistics have been updated recently. That being said it would be nice if the disparity in survival percentages on this side of the pond looked more like the stats from your side: http://www.cancerresearchuk.org/cancer-info/cancerstats/survival/socio-economic-variation/ http://www.cancerresearchuk.org/cancer-info/cancerstats/surv...
tptacek 13y ago
On cancer outcomes, the US outranks many (most?) of the countries that beat it on life expectancy. And, as pointed out downthread, life expectancy is a dodgy stat; it's heavily weighted by infant mortality, which isn't uniformly measured, and by accidental and violent deaths which, while tragic and perhaps symptomatic of other US problems, don't implicate our health care system.
- wikiburner 13y ago
  It would also be interesting to see the stats weighted to account for the much higher levels of obesity in the U.S., which has to bump heart disease and cancer deaths significantly.
- makomk 13y ago
  You have to be careful about cancer statistics, because in many cases the US diagnoses early-stage cancers that would never get recorded in other countries. Some of those cancers never progress to the point of being life-threatening, making the survival stats misleading. Others do but because they're recorded earlier US patients are recorded as surviving for longe when in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries.
  - pmelendez 13y ago
    >" in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries." That's hard to tell, you can also say that because those patient were treated earlier they have a longer life expectancy. But I am agreed, those stats have to be looked very carefully.
  - skue 13y ago
    Absolutely. It's called lead time bias, and there's a great illustration on Wikipedia: http://en.wikipedia.org/wiki/Lead_time_bias http://en.wikipedia.org/wiki/Lead_time_bias Gil Welch at Dartmouth is one of the experts in unnecessary medical screening and lead time bias. He's written numerous academic and media articles, especially regarding lung, breast, and prostate cancer screening. Also an amazing public speaker: http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph
refurb 13y ago
I know I must sound like a broken record, but life expectancy is a poor proxy for quality of healthcare. There are many factors which impact life expectancy which have nothing to do with healthcare. For example, if you correct for the number of car accidents (which is high in the US due to the number of cars on the road), the US comes out near the top in terms of life expectancy. The other thing is that to say that the US ranks 50th in life expectancy is useless without showing numbers. From what I've seen, the #1 country and the #50 country difference by less than 3 years. So is the number 50 ranked country really that much worse than the #1 country.
- mixmax 13y ago
  I just copied the first paragraph from the Wikipedia article, which happpened to be about life expectancy which is often seen as a proxy for quality of healthcare. Fair or not. Here are some other excerpts from the article: - The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population. - lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States - In 2007, 62.1% of filers for bankruptcies claimed high medical expenses. - A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence. These quotes are just from the first paragraph of the article... There are many more if you read it through. For an outside observer it's blatantly obvious that you have a broken system, and it's inexlicable why you keep defending it.
  - refurb 13y ago
    You won't get any argument from me that the US healthcare system is broken (both the private and public systems). However, using flimsy statistical arguememts to make the arguememt isn't helping anyone. Btw, the 62% of bankruptcies stat is also misleading. Whether the person had $10 or $100k medical debt is included. It's not surprising that if someone went bankrupt due to a failed business they wouldn't pay their medical bills either. Thus for many of those 62%, medical expenses had nothing to do with their bankruptcies.

by mixmax 13y ago

dantheman 13y ago

Damn lies and statistics - it's very difficult to compare countries on Infant Mortality because they have different definitions of alive. From wikipedia: The World Health Organization (WHO) defines a live birth as any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat. Many countries, however, including certain European states and Japan, only count as live births cases where an infant breathes at birth, which makes their reported IMR numbers somewhat lower and raises their rates of perinatal mortality.[24] In Germany and Australia, requirements for live birth are even higher.[25][26] https://en.wikipedia.org/wiki/Infant_mortality https://en.wikipedia.org/wiki/Infant_mortality Not to say there aren't problems with the US healthcare system, but we need to stop these comparisons that are just not relevant.

ewoodrich 13y ago
From your article: "However, in 2009, the US CDC issued a report that stated that the American rates of infant mortality were affected by the United States' high rates of premature babies compared to European countries. It also outlined the differences in reporting requirements between the United States and Europe, noting that France, the Czech Republic, Ireland, the Netherlands, and Poland do not report all live births of babies under 500 g and/or 22 weeks of gestation.[34][35][dead link][36] The report concluded, however, that the differences in reporting are unlikely to be the primary explanation for the United States’ relatively low international ranking.[36]" Your argument, will perhaps partially correct, fails to properly explain the disparity in infant mortality (mostly due to unnecessary premature births) between the US and similar industrial countries.
- dantheman 13y ago
  Yes it doesn't explain it away, there are other problems too that aren't related to health care: More teenage pregnancies (higher likely hood of low birth weight), more single mother pregnancies, more obese pregnancies). These are underlying cultural issues that while related to healthcare are different. In no way am I trying to blame the victim or excuse a bad system. I'm only pointing out that these comparisons are very hard to do correctly and can be misleading. We have an urge to compare so that we can make better decisions, but it can be tough to do this. From the stats originally posted it could be argued that we need to spend more money on the healthcare system, when in reality we just need to educate people to wait to have kids. Researchers from the NCHS found that low birthweight and short gestational age births—a leading cause of infant death internationally were more common in the United States than in Europe. Although outcomes for these births were similar, they found that the U.S. rate of low birthweight and short gestational age births was double that of Finland and Sweden.29 After adjusting for potential recording differences by excluding very short gestational age births, they found that the U.S. IMR would be 3.9 if the United States had the same rate of low birthweight and short gestational age births as Sweden. https://www.fas.org/sgp/crs/misc/R41378.pdf
krrrh 13y ago
In addition, if you limit the data to single child births, eliminating twins and other multiple births, the US actually ranks number one for child mortality. Multiple child births are inherently more risky, as are births to women over the age of 30. Due to wealth, cultural, and lifestyle factors the number of multiple-child pregnancies in the US is much much higher than in other countries. More American women choose to have children later in life and sometimes this includes fertility drugs which results in more riskier twin pregnancies. When you remove car accidents and suicides from the death rates, factors that are largely independent from the health care system, the US actually has the highest life expectancy in the world. A good source of info on this is the work of Scott Atlas. This econtalk includes a good look at the statistical biases in the micro rankings that get so much undue attention in the media. http://www.econtalk.org/archives/2012/07/scott_atlas_on.html http://www.econtalk.org/archives/2012/07/scott_atlas_on.html
- moocowduckquack 13y ago
  I am not sure that suicide rates are particularly independent of health care provision, especially suicides in the elderly, which is where there has been a massive increase.

lifeisstillgood 13y ago

Edit: It has been (correctly) pointed out downthread that I have helped hijacking a very personal post for political point scoring - which I think is fair. However we lack a decent history function in HN so I leave it here otherwise the thread will read strangely. Thank you - as a Brit I read this too. I cycled through emotions - fear and sympathy for the diagnosis, hope as some of our best professionals consider new options, and then. WTF describes it best. Americas attitude toward health care is odd from our perspective - not mismatched socks odd but like a Collegue suddenly announcing that aliens are real, they look very talk and thin and one is living in his attic That kind of odd (I am glad that the OP has recovered, heartened by every success medicine has against this disease. Just ... It's odd how nearly this was a different story) May you have a long and happy life.

tptacek 13y ago
The UK has notoriously poor cancer outcomes. http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-sur...
- DanBC 13y ago
  You understand we've done a lot since 2007, right? EDIT: specifically, "survival rate" is just "how many people lived for 5 years after diagnosis". Thus, you detect a lot of slow growing prostate cancer and your survival rates go up, even though nothing has been done to reduce the incidence of cancer, or stop any more people from dying of cancer. When you look at US cancer mortality rates they look pretty good, until you restrict the numbers to the under-65s, when suddenly the numbers look pretty average. This might be because poor americans don't get access to treatment until they're 65 and qualify for some aid.
  - dfc 13y ago
    Dan I am not challenging your statement I am just curious if you have seen any figures about the new outcomes. I did a quick look at the UK Cancer research page and it does not look like many of the statistics have been updated recently. That being said it would be nice if the disparity in survival percentages on this side of the pond looked more like the stats from your side: http://www.cancerresearchuk.org/cancer-info/cancerstats/survival/socio-economic-variation/ http://www.cancerresearchuk.org/cancer-info/cancerstats/surv...

tptacek 13y ago

On cancer outcomes, the US outranks many (most?) of the countries that beat it on life expectancy. And, as pointed out downthread, life expectancy is a dodgy stat; it's heavily weighted by infant mortality, which isn't uniformly measured, and by accidental and violent deaths which, while tragic and perhaps symptomatic of other US problems, don't implicate our health care system.

wikiburner 13y ago
It would also be interesting to see the stats weighted to account for the much higher levels of obesity in the U.S., which has to bump heart disease and cancer deaths significantly.
makomk 13y ago
You have to be careful about cancer statistics, because in many cases the US diagnoses early-stage cancers that would never get recorded in other countries. Some of those cancers never progress to the point of being life-threatening, making the survival stats misleading. Others do but because they're recorded earlier US patients are recorded as surviving for longe when in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries.
- pmelendez 13y ago
  >" in fact they're just being diagnosed ealier and dying at the same time as similar patients in other countries." That's hard to tell, you can also say that because those patient were treated earlier they have a longer life expectancy. But I am agreed, those stats have to be looked very carefully.
- skue 13y ago
  Absolutely. It's called lead time bias, and there's a great illustration on Wikipedia: http://en.wikipedia.org/wiki/Lead_time_bias http://en.wikipedia.org/wiki/Lead_time_bias Gil Welch at Dartmouth is one of the experts in unnecessary medical screening and lead time bias. He's written numerous academic and media articles, especially regarding lung, breast, and prostate cancer screening. Also an amazing public speaker: http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph

refurb 13y ago

I know I must sound like a broken record, but life expectancy is a poor proxy for quality of healthcare. There are many factors which impact life expectancy which have nothing to do with healthcare. For example, if you correct for the number of car accidents (which is high in the US due to the number of cars on the road), the US comes out near the top in terms of life expectancy. The other thing is that to say that the US ranks 50th in life expectancy is useless without showing numbers. From what I've seen, the #1 country and the #50 country difference by less than 3 years. So is the number 50 ranked country really that much worse than the #1 country.

mixmax 13y ago
I just copied the first paragraph from the Wikipedia article, which happpened to be about life expectancy which is often seen as a proxy for quality of healthcare. Fair or not. Here are some other excerpts from the article: - The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population. - lack of health insurance causes roughly 48,000 unnecessary deaths every year in the United States - In 2007, 62.1% of filers for bankruptcies claimed high medical expenses. - A 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence. These quotes are just from the first paragraph of the article... There are many more if you read it through. For an outside observer it's blatantly obvious that you have a broken system, and it's inexlicable why you keep defending it.
- refurb 13y ago
  You won't get any argument from me that the US healthcare system is broken (both the private and public systems). However, using flimsy statistical arguememts to make the arguememt isn't helping anyone. Btw, the 62% of bankruptcies stat is also misleading. Whether the person had $10 or $100k medical debt is included. It's not surprising that if someone went bankrupt due to a failed business they wouldn't pay their medical bills either. Thus for many of those 62%, medical expenses had nothing to do with their bankruptcies.