Wednesday, August 12, 2009

Read the comments and not the analysis

A really crude analysis on the cost-effectiveness of health care - findings were not surprising. I think the comments by the readers were more interesting.

Many of the comments mentioned that this analysis may not be relevant due to the fact that Americans start off less healthy or have more unhealthy habits compared to other countries.

This is probably correct, but it does not make the analysis irrelevant. PYLL (Potential Year of Life Lost) is a crude proxy for health outcomes, which include people developing bad health habits and starting off more obese/unhealthy in life compared to other nations. Our starting points in health and unhealthy habits should improve if we spend wisely.

Other posts argued that in this analysis, we make an unsubstantiated assumption that spending more on health care will lead to better health - this assumption is, indeed, untrue. (One comment says: If I'm an obese smoking couch potato I can assure you that no amount of spending will make me healthier than a vegetarian marathon runner). But I think that is exactly the point of this argument - because the US is ridden with managing chronic conditions like diabetes and heart disease, we are spending more on people at the end of their disease spectrum without much return, hence more PYLL/dollar and hence why we suck so much compared to others - because we are not spending money on prevention and stop people from getting sick to begin with.

I think this article is on to something, but not in terms of right wing thinking oranges and left wing thinking apples. I think it is on point in that right now we are arguing about how the money will be channeled to the final benefactors: through insurance companies as premiums, through the government as taxes, etc. We are ignoring the fact that in the end the money comes from you and me - the government does not make money without its taxpayers, insurance companies do not make money without their customers. If the cost does not change, changing the channeling is not going to save us any money. We indeed should look at the cost-effectiveness of our health care dollars, in order to ascertain where to save (reflex EKG) and where to spend more (prevention and public health).

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