Hacker News Reader

They say US has the best (most advanced) health care technology but not the most affordable or even effective (in that Americans don't have the longest life expectancy).

You are making the implicit assumption that health care is a major driver of life expectancy. In reality, it isn't.

Consider a (virtual) country with the exact same [1] health care system as the US: Asian America, a land comprised entirely of Asian Americans. In this imaginary land, women have a life expectancy of 85.8, making Asian America #2 in the world for life expectancy (between Japan and Hong Kong), in spite of having the same health care system as the US.

That shouldn't be possible if health care is the primary driver of life expectancy.

http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2...

(I couldn't find the stats for men in 2 minutes of googling.)

[1] Actually, it's not exactly the same. Asian Americans are less likely to have health insurance.

Americans also have an atrocious diet and don't walk or ride bikes anywhere. There's only so much medicine can do if you eat and drive yourself into obesity, diabetes and heart disease.

At least before 9/11 and the increasing paranoia over foreigners, the US was actually one of the leading destinations for medical tourists, particularly wealthier ones.

Seems obvious then to say that medical spending is misdirected toward treatment from prevention. It's a tough sell, though, because Americans, to make a broad generalization, don't like to be told what to eat or how to live. What we miss is that Big Food, Big Pharma, Big Beauty, Big Auto, etc. tell us what to eat and how to live all the time, we just don't notice.

The US is still the leading destination for wealthy medical tourists. If you want the best medical treatment and money is no object, you'll almost certainly get better treatment in the US than in your home country.

I've read, anecdotally, that wealthy Arabs have started going to Switzerland rather than the US. If you're not of an unfashionable nationality or ethnicity, I wouldn't be surprised to hear that the US is the best option.

Americans also have poor black people stuck in urban ghettos, which hurts their statistics.

Until poor black students have a good chance of getting a good education (which is hard when all the middle-class students flee "black" schools, leaving schools full of low socio-economic status students, creating big negative peer effects - teachers can't teach if they spend all their time on crowd control, and students don't learn if they don't have positive role models), you I doubt you will get any respectable demographic statistics.

I could talk about how certain educational reforms would improve education at a low cost, but there's no reason to trust they would work. What would work is large federal grants, based on low SES student numbers, to attract the high SES students to not flee, and to improve outcomes for low SES students. Start at kindergarden (in a few randomly chosen regions), and then work up if it works.

I'd like to see US health statistics disaggregated by income. I still doubt they are great, though.

There was a program on one of the PBS channels recently, it might have been Frontline, where they explored the statistics, and showed that wealth and lifespan were correlated, and as the "wealth gap" has widened in recent decades, so has the "lifespan gap."

I was only half-watching, but as I recall the study attributed this not just to wealthy people's ability to pay for better health care, but also to a tendency for wealthy people to feel more "in control" of their lives. A poor person is likely to be more fatalistic. If he gets sick he will not feel that he has any control over the situation. He will have a lower tendency to seek treatment. A wealthy person is used to being in control of everything in his life. He will be more proactive about his health care, and seek treatment sooner if there's something wrong.

I wonder if it's almost as if in some cases Americans subsidize medical innovation for the rest of the world. We pay the price for the new tech and while our system for whatever reasons keeps prices high, when it's time to sell the tech to other countries the price ends up being lower and so ironically people are going to other countries to get American-made treatments.

It's not "as if" this were the case, this is the case. Most especially with drug discovery. In many cases the only people who pay to recoup the R&D costs of a new drug are Americans, while the rest of the world only pays the marginal costs of production.

P.S. For the drug companies this isn't a big problem because they still make back their development costs and there isn't much they can do when dealing with big state run health care systems. It's not fair but from a practical standpoint it still works. However, it does put the world's healthcare system at risk because people in the US are starting to think that drug companies are screwing them and they want the same deal the rest of the world has, they want to kill the goose that lays the golden egg. Since there's nowhere else for significant profits the obvious result would be a diminishing in drug discovery.

To your second point - it is entirely possible that people are traveling abroad to get medical care that was developed here but not yet approved for the general public. That doesn't contradict their original point. I think they more than just hint that the problem is regulatory. The fact that investing in medtech has a late exit time period speaks to the regulatory hurdles and they point that out in the article.

They should at least mention that it raises the question: what good is having this technology if most people can't afford it or it's not more effective than technology available elsewhere? Shouldn't we care more about making existing technology more affordable and effective rather than chase the latest technology gizmos?

They're separate questions. In many cases, the best way to make technology more affordable is to improve the technology. Furthermore, developing new treatments where none existed before might make healthcare seem more expensive but in fact it's a flawed comparison. The cost before the treatment existed was essentially infinite.

In some ways, better insurance can actually aggravate the situation, because existing drug companies have no real incentive to do serious innovation. They're already collecting enormous revenues from prescriptions and would probably just as soon not have any technology disrupt that model.

> existing drug companies have no real incentive to do serious innovation

This is just massively ignorant. Who do you think funds drug research now? Not just the initial 'this substance looks kind of interesting', but 'we have to get this specific drug from the concept stage through FDA approval'.

Who do you think funds drug research now?

The NIH, nonprofit fundraising organizations like The Jimmy Fund, small companies like Advanced Cell Technology, and Venture Capital to biotech startups. Finally-- existing large drug companies like Pfizer, Merck, Bristol-Meyers Squibb, and Novartis; who issue grants, own large research labs and acquire startups much like IBM, Oracle, and Microsoft.

But the last are heavily biased. Consider the study covered by this article: http://news.harvard.edu/gazette/?p=88990&utm_source=Silv...

That study won't result in technological innovation. That study will result in health insurance policies more likely to cover sleeping pills. Funded by Merck and Sanofi-Aventis, who sell sleeping pills.

> existing large drug companies like Pfizer, Merck, Bristol-Meyers Squibb, and Novartis

OK, you aren't as dumb as I thought you were. Some people claim that drug companies do no research, the public sector does all of it, and Big Pharma (a big 'I'm-a-moron' catchphrase if I've ever heard one) steals or suppresses everything it can get its hands on.

> But the last are heavily biased.

Every field has its publication bias. Frankly, results announcing new things and going new places are more interesting than results confirming what we know or saying that the new thing isn't as interesting as we'd hoped after all. What's worse is trying to get science news from non-specialized news sources, like CNN or Fox. You might as well ask an overexcited six-year-old what's in the dark closet.

Your sleeping pill study isn't even in the running for the thing most wrong with how we research and produce drugs in this country, let alone with how terribly, criminally negligent the FDA is in prosecuting the crazies who are bringing crap like reiki and homeopathy into hospitals and university programs (quackademic medicine).

I admit I exaggerated, the point I wanted to make in the post that got downvoted was that health insurance doesn't reduce the costs of healthcare. Health insurance is a way to share the costs, that's it. Real cost reduction comes from improved technologies, healthier environments, and healthier behavior.

I'm not saying there aren't other major issues with regards to the FDA and the expense and politics surrounding clinical trials, just that existing large companies are probably not going to innovate with substantially more success than a healthy startup and academic ecosystem.