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Comment by Retric | Hacker News Reader

From what I have read preventative medicine has been tried as a cost saving measure and it only seems to reduce costs in dentistry, immunization, and a few other fairly narrow areas.

“Prevention can reduce the incidence of disease, but savings may be partially offset by health care costs associated with increased longevity.” https://pubmed.ncbi.nlm.nih.gov/22052182/

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Yes, this is the absurd part of the fat-hate movement, "you're wasting my insurance/tax dollars!" actually no fat people tend to die early, and US healthcare spending is absurdly weighted towards end-of-life care for terminal patients, something like 50-70% of your total life spending comes in the last 18 months of your life. Someone quietly dying at 50 of heart disease is really cheap compared to the person spending 10 years fighting lung cancer at 70.

Not that it should really matter, if the goal is to "get them healthy", right? But it's not, it's about having someone to hate and look down on. Black Mirror nailed this vibe perfectly in Ten Million Merits.

Anyway this is a specific problem with the US healthcare system though - we spend way too much on patients who are circling the drain and everyone else gets screwed. Broken bones and bad dentistry and missed immunizations are what produces the single largest improvement in health outcomes - Cuba really only has something like a 7-year reduced lifespan vs the US iirc, because they do well at delivering that basic care even if you're not going there for proton radiotherapy or other ultra-high-end treatments. And the US does the latter but sucks at the former.

I don't think there's a fat-hate "movement" tbh. I think it's always been popular to make fun of fat people. Harry Potter and the Philosopher's Stone had a fat child be described as neglected, spoiled, and a bully, and therefore it was justified to magically force the child to grow pig parts that had to be surgically moved. Published 1997.

I guess somewhat more recently we have people like Lizzo trying to push back on things like this, but the CDC has recently pushed a recommendation for bariatric surgery on children as young as 14 so. Shrug, I guess.

Growing up elsewhere, the stereotype of fat people was that they are nice and kind. The level of hate was quite surprising to me when I first encountered it.

Cuba and the USA have roughly the same life expectancy, with Cuba slightly ahead. https://en.m.wikipedia.org/wiki/List_of_countries_by_life_ex...

Your point seems muddled. If the majority of costs come from the last 18 months of care why does it matter if those last months occur at age 50 with heart disease or 70 with cancer? 18 months is 18 months.

Your point seems to rather be that some diseases are cheaper to treat than others, or that the total area under the cost-life curve is driving the cost, not just the last few months.

A. I spoke of other expenses, not merely health care, such as costs, both financial and non financial, of a minor child losing a parent.

B. I have trouble believing this analysis is really looking at the whole picture.

One of the costs of illness that is frequently cited is lost productivity. You are going to tell me that when people live longer, all of them are merely running up more medical bills without also working additional years to help cover those costs?

It is possible, in the current environment, that people’s labor, on average, is not valuable enough relative to the healthcare they might receive.

For example, how many people get coronary heart disease, and how many years of their work would be needed to pay for a bypass or stent or even open heart surgery? I assume these surgeries cost hundreds of thousands of dollars. Plus the ongoing costs after that. Same with effects of diabetes and hypertension, which might as well effect everyone.

Of course, there is liability, patents, licensing costs, etc that can be changed.

If you live long enough, you are practically guaranteed to end up with cancer (say, past age 80).

On the other hand, if you drink and drive while young and healthy, you can helpfully donate your organs to someone with a terrible condition and they can run up potentially a few million dollars in health care.

It doesn't have to be that expensive. Hospitals in India manage to do coronary bypass surgery for only $4,300 with good outcomes. I understand that costs and salaries are higher in the US, but still there is a huge amount of waste, fraud, and abuse that could be cut out.

https://www.annfammed.org/content/12/5/470

What is the purchasing power parity of $4300 in India vs the US?

https://data.oecd.org/conversion/purchasing-power-parities-p...

This has India at 23:1 for USA.

An extremely simplistic analysis would say assuming that conversion factor holds true for all costs, you are “spending” $100,000 dollars of US value when you spend $4300 USD in India.

I hear you, but reducing the incidence of someone's limbs dying because they were not allowed to get follow-up care from emergency surgery, or reducing the incidence of a 40 year old woman with advanced dementia because she didn't get basic treatment for her diabetes - that's worth it.

These folks could be doing other, more productive things with their lives, rather than wasting away in the shadows while we debate the national merit of saving them.

(These are examples from TFA)

Treatment for diabetes is one of those narrow areas. We know this because private health insurance companies will pay for measures that improve compliance.

What counts as preventative medicine?

A few years back I was hospitalised because of a bite on my arm from one of our cats (long story) and was given heavy doses of multiple antibiotics.

If that hadn't been treated so promptly I might have required surgery or might even have lost my arm (a nurse told me about someone who lost a leg to a cat bite!).

Edit: When I went to the hospital I had no idea how serious it was and turned up to the "Minor Injury Unit" - they had me in A&E and X-rayed within about 10 minutes!

Edit: Of course, having been in the hospital for 3 days rather than the expected hour or so I was fretting about car parking charges - turns out they are free at the point of parking....

Preventative medicine is that which is done before significant symptoms. The basic issue, people tend to heal from most things. So the worst case of losing an arm to a cat bite is extremely unlikely. Meanwhile your hospital trip had an cost.

Suppose the odds work out to 1:100,000 lost arm vs 300$ hospital treatment. Now a lost arm is expensive but it’s not 30 million dollars expensive.

Those numbers aren’t based on anything but that’s the kinds of calculations involved. And as I mentioned the winners seem to be extremely cheap options like vacations.

Vaccinations? :-)

That was one of the examples OP cited already as a place where preventative medicine works.

I believe they are referring to a s/vaccinations/vacations typo

The poor poster is likely getting hit by triggered HN users.

On a brighter note, no one is anti-vacation.

If people don't get healthcare but still have costs of managing their symptoms. Or when people die at home, those costs aren't in the hospital books.

But they are largely on insurance companies/public healthcare systems books.

This is why vaccines are generally free out of pocket, the ROI is very positive for the insurance company.

> A few years back I was hospitalised because of a bite on my arm from one of our cats (long story) and was given heavy doses of multiple antibiotics.

And of course there's an XKCD for that:

https://xkcd.com/1775/

The second half of that quoted sentence is really doing some work, isn't it.

> savings may be partially offset by health care costs associated with increased longevity

This is the thinking of an insane person.

Taking care of the elderly is what money is for, yes?

I mean, "increased longevity" and caring for our sick and elderly is kind of the point of civilization?

Civilization has multiple goals. That may be one valid use for it but it is not the only one. For example, I might say that money is for feeding hungry children

> Civilization has multiple goals.

No. There is only one goal: defeat entropy. ("Evolution".)

> money is for feeding hungry children

Who then (ideally) grow up and become (eventually) old, eh?

I'll be honest, I'm really struggling to understand what you're trying to say here.

It sounds like you're saying these are Universal truths, but I certainly don't think they are.

I don't think the goal of civilization is to fight entropy or Foster evolution, or prolong lifespan. I also don't think most people would agree with that.

I also don't think longevity is a singular goal on an individual or civilization level. As a simple thought experiment would you rather live to 50 and absolute happiness and pleasure, or live to 100 in complete misery?

Well, my original point was just that increased longevity and caring for our sick and elderly are, anthropologically speaking, what separated us from the primates and hominids, eh?

In re: the (sole, underlying) purpose of civilization, well, do you believe in evolution? I don't mean that in a snarky or combative way. I do, and as a corollary to that it seems clear to me that, whatever else is going on, successfully getting into the future, aka "defeating entropy", is as close to a "Universal truth" as you're likely to get, outside of physics. Evolution may have changed form when the human brain, uh, evolved, but the fundamental structure of the situation didn't change: we're still evolving, still trying to find the best way to ensure the future contains humans for the foreseeable, uh, future. Remember, all the other hominid species have gone extinct! We are not guaranteed to succeed, eh?

There's a discussion we could have around around whether caring for the elderly is really the optimum strategy, but I don't think that's really very interesting? I'm spending a significant amount of my person time and resources caring for my elderly mother who has dementia. I could put her in a home, and use the extra time to work more hours, and I would make more money even after paying for her care. I may yet have to do that if she becomes more difficult to care for, so far we have been lucky. Our neighbor's father got dementia and would sometimes try to fight them. Like throw punches and such! Mom's a cheerful sweetheart. I'm very grateful for that.

Anyway, if someone wants to tell me that I'm wasting my time caring for my mom, well, I'd question their sanity.

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> I also don't think longevity is a singular goal on an individual or civilization level. As a simple thought experiment would you rather live to 50 and absolute happiness and pleasure, or live to 100 in complete misery?

Now I'm struggling to understand you. :) The thought experiment is so simple that it doesn't make sense. Do I really sound like someone who would choose the latter option? Can you imagine anyone who would choose the latter option?

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