The Incidental Economist

The key paragraph, with added emphasis: >One reason for this is that all prevention is not the same. The task force doesn’t model costs in its calculations; it models effectiveness and a preponderance of benefits and harms. When something works, and its positive effects outweigh its adverse ones, a recommendation is made. Aaron (the author) and his partners blog here[1], it's a very good site if this sort of thing interests you. [1]https://theincidentaleconomist.com

Note that some cancers kill you very fast and other kill you in a very long time, so you have a chance of die from another cause. If the study in a small group proves that the miracle drug is ineffective and moreover it reduces the life expectancy to 1/2, then by not giving it to everyone avoid the nasty effect of reducing the life expectancy of a lot of people. Take a look at some "miracle" cures of cancer of the past, like https://theincidentaleconomist.com/wordpress/the-rise-and-fall-of-bone… Also, since a few years in Prostate Cancer the recommendation is not to treat all cases after detection https://en.wikipedia.org/wiki/Prostate_cancer#Management

>Nope, none of the stuff you mentioned falls under COGS. Ok, then please define what you mean by COGs. >This is the classic "we'll lose money per customer, but make it up in volume" argument. You misunderstand the argument. Since I wasn't clear, these two articles highlight the main points: https://www.kff.org/report-section/a-primer-on-medicare-how-does-medic… https://www.washingtonpost.com/business/economy/medicare-pricing-drive… Also with respect to these and the efficiency argument, please see: https://theincidentaleconomist.com/wordpress/hospitals-medicare-margin…

For those interested in the broader picture, I recommend Aaron Carroll's series "What makes the US health care system so expensive": https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-… Physician salaries are a part of the problem, but by his numbers they are a pretty small part (as shown in his pie chart at the bottom): https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-…

I don't see marxists here, some socialist tendencies yes. American doctors are good but "best in the world" is a very difficult claim to substantiate. One thing is certain: they aren't provided the best price-performance ratio, but one of the worse ones. It's not just doctors of course, it's the whole system. It looks like my country (Finland) shines in that price-performance ratio, according to the link provided above: https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-… Though even here, we're not without problems, e.g. in access to care in non-life-threatening situations.

Here is a post about fats from the same author: http://theincidentaleconomist.com/wordpress/a-study-on-fats-that-doesn… Conclusion: "Should we be eating more polyunsaturated fats? Should we be avoiding saturated fats? The honest answer is: I don’t know. Given my review of the evidence, I stand by my previous recommendations [1], which essentially focus more on foods and less on nutrients. I think the state of nutrition research in general is shockingly flawed." [1] http://www.nytimes.com/2015/04/21/upshot/simple-rules-for-healthy-eati…

It seems some people have forgotten the rhetoric of the time. The opposition had a wide variety of arguments against universal health care, such as government death panels[0], increased wait times for essential care[1], government control over 1/6 of the economy, free medical care for illegals, etc. I particularly remember a claim coming out that Stephen Hawking would have died under a universal system like the NHS[2]. As such, Obama proposed the ACA as some kind of middle road[3], with the goal of having something that both sides would be in favor of, and to hold the moderates that were against single payer[4]. After the better part of a year of negotiation and multiple efforts to reach out to the opposition, the ACA was passed without any Republican votes, who then spent the following eight years running for office on the idea of repealing it (with at least 50 attempts in a four year span). Unfortunately, the Republicans don't have any plan for healthcare themselves, resulting in a failed repeal attempt three years ago even after taking control of the house, senate and presidency. It should be fairly obvious at this point that logical arguments for or against policies are irrelevant, even more so than they were ten years ago - and yes, a great many people would vote against it. They spent the last decade doing just that. [0] https://www.politico.com/story/2009/08/palin-doubles-down-on-death-pan… [1]…

>You don't seem to attach much value to the lives of the elderly and those who have underlying health conditions. I presume that's because no one you care about, including yourself, is in that category. That's a pretty callous attitude. My parents are in that category, but I attach a very high negative value to using violence (or threat of it) to control people's behaviour. From my perspective it's extremely immoral to say to a huge swarth of the population: you can't work or meet your friends for the next few months, or else we'll throw you in jail if you're caught. I.e. human rights (free movement, association) are human rights; they're not compromisable just because somebody decided it's an emergency or there's some greater good that needs to be enforced. Yes it's reasonable to argue that those at risk have a right not to be infected (e.g. to require potential carriers to stay away), but this doesn't extend to requiring people they have no proximity/interaction with to stay at home and not interact with each other. > 10 years thrown away so some people can go on a march because they're angry about someone dying. 10 years lost by one person, vs 2-3 years lost by 10 people due to the permanent negative effects on lifetime outcomes of poverty resulting from the lockdown-induced depression. Not to mention lifetime reduction in standard of living. In terms of measure that actually account for this, Quality-Adjusted Life Years, it's like the intervention is probably not a…

A take from one of my favorite medical bloggers: >Where to begin? I didn’t see any sample size calculation, nor any discussion of what they expected to see. One of the reviewers did a power calculation for them (page 37) and found that based on 90 rats per group, the power was about 14%. This means that false positives are very likely. The cancer difference was only seen in females, not males. The incidence of brain cancer in the exposed groups was well within the historical range. There’s no clear dose response. Why schwannomas? Schwannomas in other locations than the heart were not significantly different. These are rats. I don’t know how this compares to real world exposure. And one more thing – the survival of male rats in the control group was relatively low, and if these tumors developed later in life, this could be the whole reason for the difference. >Cell phones are UBIQUITOUS in the United States. If they were causing cancer, we would expect to see rates of [brain] cancer going up, right? That’s not what we’re seeing. They’ve been decreasing since the late 1980’s. At least when we talk about vaccines and autism, the rates of the latter went up as we increased the former. With cell phones, there’s an inverse relationship. What’s going on? I suggest reading the whole post. Personally, I am unconcerned by this single study of rats, in groups of only 90, that found barely significant correlations out of many possible correlations looked…

It's definitely not settled science that you should never eat grains. Yes, some experts say you shouldn't, but if you're rejecting one expert because he disagrees with two others, it's definitely not sufficient to say it's "based on science". As for dairy, while he mentioned using butter without paranoia about fat, he didn't seem to advocate for dairy. Eating dairy might be bad, but "don't eat dairy" is bad (or ineffective) advice because _people won't follow it_. Don't make perfect the enemy of better. (If it makes you feel any better about him, Dr. Carroll regularly rails against "the milk industrial complex"[0][1][2][3].) [0] http://theincidentaleconomist.com/wordpress/finally-someone-takes-on-t… [1] http://theincidentaleconomist.com/wordpress/another-blow-against-the-m… [2] http://theincidentaleconomist.com/wordpress/yet-another-blow-against-t… [3] https://www.youtube.com/watch?v=hzyFZcuHmeI

You should probably also mention this: http://theincidentaleconomist.com/wordpress/when-checklists-work-and-w… Atul Gawande is probably the foremost proponent of surgical checklists and in that article is responding to an Ontario study reporting that checklists were not significant---it sounds like a pretty bad study. Surgeons don't particularly like checklists. "For starters, the most controversial idea for teams to accept is perhaps the simplest item in the checklist. Require all team members say their names prior to the launch of the procedure. "'This has been one of the most important things that help people feel comfortable speaking up' if they're unsure or unclear, for example, that this is the right patient, right site, right procedure. "'It acknowledges that you're part of a team and are allowed to speak.' "Gawande says that there has been resistance to accepting checklists at another level. 'The concept has forced us rethink what it means to be great at what we do. And I hadn't grasped this until I saw it recur over and over again. There's a set of values in the idea of a checklist, and they're in distinct conflict with some of the values we have in medicine.' "'We value physician autonomy, which works well when there are just two full time equivalents providing care, but when we have 19.5 FTEs trying to make things work, it becomes a problem.'"[1] Any of that sounding familiar? [1]…

Economics analysis was wrong for years in multiple place thanks to an error in one of Piketty's spreadsheets. AI hallucinates. That is a fact. Trusting language models to fill spreadsheet cells ought to be an arrestable offense. https://theincidentaleconomist.com/wordpress/on-piketty-and-spreadshee…

You are mistaken. You can have causation without correlation. For example, suppose my umbrella keeps me dry. But I only take my umbrella out when it's raining. The correlation between my taking my umbrella and my being wet is zero: I either don't get rained on because I have an umbrella, or because it isn't raining; I'm only wet from other causes, unrelated to umbrellas or rain. However, my umbrella causes me to be dry. If I didn't take my umbrella out, holding everything else constant, I would get wet. Here are more details and examples: https://theincidentaleconomist.com/wordpress/causation-without-correla… In this case, it's quite possible that (a) mask-wearing keeps you safe but (b) mask-wearing is only brought in when Covid is bad; and that the two countervailing effects lead to an estimated correlation of zero.

Here is a random factoid: https://theincidentaleconomist.com/wordpress/analysis-of-whats-23-of-t…

U.S. Healthcare is more expensive because every single step along the way costs more. This blog series[1] by healthcare professionals goes through it all. The primary culprits are: more expensive inpatient care, more expensive outpatient care, more expensive drugs, higher administrative costs, higher insurance costs, higher health investment costs, higher disease prevalence costs, and higher defensive medicine costs. https://theincidentaleconomist.com/wordpress/what-makes-the-us-health-…

> wired on sugar That's not a thing. http://theincidentaleconomist.com/wordpress/sugar-and-candy-do-not-mak… (From one of the co-authors of this article)

The limiting factor is not the spots for medical students, but rather for residents and fellows, who are primarily funded through medicare/medicaid and the VA. An interesting post on this is here, although it somewhat contradicts the popular notion that graduate medical education is limited by funding: https://theincidentaleconomist.com/wordpress/gme-federal-funding-and-r…

Lack of access to healthcare actually probably has very little effect. See figure 8: https://jama.jamanetwork.com/article.aspx?articleid=2513561 Or see the Oregon experiment: https://www.nber.org/oregon/ Food deserts are actually the result of people's consumption choices - poor folks choose not to buy healthy food, so no one sells it to them. Making healthy food available does not change this behavior. http://theincidentaleconomist.com/wordpress/giving-people-access-to-he…

There's nothing that prevents companies from selling insurance along state lines - as long as they comply with the insurance regulations of every state they want to sell in. See: http://theincidentaleconomist.com/wordpress/meme-busting-selling-insur… "Selling insurance across state lines" is a misleading way of saying that companies should be allowed to sell in a state without complying with that state's regulations, just the regulations of their home state. Given the example of how this played out in other markets (e.g. credit cards), a more accurate summary would be "remove state-level insurance regulation".

Do you have a source for US outcomes being better? http://www.washingtonpost.com/news/to-your-health/wp/2014/06/16/once-a… http://theincidentaleconomist.com/wordpress/the-state-of-us-health-ain…

And a 2012 survey of 200+ studies showed no significant difference in nutrition or contaminants. http://annals.org/article.aspx?articleid=1355685 http://theincidentaleconomist.com/wordpress/healthcare-triage-organic-…

The click through from the LA Times: http://theincidentaleconomist.com/wordpress/vaccine-preventable-outbre…

"too much sugar in the diet" This, at least, is not the case. http://theincidentaleconomist.com/wordpress/sugar-and-candy-do-not-mak…

On the other hand, there seems to be a big shortfall in the supply of doctors, in the US at least, so less strict testing than we have now might be a good thing. http://theincidentaleconomist.com/wordpress/why-cant-we-have-more-doct…

By race here: http://theincidentaleconomist.com/wordpress/subtleties-of-life-expecta… .

> Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones. I'd be interested to see these findings. Do you have links? As far as Medicare Advantage is concerned, it's not the least bit surprising that patient satisfaction is higher. But I wouldn't go treating that as some kind of referendum on Government-run healthcare: "Many private [Medicare] plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission." MA was supposed to demonstrate that private insurers could deliver care at lower costs than Medicare, and it hasn't done that. Basically, for every $1.00 the gov spends on a medicare patient, it pays $1.14 in subsidies for an MA patient, with the evidence indicating a lot of that goes straight into the pockets of insurers as profit [2] [1] http://www.washingtonpost.com/wp-dyn/content/article/2009/10/14/AR2009… [2] http://theincidentaleconomist.com/medicare-advantage-cuts-once-more-wi…

I'm not looking at the average for the whole country, I am looking at a specific piece of the FBI crime data, and comparing that to what should be by your own logic numbers that are already on the high side for other countries. In fact, the group I picked is of only areas with a population of less than 10,000, including areas where there is no population at all, as well as universities and colleges, excluding suburbs. It's about as biased toward the point you are trying to make as you can get from this data source and it still doesn't line up with what you are claiming. Feel free to provide evidence for your claim as you still have not done so. Here is one nonpartisan resource about healthcare I have offhand and a summary video by john green for those who don't feel like reading so much: http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-c… https://www.youtube.com/watch?v=qSjGouBmo0M Relevant points from it: no, obesity does not account for a significant portion; yes, it affects even those who pay; yes you need to look at a lot of data; and no the data does not agree with you. The John Green video has 2 other links of interest in the description, too. Your claims are still entirely unsubstantiated, and you keep throwing in more of them instead of backing your existing claims up with data.

> In most proposed treatments the discussion is not if they are more or less "effective", the problem is that they don't work, and some of them even have side effects. Well, in this context, whether treatments work or "don't work" is the definition of effectiveness, and whether or not they have deleterious side effects is the definition of safety. But apart from that, I'll again point out that whether or not a treatment works is determined by what results the patient considers satisfactory, and whether or not something is safe depends on what risks the patient is willing to bear; generalizations simply don't suffice here. If the unlikeliness of a procedure's success and the nature of the possible side-effects are known, then they can be communicated to the patient so that he can decide whether the higher probability of side effects is justified by the lower probability of relief according to his own hierarchy of values. If how well the treatment works and the nature of its side effects aren't known, then no one has the relevant knowledge to make an informed decision, and it still remains up to the patient to weigh the unquantifiable possibility of relief against the equally unquantifiable risk of a bad outcome. There's simply no way around the fact that the question always boils down to a deeply personal value judgement that no third party has the right to usurp. > Terminal ill people are often desperate and would try whatever is trendy Right. They're desperate…