• Some days I despair

    I have a hard time with the “best in the world” triumphalism that often surrounds “debates” on health care reform. I’ve done my best to have a reasoned discussion about quality in the health care system. There are times, though, when I see what we’re up against, and I despair:

    GOP congressional candidate Chris Collins knows health care is expensive these days, but he argues it’s for good reason: People are no longer dying from deadly forms of cancer.

    “People now don’t die from prostate cancer, breast cancer and some of the other things,” he told The Batavian in an interview that was flagged Tuesday by City & State NY. Collins was discussing his desire to repeal Obamacare.

    “The fact of the matter is, our healthcare today is so much better, we’re living so much longer, because of innovations in drug development, surgical procedures, stents, implantable cardiac defibrillators, neural stimulators — they didn’t exist 10 years ago,” he continued. “The increase in cost is not because doctors are making a lot more money. It’s what you can get for healthcare, extending your life and curing diseases.”

    I was going to try and unpack this, pointing out that it’s actually prices that are often driving spending [increases] and such, but I’m too tired. If your starting point as a candidate is that people aren’t dying from diseases in the US, then you’ve left field of play.

    P.S. I don’t even care if his point was that so many fewer people are dying than before. That’s not true either:

    UPDATE: Edited for clarity.


    • Just know that your readers despair less because you post this stuff.


    • Not defending the candidate’s point, but don’t the last two graphs back him up? The death rate for breast cancer and prostate cancer is down, correct?.

      I can’t imagine that he meant that people aren’t dying from these cancers at all, but that there are people who are living today that wouldn’t have 10 or 15 years ago. And that appears to be the case if I’m reading the graphs correctly.

      • You’d need to argue that these improvements aren’t happening in other countries. Is that the case?


        • And further argue that the size of the effect of having more MRI and CT scanners and Blood Labs is significantly improving life expectancy and quality of life.

          • Since technology is available across borders (e.g., a cardiac stent invented in the US 5 years ago may for regulatory reasons actually appear in the EU first), I am not sure supporters of this congressman’s point actually need to prove that these improvements aren’t happening in other countries.

            Also, to argue that MRI (or CTs) don’t save lives or increase life expectancy is pretty dubious (as LovelyLibertarian seems to imply), especially given the latest evidence from lung cancer screening, reductions in ex-lap rates, etc. Again, to separate out the exact value of these tools’ specific contributions is extremely difficult even after controlling for the obvious (e.g., disease severity, age, etc.) in patient populations and so its not unreasonable to argue that they have a positive impact (neglecting cost)

            I view the argument that the care here isn’t (or is) the best in the world as a distraction. Isn’t it enough for Aaron to merely show that prices are driving the increase in total cost and we aren’t necessarily getting a great deal enough? If we get mired into the minutiae of whether or not this care is the best, we avoid talking about the much more obvious (and provable)

            • V…

              In other words, the effect size of adding more MRI/CT/Blood Labs is not sufficient to allow easy measurement – or observation…

    • Ever since I heard you a couple years ago on Stand-Up with Pete Dominick, I have been a fan and a very appreciative American. Thank you Dr. Carroll, for your efforts, your knowledge shared and your insight which has become very valuable to me.

      I too despair, way more often than I used to. Reality seems to have no bearing with some folks and nothing can change that. It is scary!

    • More evidence of the Robin Hanson hypothesis?

    • is it not the case as Mr. Peterson laid out a few years back aftering seeing how the Brits do it, that we spend too much on healthcare for our elderly? and why is that not being discussed more. If it is true that Medicare spends some # on average for the elderly, and that amount is more than what a lifetime’s earnings plus inflation put into Medicare, then why don’t we tackle that problem head-on instead of trying to build a perfect one-size fits all model for the middle class?

      If we want to pay for our parents/grandparents expensive healthcare because they are living longer and consuming more-lets start that conversation. Because everything else is expensive too (the fee we pay for our 401(k) for instance) Maybe we get more stuff in our cars these days-you economists say that in real terms stuff is cheaper these days because of all the safety and convenience technology brings us, but a $30,000 car is still expensive so why wouldn’t we want to pay more to live longer?

      I am not an economist but economist’s track records have not been much to crow about – it does seem that when the government gets involved in anything, costs go up.

    • Am I wrong in concluding from the graphs that we spend a lot of money finding out earlier that we need to buy very expensive treatments that reduce our quality of life so we can live a year or two longer…

      Maybe I am too cynical to matter…

      For the record I am a 65 year old male and WILL NOT accept any chemo or radiation therapy if and when I am found to have cancer or some other horrible condition – my living will reflects this…

      I want to be alert and responsive and me for my wife, children and grandchildren

      • I agree with your attitude. Robin Hanson says that we give healthcare to show we care rather than to help.

        For the record I am a 65 year old male and WILL NOT accept any chemo or radiation therapy if and when I am found to have cancer or some other horrible condition – my living will reflects this…

        I am curious, if your doctor discovers that you have cancer would like for him to not tell you? Sometimes I think that it would best to not know.

        • Flo…

          As to your last question my answer is different today than it was a year to two ago…

          I am more at peace with the idea that my life will end at some point – and that having an idea of when that might be if a Doctor found a problem might make preparing for that day a bit easier for me and my family – so yes I would like to know…

          AND I am determined to live a great life as long as possible – 95+ if that is what I am able to do…

          I am a huge fan of Robin Hanson – and greatly wish his voice got a wider consideration.