Flutterby™! : Healthcare spending 2010-08-25 17:49:48.939226+00

Healthcare spending

2010-08-25 17:49:48.939226+00 by Dan Lyke 10 comments

Just pullin' numbers out of my ass: If smoking has gone from 44% in the 1950s to 24% in the 2000s, and life expectancy at birth has gone from 68.2 to 77.9 years and smoking reduces your life expectancy by 25 years (there are differing opinions on that number), and health care spending for roughly the same period has gone from < 5% of GDP to > 16% of GDP, then is it reasonable to say that we're spending 11% more of our GDP on 4.7 more years.

Or, if our working lifespan is about 40 years, we're now devoting 4.4 more of those years to paying for healthcare, giving us a net gain of less than four months.

Hmmmm...

Further perversion of numbers: How does the increased life expectancy from improved workplace safety standards pull into this?

(Yes, I know that the 25 years for smoking is probably total hogwash, the number is closer to 10 years, the 4.4 years only counts if you assume 100% working, bla bla bla. I guess my point here is to show one thought process by which someone could come to the conclusion that modern medicine is mostly smoke and mirrors.)

Talking about "net gain" in this context suggests that any time spent working is a cost, and any time spent doing something else (e.g. retirement) is income. The model is naive, because while there's some truth in it, it doesn't take job satisfaction into account at all. Or did I misunderstand the calculation?

Linus, yeah, that's one of the obvious flaws. There are just a couple of arguments about the efficacy of modern medicine, especially among people like the anti-vaccination crowd, that are often dismissed as silly. I'm trying to figure out various ways to get there.

I wonder about the quality of those additional 4.7 (or whatever) years. It seems to me that in days of yore, we died at home after short illness or acute event, while now many of us linger on, comatose, with tubes in every accessible orifice and vein, bereft of any meaningful, joyous life. (And we do so because of the rabid religious right's insistence on staving off the ultimate and inevitable passage into their "glorious reward" of eternal peace and happiness)

I guess I'm not running in the same circles - but this is coming from the anti-vaccination crowd? I wouldn't trust these people anywhere near my young statistics. Vaccination, much to the detriment of the Earth, is probably one of the most effective treatments to come out of evidence-based medicine. It works too well and has been a primary cause of the population bomb. That and industrialized agriculture... but I won't go there.

Seriously though, it's hard to argue statistics against evidence-based medicine when your main rally point is in complete denial of the statistics.

Andy: I can see a "birth-school-work-death" bar graph that now includes "birth-school-work-ICU-death".

I'm starting to ramble now... but is it legal to discriminate based on immunization? I guess it is because public schools can require proof of immunization. I can see employers refusing to hire non-immunized people. (especially if the job is "statistician"... snicker).

I'm not sure about all those years, but if the last 4 months are anything like Charlene and I saw happen this spring with Cynthia, I'm definitely up for missing that. If I'm spitting out the feeding tube, y'all can take that as a statement.

Eric, no, this isn't coming from the anti-vaccination crowd, this is me trying to understand the alternative medicine crowd, a subset of that being the anti-vaccination crowd. I think there are a lot of people who are questioning the (huge) advances in medicine made in vaccines and antibiotics based on some of what they see in modern times.

I'm trying to make sense of what I'm seeing in modern times, and in throwing the numbers around I can see how one might tend to mistrust mainstream medicine.

But not all of us will linger for comatose months in ICU filled with tubes. I can think of a number of my own family members who lingered a bit, maybe a few days on tubes or heavily sedated, but the worst case scenario you cite is, I suspect, fairly rare. I know few people who will demand the doctors carry on no matter the poor prognosis for their loved ones. And religious bodies do make distinctions between extraordinary measures and necessary ones. A few strange cases like the Sciavo affair are rare events.

As to requiring vaccination: I have heard of companies trying to dump employees who are overweight or who smoke, but vaccination doesn't really enter into that corporate calculation. Whooping cough is not a major fear in the human resources department

Not yet... but if the anti-vaccination crowd gains much strength, it will be a major fear. One could also see it as a sign of "different" judgement and poor knowledge of statistics.

As for end-of-life care, in terms of suffering, even a few days seems like months, weeks, like years. It's not always in ICU with tubes. It may be a lingering period in hospice or years confined to a bed in a back room at home.

My wife has had two friends die miserably in their 30s. Both were exceptionally healthy people. One was a pre-Olympic athlete who suffered a series of brain tumors that degraded his quality of life over four years (starting from being a young lawyer living in Aspen, Colorado to being vegetable in his parents house on Signal Mountain). The other was a fishing boat captain how, just after getting his paramedic license and starting a job as a NYC paramedic, spent almost six months in hospice dying of pancreatic cancer.

I find myself grateful when I heard of someone passing relatively quickly. In my experience, it's just not that common.

#Comment Re: made: 2010-08-28 12:54:29.883226+00 by: jeff [edit history]

I need to do some research to answer a few long-running questions of mine. For example, how much money is spent on medical care as function of time over the span of a person's life? Without appropriate scaling here is a VERY ROUGH estimation:

This rough hand-drawn graph with no empirical data probably understates how much money is spent on health care during our last years; medical costs are probably closer to asymptotic near the end of life. Going even further, how about a plot of "contribution to society" as a function of medical care costs? Leaving out any personal and subjective "quality of life" coefficients, what does spending huge amounts of money simply to keep people alive really do to help the economy? The country? Where is the altruism?

Without question, many of us will spend huge amounts of money on health care during the last months of our lives. But for what ethical, moral, or pragmatic purpose? Frankly, I'd rather hand down any assets that I might have at that time to loved ones or to charities of my choice.

This is a complex question, but I have no doubt where the medical community stands on it. A large proportion of their total income is undoubtedly derived from just "keeping people alive."