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Comment by graeham | Hacker News Reader

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graeham

There is different math for each system.

In the USA:

if riskFromTreatment <= riskFromNoTreatment: doTreatment

In most public systems:

if (treatmentCost <= someThresholdPerBenefit) && (riskFromTreatment <= riskFromNoTreatment): doTreatment

In practice, treatment outcomes are pretty similar, but more treatments are preformed in the USA system. Being a for-profit system is one cause, but so is the litigation culture. Not doing every possible treatment and test can lead to the physician being accused of being negligent.

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That's a bit of a strawman argument. In your math, you need to include the point that the article makes - that the American system always considers riskFromNoTreatment to be close to infinite. The risk is completely skewed on the American side, doctors are saying "EVERYTHING WILL KILL YOU TREAT IT NOW"!

That's an overbroad generalization. Not even close to all doctors constantly push for aggressive treatment of all medical conditions.

You have the US math wrong.

    if profitFromTreatment <= profitFromNoTreatment:
        doTreatment

The legal system enters into it because it affects profit. Health risks only enter into it indirectly through the legal system.

It is easier to sue for not treating than for over treating, and treating generates a profit. Therefore the default is excess treating EVEN THOUGH health outcomes are equivalent to worse.

(If you think this might be absurdly expensive, you are right. A glance at the costs and outcomes in the US vs other countries verifies this.)

I like the idea of more tests and data-driven medical decisions.

It would be nice if most of those tests were usually 'effective' (fairly accurate, or really cheep with rarely a false negative and a better confirmation test if warranted).

It would be nice if the goal was to /prove/ someone was healthy, just like how burn-in tests 'prove' that built systems function within the desired parameters.

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