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Comment by Fernicia | Hacker News Reader

The methodology here is not good. All they're doing is comparing average health care cost vs life expectancy. They don't measure standard of care, accessibility of treatment, etc.

This is especially important when looking at end-of-life care, which I speculate affects these both of these metrics the most. A hospice with private rooms, friendly staff, and social engagement will score lower than a hospital that keeps someone alive in a coma.

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Bloomberg analysis gives one point of view.

OECD has published data where you can compares 5-year survival rates after major cancers, heart attack 30-day survival after hospitalization, stroke, ischemic stroke etc. They also keep track of infant mortality, maternal mortality etc. http://stats.oecd.org/index.aspx?DataSetCode=HEALTH_STAT#

Data shows that Japan, South Korea, Israel and Nordics are have the best healthcare quality using these measures. US is often in top 10, or at least mid-tier. Beast cancer is treated very well in US.

But what is wrong with the US and infant mortality and perinatal mortality? How can the US be so low?

In the US, we make services used by the poor inconvenient and ineffective in order to (ahem) motivate people to not be poor. Lousy results are to be expected for that segment of the population.

Motivate? Most definitely yes. Equip? Not at all. The American Dream (especially that pesky part about "opportunity") died long ago. If you're born with a chronic condition such as diabetes or your parents can't afford an education giving you the chance of a decently paying job, better go die.

That being said, just looking at the raw numbers I'd dare to say that health care in the US is just about as inconvenient and ineffective for rich people as it is for poor...

Rektang was being facetious with that comment, as tipped off by the “(ahem)”, implying the real reason we make services for poor inaccessible so they won’t be able to use them and thus drive up costs for them.

That's part of it. But there are other factors at work including political concerns -- for example in exempting rural majority-white counties in Kentucky from Medicaid work requirements while imposing them full-force on urban majority-black counties.

>If you're born with a chronic condition such as diabetes or your parents can't afford an education giving you the chance of a decently paying job, better go die.

This has always been the case. Most of these people just died before while today we have methods to keep them alive.

The American Dream reduced to eugenics steered by capitalistic market fitness?

That strikes me as an overly simplistic view, largely because it implies a unity of motivation across the various persons involved in U.S. healthcare policy-making and delivery.

If you're sure of your statement, it would be helpful to cite some supporting evidence.

The best example is work requirements for Medicaid as implemented by some states (Kentucky for one), which end up making it difficult to stay eligible for Medicaid.

Some of it is different reporting requirements, but some of it is clustered in at-risk groups that are underserved.

http://www.nber.org/papers/w20525

Big recent declines are due to safer sleeping practices reducing SIDS / asphyxiation.

Education about safe sleeping is a factor, and also if you are in a household that can't afford a crib, that's going to have an impact too.

https://www-m.cnn.com/2018/01/04/health/infant-mortality-by-...

> US is often in top 10, or at least mid-tier.

Yet US govt healthcare spending is absurdly high and far out of line with the rest of the world either per person or by gdp.

Seems to suggest that efficiency is terrible and that's still ignoring the out of pocket costs to the end consumer.

At least 100 boys in the US are killed every year by circumcision

To your point, the key drivers of the recent decline in US life expectancy seem to be suicides, alcohol, and opioids.

Some of these are definitely mediated by the quality of the health care system, but culture, public policy, and economics have impacts too.

https://www.webmd.com/mental-health/addiction/news/20180816/...

If I were considering running for President in 2020, and I owned a large media company, I might publish articles like this, too.

That aside, you can't tie all of life expectancy to health care. For example, diet, life style, genetics, and environment are all factors too.

The vast majority of the large scale increase in human lifespan you can put down to improvements in medical knowledge. People used to get their teeth knocked out and replaced with wooden ones as a wedding present, the idea being that the lucky couple would then have less risk of being killed by a tooth infection before the age of 40, as was common.

You would have to keep a heck of a lot of people in comas for a heck of a long time to be able to move the needle on life expectancy by several years.

Could you indicate which health care systems you think are skewing the results in this manner? As it would seem to require keeping large numbers of the very elderly alive in comas while also not providing widespread elderly care, which seems an unlikely policy to pursue.

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