Robin Hanson Discusses the Karnataka Health Insurance Experiment | Hacker News Reader

Robin Hanson Discusses the Karnataka Health Insurance Experiment

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67 pointsqualudeheart70 comments

The study at issue is much more limited than the article suggests, and explicitly disclaims applicability for the kind of conclusion it is being used to argue for. From p. 14 of the cited study (interword spacing is somewhat inconsistent because that's how it pastes out of the study PDF):

This study is, to our knowledge, the largest experimental evaluation of health insurance in an emerging economy and the first to examine spillover effects. Nevertheless, it has limitations. First, the study was designed to be powered to detect a change in the hospitalization rate, not necessarily changes in health outcomes. Recent research has shown that samples sized in the millions may be required to find effects on rare outcomes, even with insurance that covers not just hospital care, as in this study, but also outpatient care and drugs (Goldin, Lurie et al. 2019). Second, the study examines a plan without coverage for non-surgical outpatient care and prescription drugs. This limits applicability to more comprehensive insurance schemes. Third, while the study helps predict the effect of expanding eligibility under India’s new PMJAY insurance, it does not inform the effects of that plan’s expansion of coverage to non-acute hospital treatments.

Eh, the article does mention that point: "It only looked at the effects of hospital treatment, but to many that is the crown jewel of medicine."

So health insurance may be useful, but health insurance for hospital treatment isn't. I don't think that conclusion is much weaker.

> Eh, the article does mention that point: "It only looked at the effects of hospital treatment, but to many that is the crown jewel of medicine."

What you quote is a mischaracterization by Hanson. From the study (from the GP comment):

> the study was designed to be powered to detect a change in the hospitalization rate, not necessarily changes in health outcomes.

The interesting questions are: which causes a better gross outcome (what Hanson discusses) and, if outcomes are the same which costs less.

If insurance means there is more primary care and that causes less hospitalization then you clearly save money and have a better QoL.

Insurance also handles a different class of cases, e.g. you are hit by a car. These are outlier cases (for which insurance makes the most sense and implies no moral hazard). This is ignored by Hanson who considers only baseline chronic conditions like cholesterol levels.

The study could imply that insurance coverage could be modified (covering less routine care), though more work would be needed. I’m dubious, but that could be the right thing.

> Eh, the article does mention that point: "It only looked at the effects of hospital treatment, but to many that is the crown jewel of medicine

It mentions only one of the three points.

> So health insurance may be useful, but health insurance for hospital treatment isn't.

No, that’s not justified by the study, because as the study says, it only was designed with the power to detect changes in hospitalization rates over the term of the study. not health outcomes, which would require a much larger study. The study is useful if you are trying to use pre-policy hospitalization rates to predict the usage under (and therefore cost of) a public hospitalization-only insurance policy over the first several years, but it is very much not useful in evaluating whether that or any other insurance policy is useful.

If anyone wants some interesting correlational data on life expectancy vs. wealth and health expenditure per capita ourworldindata is a good source. At a country-level the correlational relationships are weaker than many people think.

- Costa Rica $14k GDP per capita (2018) $1.1k health expenditure (PPP 2011)

has a higher life-expectancy and healthy life-expectancy than

- Saudi Arabia $50k GDP per capita (2018) $2.5k health expenditure (PPP 2011)

Overall, there is a weak relationship between wealth and health expenditure vs. outcomes beyond $30k GDP/capita and $1.5k expenditure.

Many Europeans and North-Americans would expect significantly worse health outcomes using the system of Costa-Rica, Barbados, Uruguay or Turkey, but the data shows similar aggregate outcomes.

Of course there are more complexities in understanding the individual data-points.

https://ourworldindata.org/grapher/life-expectancy-vs-gdp-pe...

https://ourworldindata.org/grapher/healthy-life-expectancy-v...

Are those directly comparable though? From what horrors I have heard of the US healthcare system, one can easily pay $5000 for a procedure that someone in my country can easily get just by walking into a private clinic and paying $50 out of pocket. So outstanding health expenditure per capita in the US can just be the symptom of how uniquely bloated their healthcare system is, and not the sign that US citizens use health services so much more.

Yes, there are lots of factors like this when comparing any two countries. USA does have uniquely high expenditure supporting your bloat claim.

The point is other countries e.g. France, Switzerland, Canada, UK, there are also not significant differences vs. countries with lower GDP per capita.

I'm not saying this proves a relationship but it's a useful indicative signal, and the randomised studies cited by Hanson, combined with the health outcomes of American Amish all together make more more sceptical of the benefits of health expenditure.

I'm not certain though and would love more info. If anyone has any evidence pointing in the opposite direction then would be really interested to see it.

Mean numbers are likely misleading here. I'd expect a massively different distribution of wealth between these two countries. The richest in SA probably have terrific health outcomes.

I have never been to Saudi Arabia, but my friends were, and according to them, SA is a pretty unhealthy country.

Many people do not engage in any physical exercise at all, overeating is common, consumption of sweetened beverages very high, illicit drugs are way more common than they theoretically should be.

Medical care isn't magic and cannot completely neutralize accumulated consequences of such bad lifestyle decisions.

Yeah I think there is lots of nuance about individual datapoints. Does the overall distribution match your mental model?

To me it's surprising there aren't at more high spending countries with significantly better outcomes measured by these metrics.

Can you think of a country with more equal health expenditure than Saudi Arabia that has much better health outcomes than countries with GDP per capita around $30k?

> Overall, there is a weak relationship between wealth and health expenditure vs. outcomes beyond $30k GDP/capita and $1.5k expenditure.

Because healthcare is labor intensive, you probably want to at least adjust per capita spending by PPP, and it might even be better to look at per-GDP spending (really, relative healthcare costs is the goal, but you can't easily get that directly.) So, Saudi Arabia has worse outcome but plausibly is lower on the relevant spending measure, as well, compared to Costa Rica. Otherwise, the effect of healthcare consumption is being masked by differences in the cost of healthcare.

(Of course, even looking at per GDP spending, and compared to other advanced nations so that there are fewer confounding factors, the US proves it's possible to spend a lot extra with no result, if you design the system badly enough.)

The link is PPP adjusted already

Yeah, I missed that, but as I said (perhaps overly tersely) upthread PPP understates and GDP is probably closer, given the kind and degree of labor intensity of health care services and how the relevant labor costs tend to trend with other economic measures (in general, a nurse in a richer country doesn't have the same cost, even at PPP, as one in a poorer country.)

So... US being 46th in the world for life expectancy (behind Cuba, ffs...) isn't relevant because? Just saying, there's a lot of first world countries with far higher life expectancy than the US.

Access to healthcare might be an answer. (Probably not the only answer though, but likely other answers will be aligned similarly)

Here's something with some evidence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222401/

> Conclusions. The high prevalence of obesity in the United States contributes substantially to its poor international ranking in longevity.

> Access to healthcare might be an answer. (Probably not the only answer though, but likely other answers will be aligned similarly)

I wonder how much of this is explained by the obesity epidemic. And this isn't something that is solved by better access to healthcare - the best treatment that modern medicine has to offer (diet and exercise) is kind of obvious and accessible to everyone. One can argue that access to healthy and cheap nutrition options matters, but again, this is not something that one would classify as "healthcare".

Not sure if healthy food is accessible to everyone: if you're juggling 2 or 3 low-paying jobs you neither have the money nor time to buy and prepare healthy food. In the US fastfood is often cheaper than healthy food.

This is a feel-good trope that doesn’t remotely reflect the typical situation facing lower income people. Fast food is cultural, not economic. If you go to poor Asian and Latino neighborhoods in urban areas, you’ll see ethnic grocery stores underpinning a food culture that is independent of fast food. My poor Bangladeshi immigrant relatives don’t eat fast food; they buy food from the halal grocer and cook. What’s been destroyed among native born American poor people is that food culture.

Fast food is both cultural and economic. Many immigrant households are very traditional and the woman take on the duty of buying and preparing foods. If you are single American, or single parent, working multiple jobs economically it's more convenient to eat fast food. I have rarely seen immigrant men from non-western countries in any type of grocery store shopping for fresh produce.

Being single for an extended time in adulthood, or being a single parent, are cultural as well.

And I think the jury is out on “fresh produce” being the key differentiator. It’s hard to find real science that backs that theory up.

I have rarely seen immigrant men from non-western countries in any type of grocery store shopping for fresh produce.

https://i.redd.it/h4plv5xwq4861.jpg

There's something to this, but one has to ask: were your poor Bangladeshi immigrant relatives redlined out of home ownership? I live on a redline boundary street in Chicago and there is a reason that the grocery stores that serve the Black community across that street are on my side of the line.

No, during the era of redlining they were living in a third world country, where even an upper middle class family’s apartment looked something like this: https://www.bproperty.com/en/property/details-1890101.html. The low income NYC and Toronto housing they moved to when they got here wasn’t much of a downgrade. (And of course whatever equity they had wasn’t worth much converted to USD when they came here.)

Rayiner, there is no "era of redlining". De jure redlining is over, but de facto redlining obviously lives on, as you can immediately discern from a 10 minute walk in the west side of Chicago. The point, of course, is that there's a commercial infrastructure in many ethnic neighborhoods that doesn't exist in the redlined neighborhoods due to decades of overt systematic disinvestment. It's why you'll see Mexican groceries every couple blocks in Belmont-Cragin, but only Food and Liquors in Austin. Economic path dependence is a hell of a drug!

I don't know if redlining is the only reason for this gap, or even one of the most important, but it's obviously a part of the story. If you're going to make generalizations about entire cultures this way, I think the onus is on you to engage with the history, even if only to say why you think it's not playing a part here.

The path dependence argument runs in the other direction. Houses in redlined Black neighborhoods might be worth less than in equivalent white neighborhoods. But they’re worth a lot more than houses in Guatemala or Bangladesh. Likewise, inner city American schools may be worse than schools in affluent suburban neighborhoods in America. But the school in my dad’s village literally had no walls.

But we're not talking about why they had whatever food culture they had in Bangladesh. We're talking about what they end up building when they get here. I'm saying one reason why Austin and Lawndale are food deserts, but Belmont-Cragin isn't, is because Belmont-Cragin was regulated differently from Austin and Lawndale.

Redlining is a huge big deal; despite ending in the early 1970s, it literally defines the neighborhood boundaries across much of Chicagoland in 2021. And grocery stores are scarce in redlined neighborhoods, but not as much in working class Mexican neighborhoods.

Or look at a place like south-suburban Olympia Fields, which is majority Black but wasn't redlined (presumably, it's where a lot of upwardly-mobile families locked into Lawndale and Englewood fled to). Plenty of grocery options.

Do you really think redlining has nothing at all to do with this? That seems like an extraordinary claim.

> De jure redlining is over, but de facto redlining obviously lives on, as you can immediately discern from a 10 minute walk in the west side of Chicago.

Why does "de facto redlining obviously lives on"? How do you know that the areas with less investment in the west side of Chicago suffer race-based discrimination in investment (i.e. "redlining") as opposed to data-based, rational investment decisions?

Path dependence means that the "data-based, rational investment decisions" you're talking about were determined long ago (the early 1970s) by overtly racist policy. It's like making building and investment decisions about a superfund site.

But the current decisions were not determined long ago. They are made now. And everything indicates that they are made rationally based on data that actually affects the probability of investment returns. That is not race-based discrimination, and that is not redlining.

Yes, but they're made based on economic conditions that were set in place decades ago. This is a point Rayiner has made about other equity issues (for instance: about the need to explicitly correct for the underrepresentation of women and minorities in the professions); this is simply another instance of that.

You can raise the standard of living in the redlined neighborhoods, and that does happen at the margins, but it happens slowly and only when economic conditions across the city are good.

So no, it's not the case that Whole Foods or Pete's is just going to spontaneously site a new store in K-town. They're not avoiding that area because they're racist, but they are avoiding it because of racism.

It's disingenuous to say they are "avoiding the area because of racism". They are avoiding that area because it provides less return of investment than other areas. Part of the reason why that area provides less return of investment than other areas is because of racism that happened 50 years ago. Part of the reason is *not* due to racism.

Regardless, it is not "de facto" redlining, as redlining is race-based discrimination in investment, and that is not what is happening now. If you are criticizing rational, data-based, non-discriminatory investment, then you should not caracterize it as redlining, as the defining characteristic of redlining (i.e. race-based discrimination) is lacking in the current situation.

It provides less return on investment... because of redlining. It's not rocket science. If you think redlining isn't a factor, the onus is on you to provide evidence to back up your argument that the almost 1:1 correspondence between redlining boundaries and disinvestment has nothing to do with redlining policy.

I didn't say that. I didn't say anything close to that. I don't know how someone could have interpreted what I said as what you wrote in good faith. I believe you are arguing in bad faith; so I will stop engaging.

You don't need extra time to eat less. Regardless of how much time someone has, you can only _gain_ time in your day by spending less time eating.

You're first sentence points out there are multiple budgets at play (time, money) so it's hard to dispute the ambiguous conclusion. I would guess that your conclusion is true by definition everywhere including the US in terms of time budget. I'm skeptical of its truth for any other budget.

> So... US being 46th in the world for life expectancy (behind Cuba, ffs...) isn't relevant because?

> Access to healthcare might be an answer. (Probably not the only answer though, but likely other answers will be aligned similarly)

I look forward to hearing how Mexican Americans enjoy better access to healthcare than non-Hispanic white Americans.

It’s not relevant because the life expectancy numbers don’t correlate well with health insurance access. Asian Americans have slightly lower health insurance access than whites, but live longer than Asians in rich Asian countries with universal healthcare. Hispanic Americans have much lower rates of insurance access, but live as long as people in Denmark.

Low American life expectancy seems to result from other factors (obesity, high homicide rates, etc).

That's not how you build correlational models. You have to build a survival model and estimate a hazard ratio by access to health insurance, along with other features such as race etc.

Otherwise wevcan cherry pick pairs of data points to match up with whatever belief one likes to hold.

https://en.wikipedia.org/wiki/Survival_analysis

Even survival analysis is far from perfect because its correlational, not causal. There are other techniques such as front door criteria etc. to figure these out.

https://en.wikipedia.org/wiki/The_Book_of_Why

> Asian Americans have slightly lower health insurance access than whites, but live longer than Asians in rich Asian countries with universal healthcare

This is contrary to what I recall reading previously, so I looked up some sources. One study says: “When people come to the United States, they are positively selected, so people coming here are usually younger and healthier,” Baluran said. “What researchers found is that the longer people [immigrants] stay in the U.S., their health begins to deteriorate; by the time [they] reach the second and third generation, the health advantage that immigrants have almost disappeared.”

https://asamnews.com/2021/12/23/immigrants-asians-live-healt...

Fundamentally, the original post is simply cherry picking data. Once you cherry pick, you can arrive at whatever conclusion you like.

For example, the data distortion caused by having younger asians in the United states is an example of Simpson's paradox. These can be eliminated using survival analysis

https://en.wikipedia.org/wiki/Survival_analysis

I'm posting the entire distribution and describing two data points because the post would have been very long if I described every country.

My aim isn't to cherry pick but simply to describe the distribution of outcomes we currently observe.

I was referring to rayiner's post. Not yours.

Cool, I think I got confused by nested threads

Lifestyle could explain a lot. Standard American diet is horrible and the fact that majority of Americans survive on it until their 70s is a medical miracle. But there are interesting subpopulations.

Amish people tend to be healthier in their old age than an average American [0], ethough their total life expectancy is lower (but there is a subset that lives much longer - on average to 85 - and they are subject to genetic studies [1]).

Of course, only 4 per cent of Amish are obese, even though their typical diet is not exactly vegetarian (meat, dairy products etc.)

[0] https://time.com/5159857/amish-people-stay-healthy-in-old-ag...

[1] https://news.feinberg.northwestern.edu/2017/11/amish-longevi...

Mormons also seem to be healthier than average Americans [2]. Of course, the religious ban on tobacco and alcohol might help with that.

[2] https://www.latimes.com/archives/la-xpm-1997-04-26-me-52680-...

Do you think the carb rich Japanese diet is also horrible?

I don’t know, are they averaging 3700 kcal of carbs a day?

Life expectancy is a terrible measure for quality of healthcare.

First off, it’s not necessarily calculated the same when it comes to stillbirths versus infant deaths, which drastically skew numbers.

Second, other factors unrelated or weakly correlated to healthcare systems can impact life expectancy (alcohol use, diet, traffic accidents, suicide).

Third, racial differences in longevity.

How is treatment for substance misuse or suicide not healthcare?

> Third, racial differences in longevity.

You may want to investigate the healthcare reasons for these.

Fun fact: Hispanic Americans, who have by far the lowest health insurance access of any group in America, have the second highest life expectancy, after Asian Americans, and we’ll ahead of non-Hispanic whites.

Many cohorts of Hispanic Americans are effectively "immortal", because they go back to their origin countries by the end of their lives to retire on money made in the USA... So it's hard to make conclusions based on them.

I’m sorry what? You think the US tracks people through out their life and assumes they are alive unless otherwise proven?

No, they just look at deaths. If someone leaves the US, their life expectancy isn’t counted.

All other things being equal, shorter people live longer. Less volume to get cancer in, among other things. Hispanic-Americans will on average live longer, Asian-Americans will on average live longer, women will on average live longer.

Random citation: https://pubmed.ncbi.nlm.nih.gov/12586217/

Do you have any study about what you're saying that controls for height?

-----

edit: for example...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071721/

  Table 1

  Age-standardized death rates from all causes, coronary 
  heart disease(CHD), and stroke per 100,000 population 
  (males) for 6 ethnic groups in California

  Ethnic groups*   Height, cm (in)  Age-standardized death rates/100,000
                                    All cause   CHD   Stroke
  African American 178 (70)         1,800       316   102
  White            178 (70)         1,243       302   60
  Hispanic         172 (68)         856         175   49
  Asian Indian†    170 (67)         668         258   33
  Chinese          169 (66)         773         155   62
  Japanese         169 (66)         693         146   52

  *In order of decreasing height.

  †Based on height data for upper socioeconomic status in India.

Is the point of health insurance to increase health, or to insure against catastrophic health failure?

Yes exactly, it's written like "when you have insurance you take more medicine which is not healthier" Insurance is normally not for small stuff but big failures...that's why you need insurance (and only for that)..because it's ~impossible to pay for it.

Yes. Insurance should be for uncontrollable things like treating things like road accidents, super rare medical conditions etc.

But in many countries insurance seems to work like a subscription service that covers everything including things that have a 100% probability of happening (like common cold).

Quite naturally, the people who are already paying for it would want to go to the doctor's office and the people who would have to pay for it out of pocket, would not.

This is kind of what Hanson is angling at. As I understand it, his thesis is that outside of obvious emergency stuff like infections, tumors, broken bones and such most health impact comes from lifestyle variables such as diet, physical activity, level of stress and quality of sleep. This is not traditionally understood as "medicine" (i.e. something doctors prescribe). But when people have easy access to medicine, they will be compelled to go to doctors more and doctors have an incentive to prescribe more treatments than necessary to maintain the prestige of their profession. So in the end many of these treatments will have either negligible effect on health or even be actively harmful.

Yeah that seems TFA's take - i think OP's is (and mine is) that the effect of insurance is that if you're really unlucky and have a catastrophic illness/accident/etc, at least you won't be forced into poverty.

This should not then be measured by health outcomes, but economic!

It's quite plausible that health outcomes would be similar in aggregate. If you need urgent expensive surgery that takes your home deposit, you'll still pay it and live if you have no other option.

I had an intermittent chronic pain issue for a few months this year that went untreated because of covid backlogs (UK). It stopped before they had a chance to figure out the issue. Even assuming it never comes back again, and I am now "healthy" again - the impact this had on quality of life was stunning to me, as someone who had never experienced this before. Pain, anxiety, frustration - I would have paid good money to get it treated earlier, and I don't know what I would have done if I was poor + living in the US.

I'm not sure if this answers your question - but in general I don't believe health care should just be about preventing death.

Interesting to consider if they gave you a useless treatment, and your pain went away the same as it did, would you have thought it was because of medicine?

I think doctors get a lot of credit for reversion to the mean.

I am a bit dubious about the way this is measured, with rare exceptions the kind of medicine considered healthcare isn't good enough to actually improve these metrics but rater mostly improve quality of life in subtle ways, and the analysis does mention stress reduction/depression reduction. I totally get it reduces stress to have access. But how many things happen to people in a few years that healthcare can actually treat? or at least treat in a way that shows up. I've been to the doctor once or twice a year, but its been twenty plus years since appendicitis which is the one thing in my entire life they could fix which concretely improved health.

Vaccines are great, but we generally dont count them into things like this. Painkillers are great for pain, but generally not required. As are splints, physical rehab, stitches and plastic surgery to reduce scarring, but none of which actually improve health in a way measured by studies like this. Dentalcare is great, and the most common form of surgery people truly need, but again, not in studies like this because they are still a part of the blacksmithsguild instead of healthcare for obvious reasons. Antibiotics are great, but its damned rare you actually need them, and a lost week of work doesn't show up in studies like this, and contrary to common opinion, almost all infections go away with soap, rest, and careful cleaning. Breaking a bone and not getting it professionally set is risky, but is more likely to result in permanent pain and minor damage, but it wont kill you, or force you out of work long time. Antihistamines are great, but are available without prescription in most places,

With rare exceptions medicine just isn't good enough to actually help, not in a way that measurably improves lifespan. But what it does do is give you something to do about your suffering, and trusting this help exists helps, as does having some rituals to follow when temporarily suffering, massively reduces stress in a way that is worth it for society.

> Antibiotics are great, but its damned rare you actually need them, and a lost week of work doesn't show up in studies like this, and contrary to common opinion, almost all infections go away with soap, rest, and careful cleaning.

I'm glad that even in our shitty underfunded universal healthcare when I had a respiratory infection which did not go away after 1 week of nothing + 1-2 weeks of the typical broad spectrum antibiotics my primary care doctor made an appointment for me for basically immediately at the nearby respiratory care department, and there they made an Xray then prescribed an antibiotic that worked.

Sure maybe it would have gone away by then without all this intervention :)

> With rare exceptions medicine just isn't good enough to actually help, not in a way that measurably improves lifespan.

Yep. Unfortunately we are not there yet.

Except the usual success stories of insulin, psychiatric meds, etc.

I'd wager odds you would have survived without are above 95%, so its beneficial, but when averaged out, a very slight improvement, quite possibly too low to be captured with significance in 10k people over 10 years with confidence p=0.99. A few years latter the effect of a month+ sick at home is almost certainly absent from blood pressure, etc.

Insulin might show up, though its prevalence is what, <2% ? And most diabetics do survive without, they just have to be very careful about what and when they eat, and a bit lucky. Psychiatric meds probably dont count, as its often not a part of healthcare, for similarly sane reasons as dentistry. Even if it does, it pretty much has to prevent suicide, or it will count as zero, as neither preventing forced hospitalization, nor homelessness will count as improved health.

I've reread your comments and while I generally agree, my hypothesis is that simply having good healthcare improves the economy which then in turn leads to improved life expectancy. Of course it's next to impossible to measure this, because of the endogeneity problem.

That said, I'm not sure I understand what you wrote about psych meds ("not a part of healthcare for [...] sane reasons [...]"). To me it makes the most sense to have psych meds socially paid, to ... you know keep people sane, keep them in the workforce instead of waiting for their problem to grow so big that now they need to be put into the psych ward (or court mandated rehab).

I am pretty sure that convenient access to good healthcare significantly improves health and is good for society in general, just not the way measured by these studies. I dont think it was intentional, but when carelessly read they needlessly discredit public healthcare. More importantly, I think lifespan is overrated in terms of health, it isn't what people care about the most, nor what is valuable to society. Proxies for economic productivity, and quality of life should be used as well.

Difficult to be sure, but not impossible. The problem lies more in the ability of the analyst and the limited, highly abstracted(compressed), often anonymized(lossy) data used. I think the kind of AI we need is already here, and we are slowly but surely transitioning into a true information society. A futuristic idea is that people will all wear sensors which provide a bunch of medical statistics which are then used by semi automated healthcare, but I dont think thats the way it will come to pass, or at least not the entire story. Why wear a device measuring your pulse, when a webcam can do the same while being used for other things, or just not turned off. Your pupillary response speed is another useful metric that a high res webcam can measure. To my knowledge the two aren't used to measure ad responsiveness or engagement to unaware users yet, but they will. This kind of non-abstracted, non-anonymized data already allows some companies to predict health, especially mental health, very well, and that's by accident.

Oh I mean the same reason that dentists are considered blacksmiths rather than doctors, people are just dumb sometimes.

I may have sounded a bit pessimistic about healthcare, but I am more disappointed than pessimistic. I think medicine can and should be improving much faster. I think part of the reason it isn't, is because the public is missinformed about the medical outcomes. And if they knew, far more funding would become available. But faith in doctors ability, has been and, may still be more important than treatment. By this I dont mean mean placebo, I mean it would scare people in general, and that good empathic doctors would burn out fast without an optimistic view of their outcomes. This was even a stronger factor in the past, and as a result this idea is strong, and prevents more ambitious programs.

That 30% reduction in depression sounds pretty good, though. Depression kills.

Mental health is health.

I take it the RAND Corporation cancelled their employees’ health plans when their study was published.

https://tcd.uchicago.edu/projects/value-of-health-insurance-...

I suspect every one of these cases the patients were customers of private health care clinics. The motive of the health care could completely change the outcome.

In Nordic countries you get the same or better healthcare with less exams and medicines than you get in the US because doctors prescribe treatments and medicine only when necessary.

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