Comment by civilized | Hacker News Reader

Comment by civilized | Hacker News Reader

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Reducing maternal mortality would not materially help close the gap between the US and peer countries. Here is data and an argument that show this:

1. Total maternal deaths are 650 to 750 per year in the United States [1].

2. Accidental deaths by all causes total about 80,000 per year for ages 5-44 [2] (here I am eyeballing the Tableau chart by age group).

3. The risk of a 5-year-old dying in their 40s in the US is about 4x that in peer countries like the UK [3].

Putting #2 and #3 together, we would have to reduce yearly US accidental deaths for ages 44 and below by 4x to reach parity with peer countries. We'd have to go from 80,000 deaths per year to 20,000, meaning we'd need to save 60,000 lives per year from accidental death causes such as drug overdoses, vehicle accidents, and homicide.

Bringing the US maternal mortality rate down to the EU rate, while highly desirable, would only save a few hundred lives per year, a fraction of a percent needed to close the gap.

[1] https://www.commonwealthfund.org/publications/issue-briefs/2...

[2] https://injuryfacts.nsc.org/all-injuries/deaths-by-demograph...

[3] https://archive.ph/3OlNW

I think that OP implicitly assumes that new mothers are dying more due to systemic failures that apply to other patients too.

The numbers don't really work for that theory either.

Eyeballing this CDC death chart [1], non-accidental deaths from ages 5-44 add up to less than 30,000 per year. Most of those are cancer and heart disease deaths in the later ages. The US health system is not necessarily worse than peer health systems at dealing with such issues, and in any case, the health system can only do so much about them, because there are public health issues upstream like obesity.

But even if you magically completely wiped out those deaths only in the US and not in peer countries - which could never come even close to happening - it wouldn't do more than close half of the 60,000 gap I pointed out in my previous post. A gap caused mainly by accidental deaths (and suicide).

All this is just putting numbers to the basic, commonsense facts we know about mortality in the young: they don't die in the hospital, so making the hospital better doesn't do much to fix their mortality. And reducing the mortality of the young is the main thing needed to bridge the gap between US and peer countries, as I explained in a sibling comment.

[1] https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_dea...

So what you’re saying is that John Horgan made a rhetorical blunder by using life-expectancy as a case for how bad the health-care actually is? Perhaps it was, perhaps life-expectancy is just one indicator of many (as is maternal mortality). But as the parent of your sibling comment points out, John Horgan is not doing this to win a debate. Luckily Horgan cites a report[1] in his article which has spends an entire section on health care outcomes which includes life-expectancy (after age 60), maternal mortality, infant mortality, preventable mortality, treatable mortality, etc.

> The U.S. ranks last overall on the health care outcomes domain (Exhibit 1). On nine of the 10 component measures, U.S. performance is lowest among the countries (Appendix 8), including having the highest infant mortality rate (5.7 deaths per 1,000 live births) and lowest life expectancy at age 60 (23.1 years). The U.S. ranks last on the mortality measures included in this report, with the exception of 30-day in-hospital mortality following stroke. The U.S. rate of preventable mortality (177 deaths per 100,000 population) is more than double the best-performing country, Switzerland (83 deaths per 100,000).

Sure, any one of these might have alternative explanations, perhaps the abnormally high suicide rate has more to do lack of public transit, easy gun access, or something, than lack of psychological treatment, or the infant mortality is high because of endemic substance abuse (which is also a health care problem, but lets leave that for now). But taken together, the fact the USA consistently falls last in all but one of these metrics, must have a simpler explanation, and that explanation is that a large proportion of the USA population does not benefit from a good health care system.

1: https://www.commonwealthfund.org/publications/fund-reports/2...

None of this seems to engage much with the original commenter's point: America has uniquely bad public health problems which worsen both its direct outcomes (e.g. mortality) and the outcomes of the health care system, by putting more burden on that system. So it's not that easy to distinguish America's public health issues from its health care system issues.

Maybe deeper analysis is needed, not just the pet theories Horgan trots out on this and the other topics. He seems to be swinging about as wildly as those he's criticizing.

How would you characterize the quality of a health care system than? Which measures should a poor performing health care system fail to deserve being called worse than others?

It seems to me as you are setting the conditions for measuring the quality of a health care systems as to make it impossible to value the quality of the American one compared to other nations.

It sounds like you think I am trying to win, or not lose, a debate by making it hard for you to succeed in your argument. I am not. I am not in the slightest personally invested in the question of whether the US health care system is better or worse than other countries'. I just don't think these statistics add up to a meaningful analysis of this complex problem, or a meaningful attribution to the health care system versus other causes. The world doesn't owe us a tidy statistic on which we can lay out all the nations and say whose health care system is good and whose is bad.

I would refer you to the original commenter's point, supported by my subsequent points. Public health issues seem to matter more than the health care system, and the US has uniquely bad public health issues, most of which the health care system by itself can't do much about. I don't think you've effectively disputed that point. "It's unfair that there's not a metric you'll accept showing how bad the US health care system is and how important that is" is just relying on the exact premise we're disputing.

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