[tptacek]

Not sure how we get to the word "dwarfed" in that analysis, since despite ranking below Europe on life expectancy, the US does significantly better on heart disease and cancer mortality.

Point being: something's going on here that confounds life expectancy comparisons.

[kiba]

I didn't disagree with your analysis. I was only pointing out that accidents(ranked 5th) are indeed one of the top cause of death in the US, which I didn't make it clear in my last comment.

[jamesaguilar]

I believe we also count infant mortality in life expectancy. Not sure.

[Retric]

Your statistics are simply wrong. Which is why they numbers don't seem to add up correctly. US has a mixed heath-care system with some people reviving enough treatment that it actually lowers there chances of survival and others getting little to no treatment.

PS: It's hard to get good data. Japan has twice the US suicide rate and a longer life expectancy. However, some of their numbers are off due to people not reporting deaths so they can continue to collect pension benefits.

[tptacek]

Is there data to back up your argument? What you're saying seems to amount to this:

If you're wealthy, the US health care system is so good that not only does it outdo Europe's system at handling heart disease and cancer, but it does so much better than Europe's that the effect is evident from mortality statistics even though 75MM people in the US make less than $22,000/yr. At the same time, you're saying that regardless of the fact that US hospitals are required by law to treat indigent patients regardless of cost, enough people receive so little care that they bias the mortality statistics.

This seems like an extraordinary claim.

I am not an apologist for the US health care system, as a cursory look at HNSearch will show you. But I don't think the problem is that people don't get care in the US; it is, as policy wonks will tell you, better (from a health care perspective) to be homeless in 2012 than it was to be President in 1955. The problem is that the US health care system routinely bankrupts patients.

[yummyfajitas]

The problem is that the US health care system routinely bankrupts patients.

This is unclear as well. This stylized "fact" only became a talking point in the last election, and is drawn almost exclusively from a deeply flawed study by Elizabeth Warren.

http://www.theatlantic.com/business/archive/2009/06/elizabet...

http://www.theatlantic.com/business/archive/2010/12/will-hea...

Among other flaws, the study doesn't measure causation or even correlation.

[tptacek]

Here is a list, I feel like it's fairly representative, of conditions that will generate an "automatic decline" for a regional health insurer. I chose it because it was the first on the Google SERP; I can be more rigorous if I need to be:

http://echealthinsurance.com/health-insurance-advisor/wp-con...

The fun stuff starts on age 18.

A huge number of Americans have conditions with a "D" in the right-hand column, which is "automatic decline coverage". Many of those people cannot get insurance on the private market at any cost.

Why do you have a hard time believing that our health care system needlessly bankrupts people?

Is it something along the lines of, "there is a savvy way to negotiate this system without having health insurance"? I'm prepared to concede that someone knows someone who's mom paid pennies on the dollar for care by playing hardball with providers. I just don't think that's a viable solution to the problem overall; providers will more often than not just send the bills to collections.

[lotharbot]

I submit that the system does needlessly bankrupt some people, but there are also a number of alternatives which allow a large percentage of the uninsured to avoid such a fate.

If I may submit two personal stories in place of rigorous data:

my incredibly poor sister recently injured herself and was facing nominal charges of about $40,000. She was able to get that written down to a few grand and then get donations from family, friends, and charities to cover her bills. She didn't have to "play hardball"; she just explained her situation and the hospital bent over backwards to help her. The hospital staff treated it as a routine occurrence.

My wife and I do not have health insurance at all. We use something called "Christian Healthcare Ministries" [0] which is not insurance, and (at our level of participation) doesn't cover routine visits or small problems, but covers us in case of conditions that might otherwise bankrupt us. So while I personally cannot get insurance on the open market, and routinely get counted in the "not insured" category, I still have coverage.

(Note that I'm not defending the US health care system overall, just introducing some information about alternatives that help people avoid bankruptcy.)

[0] https://www.chministries.org/

[Retric]

They might not call it heath insurance, but it still is de facto heath insurance. Also, nominal charges of 40k is small potatoes in the healthcare world, that can literally be a few days of moderate care in some hospitals. However, a lot of medical bankruptcys are around end of life care, where medicare forces people to 'go broke' before picking up the rest of the tab.

PS: I have awesome medical coverage, that limits out of pocket expenses to 2k per year with an unlimited sealing. However, many plans cap lifetime expenditures to 1million in coverage because people really do spend that much and far more.

[yummyfajitas]

Why do you have a hard time believing that our health care system needlessly bankrupts people?

I'd like to see good evidence that it's a significant problem. You haven't provided any. No one I've asked has provided any, beyond Elizabeth Warren's study and the claim that it's "obvious".

As for "savvy way", it's paying in cash, up front. Prices magically drop when payment is convenient. In my experience, and those of the many uninsured people I know, it's that simple. I'm going to speculate that you don't know very many uninsured people...

(Sadly, there is little data on this. If you have some, I'd love to see it.)

[Retric]

Your assuming at the lower end of the scale are accurately diagnosed.

However, for a simple idea of how bad the US healthcare system really is look at this: http://www.cddep.org/tools/methicillin_resistant_staphylococ...

[jerf]

No, he's not assuming anything like that. He's observing that if the US is slightly worse on average (for the sake of argument), but you have what you claim are a large number of people being actively harmed by the system, then to make up for it you must have a large number of being receiving unbelievably good outcomes, or you can't end up with "slightly worse on average" in the end. It's a very simple mathematical point.

I'd observe that in general, the complaint with the US medical system is that it is too expensive, or that for what we pour into it it ought to be clearly the best everywhere across all measures instead of merely near the top. (Which is rather more accurate; it isn't "slightly below average", it's "slightly behind best", and there are rather a lot of individual measures in which it is the best.) It isn't that it's a terrible system in general. You have to game stats pretty hard to make it an actively bad system in terms of raw outcome.

[danielweber]

Simpson's Paradox says you can have rich people country A outperform rich people in country B and poor people in country A outperform poor people in country B and have country B outperform country A when both groups are put together.

This is probably not the case, but since this is hacker news I'm being a dork about the math.

[tptacek]

In 2007 there were 8,324 deaths linked to MRSA in the UK. In 2005, there were between 4,429-8,850 (6,639 w/ 95% CI) deaths linked to MRSA in the US. There are more than 5 times as many people in the United States than in the UK.

I obviously do not have the specific stats at my fingertips to refute the anecdote you've supplied, but if there were a way for us to bet on which of our arguments the correct statistic is going to support, I'd bet on my argument.

[Retric]

Where do you get those numbers? MRSA is thought to have caused 1,652 deaths in 2006 in UK up from 51 in 1993.[104] http://en.wikipedia.org/wiki/Methicillin-resistant_Staphyloc...

Still, for those numbers to be useful the rate of infection, detection, treatment, death, AND linking deaths to MRSA must be considered before you can compare those healthcare systems as well as a near constant rare of infection.

[tptacek]

Sorry, I got Clostridium confused with MRSA. But 1,652 normalized for population is still higher than the US MRSA fatality number!

I'm not sure what the second sentence means. If you're saying we don't know how to properly attribute deaths to MRSA, what does any MRSA statistic say about health care?

You have a long row to hoe with the overall argument you're making. It is, for instance, not hard to link deaths to heart disease, and heart disease is the leading cause of death in the US. The US has fewer heart disease deaths per 100,000 people than Austria, Sweden, Norway, Iceland, the UK, Finland, the Czech Republic, Ireland, Hungary, and Slovakia, and is closer to Germany and Denmark, the #14 and #15 followers to the US's #12, than it is to Austria's #11.