Arnold Kling  

Is Health Care Worth It, Con't

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Following up on Bryan's post, a couple of points.
He quotes Robin Hanson to the effect that a RAND study found that people who reduced health care spending by 25 or 30 percent showed little benefits, although "Blood pressure may have been reduced, but the point estimate was that this produced a 1% reduction in future mortality rates, which translates to roughly seven weeks of life."

Well, if David Cutler is right that a year of life is worth $100,000, then seven weeks is worth about $14,000, which is close to triple the per capita spending rate on health care today. In other words, seven weeks of life is worth not 25-30 percent of health care spending, but 250 to 300 percent of health care spending.

On the other hand, here is factoid from Matt Ridley's Genome that works in Hanson's/Caplan's favor.


It is a curious fact that nearly all studies of cholesterol-lowering drugs and diets in ordinary people show an increase in violent death compared with control samples that usually match the decrease in deaths from heart disease...It has been known for twenty years that impulsive, antisocial and depressed people...have generally lower cholesterol levels than the population at large.

Sort of gives new meaning (or a new twist) to the question, do you eat to live or live to eat?

The Hanson/Caplan thesis is that for every gain in health from medical care, there is a loss somewhere else, and that explains why we don't see a tight relationship between spending on health care and health. My contention is that the relationship is there, but it's small and drowned out by other factors in aggregate studies of longevity.

It could be that there is some truth to both of our views. Perhaps health care does some good, but it has reached a point of diminishing returns. Here is Ridley again:


[as the body creates new cells] every time the chromosome is copied, a little bit of the telomere is left off. After a few hundred copyings, the chromosome is getting so short at the end that meaningful genes are in danger of being left off...That is why cells grow old and cease to thrive beyond a certain age.

The sense I get from this is that as we get older the probability of being betrayed by our cells in some fashion gets very high. Whether it's cancer or some other disease, we are going to succumb. So even as we get much better at treating individual diseases, the overall lifespan does not rise very much. Or, to put it another way, although we continue to extend life, the marginal cost of adding a life-year is increasing.

Aubrey de Grey has another approach to medicine. Instead of attacking diseases, he says, focus on eliminating deterioration of cells. In American football, going after diseases is like trying to stop a pass play with a prevent defense that aims to cover every possible receiver. De Grey's approach is like sacking the quarterback. See the essay on de Grey in my book.

It could be that between now and such time as we figure out how to sack the quarterback, as it were, we will have to keep chasing after wide receivers. Now that we are on the steeply-rising marginal cost curve for increasing longevity, we may stay on that curve for quite some time.


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COMMENTS (4 to date)
Biopolitical writes:

Do you know that among very old people mortality rates decline with age? And that this is so despite death risk increasing with age among those same people?

Mr. Econotarian writes:

I don't have a lot of faith in a wide range of drug treatments to prevent chronic diseases.

What does seem to work well is acute diseases treatment (car accidents, immediate care for stroke, heart attack, etc.)

It would be interesting to try to break down health care treatments of chronic and acute illnesses, and compare the cost/benefit ratios.

Bernard Yomtov writes:

Ridley's book was published in 2000. His statement about increased mortality from non-cardiac causes may have been correct then, but I think subsequent studies have not shown this result, suggesting that statins do lower mortality.

Reason writes:

You can read more about Aubrey de Grey's views and activities here:

http://www.gen.cam.ac.uk/sens/

You might also get a lot out of his recent paper in EMBO Reports - economics buffs should have a good time explaining the current strange situation of incentives and actions in gerontology. A summary with links here:

http://www.fightaging.org/archives/000531.php

Lastly, Aubrey's Methuselah Foundation is currently auctioning a charity lunch with entrepreneur Ray Kurzweil with the proceeds going to the Mprize for rejuvenation research - now there's an interesting competition of values!

http://www.mprize.org/auction/

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