A Fundamental Health Care Issue

On breast cancer, prostate and more, I heartily recommend Gerd Gigerenzer's "Reckoning with Risk", for layman, economist and medic.

A stunning example of this is my 80-year-old grandfather. He's not undergoing treatment for stage 4 lukemia because it only has a 10% chance of helping and at 80, you'll be dead inside of a few years anyway. But I'm sure there are plenty of people out there who insist on spending the money for such treatment because, hey, you might as well, the alternative is dying.

Very few players in the American Medical establishment have economic incentives that align well with the goal of good patient outcomes. An obvious example is the lack of incentive for drug companies to do research into therapies that can not be patented. Many people are on therapies that are much more expensive than previously existing therapies that are as good, or almost as good. E.g. Celebrex.

I get the feeling that many economists like the idea of high-deductible health insurance. They should have taken some courses in psychology. If it costs $100 out-of-pocket to see the doctor when you have the flu, it's the same disincentive for the common man whether or not it counts against a deductible. Doctors know this, and many will be reluctant to undetake a procedure costing a couple thousand dollars if the deductable has not been met since they know from experience that will proabably have trouble getting paid.

"But it is equally important to recognize that health insurance can not be the central reason for the better health outcomes in England because the top socioeconomic tier of the U.S. population have close to universal access but their health outcomes are often worse than those of their English counterparts,"

Which suggests that if America moved to a system of "universal access" (I think they mean universal coverage) we would not see the rosy results that radical reformers promise.

America is diverse. Health outcomes have a lot to do with ancestry. If you compare health results by ethnic group to health results of co-ethnics in the ancestral motherland, your odds are better in America.

If you look at prognosis per treatment, your odds are better in the US than elsewhere.