# Heath care costs

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I would like to begin with an analogy. Many auto manufacturers recommend changing the oil every 5000 miles. The Jiffy Lube chains, where you can go for a quick oil change, recommends every 3000 miles. Relative to the cost of oil changes, the 3000 mile is more expensive over time, but we are told it will reduce the risk of engine wear.

This valid risk concern has been successful, with many people not willing to change their oil every 5000 miles, since they can see the risk. We could lower this risk even more if we change oil every 2000 miles. But there is still some risk even in this. Maybe we can change the oil every day. But even that has a risk. It also starts to affect supply and demand with the cost rising due to demand, until the market adjust and more jiffy lubes open all over the land.

Like any good auto service shop, changing the oil is not the only service offered for your protection. Once on the lift, there are other risks which we need to point out and address. Rotating the tires is risky at 7500 miles, even of the manufacturer says so. He wants your tires to wear. Maybe we can lower the risk even more by rotating at 5000 miles to avoid the risk of poor handling and blow out. But even that can be risky, so maybe we need to lower it to 2000 miles. What the heck, maybe each day we can rotate the tires while we change the oil. This will minimize the risk but there will still be some risk.

While we change the oil and rotate the tires, there are many other things things than can cause risk. Modern cars have computer to monitor all these risky devices. To lower these risk, we need to plug into that machine every 15,000 miles. But that can be risky. Things can change quickly. Maybe while we change the oil and rotate the tires, we also need to plug into the machine to lower that risk.

I am kidding around, but one can never reduce the risk to zero. Trying to do so, gets very expensive. But it would also increase the rate of growth of the quickie lube industry. How can you argue against trying to reduce risk, no matter what the price?

But since minimal risk is very expensive, how can the average family afford to own an auto? The daily oil, tire and diagnosis could add up to tens of thousands of dollars per year and take up a lot of time sitting the waiting room. Maybe we need the government to step in, so the wait is less and help offset the costs. Some people just can't afford this and are suffering great risks changing that oil every 5000. Just skipping one day at the shop can double your risk. With every 5000 miles, the risk boggles the mind and borders on criminal neglect. We may have to force them for their own good with a fine or jail.

Risk analysis is valid math, but it is an odd correlation, since the weight of a few data points counts more than the majority of the points. As long as you use the buzz word risk, 2>98

To put it in perspective, you run experiments and generate 100 data points. We pick one or two points and draw a curve through only these two making sure it does not touch the other 98. This line is what we need to believe and prepare for. It sounds like soft science, until we use the buzz word risk. Like magic it get an harder. It is called emotional science, where emotion distracts us so we can forget the 98. Now daily oil changes makes sense since the two point curve says this.

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I am sorry, but I do not get the point of this post. In health care there are of course cost-benefit studies that are often a basis for standard policies.

One of the problems with the cost, of course, are end-of life treatments. I recall that the majority of health care costs are generated (obviously), and it is here where most cost-benefit analyzes turn ugly. For instance, there are certain treatments that go for around 10-100 k per treatment cycle but on average only prolong life for around 2 weeks or so. Question is whether such treatments should be denied or not.

Similar questions arise for certain screening approaches. Recent studies for instance show that PSA screening for prostate cancer do not increase life expectancy (but increase overtreatment). And I have heard similar for mammographies.

But in the end, for a number of treatments such studies are there. Arguably there are not enough due to the cost involved in performing them (oops yet another cost factor)...

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The auto analogy doesn't hold up, mainly because there is a fairly fixed value on a car. You need to fix a value on human life before any general application of risk analysis can be meaningful.

There are cases where certain treatments are being downgraded due to risk. I heard on NPR this morning that, in the US, the AMA isn't recommending PAP smears until the age of 21, where previously the recommendation was 21 or 2 years after the onset of sexual activity. Studies have proven that the costs prior to the age of 21 aren't worth the additional risks.

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The point is once you add the buzz word "risk", a correlation can create fear beyond any final reality. It is a nebulous concept, which gives everyone risk even if the actual event never pans out. How can you have something and not have it in the final reality? It is called fantasy.

For example, I have risk of being struck by lightning. I can also go my entire life and never get struck. In final reality, I never had any real risk based on the final hard data, since there was no real cause and effect for me. But according to the math, I had risk, even if it never happens in reality. It a type of magic alternate reality. It is emotional science.

Risk it is based on a lottery mentality. Someone will win the megabucks. This is like the risk. Before the reality of the drawing, everyone has the fantasy of winning, since the odds of winning are spread out equally to everyone who buys a ticket. If you buy your ticket early, you can imagine winning all that money and living in your new beach house. After the drawing, when reality sets in, most of the collective imagination was only fantasy that generated millions.

Whereas the money lottery uses desire for the imagination, a risk lottery uses fear. Instead of imagining sipping a cool drink in your new beach house, with a supermodel, winning the risk lottery will cause us to imagine rotting away even if it never pans out in final reality. In this case, we want to give the ticket back. There is a procedure to return the ticket and get out of the lottery. If you pay and the doctor says, you are fine, he gets the ticket and the magic spell is broken.

I tend to believe a better way would be a positive correlation that touches the most data points instead of a negative correlation that uses the watered down standard of only a few point for all. If we went into the lottery and it told us the reality of winning was low, so don't quit your job or drift into fantasy, the fantasy would lower. But this would not allow us to sell as many tickets. We need to keep the fantasy fresh.

Relative to any lottery, the more often you buy tickets the better the odds of winning. The more risk tickets placed into your pocket the better one feels about the fantasy as reality. The odds are on you side.

For example, hangnails can be painful but few lose sleep over them. If we decided to screen every month for hangnails, this will now look more serious, even if it isn't. If it wasn't that bad, why would they require monthly screenings. What do they know they are not telling us. Maybe we need to screen even sooner than that. The more often you buy a ticket, the more excitement we can generate, and more tickets people will buy to increase the excitement of the fantasy.

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But it's not nebulous. It can be analyzed very concretely. You have a X% chance of getting Y medical condition per year, that can be prevented at a cost of Z dollars per year, or cured at a cost of W dollars. From that you can make a rational choice based on risk-benefit analysis. It's even more concrete on the large scale, as instead of just a rational bet, you can make accurate predictions.

For example in your analogy, if everyone changes their oil every 2000 miles vs. every 5000 miles, there will two different costs of how much people will spend on oil + problems that would have been prevented by oil. One is lower. There is a right answer. So where do emotion and "buzz words" come in?

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Emotions come in if one is on the receiving end, I presume. Say, you got cancer and a 100k treatment will be denied as studies suggest that it will prolong your life for only a week or so. Or if a DNA screening shows that you got an allel which makes you unresponsive to said 100k treatment.

Logically one could say that it does not make sense, but if one is desperate it is much harder to do so.

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When we talk about people with condition X, there is a reality connection between the risk and the condition. But risk analysis will give risk even to those who will never acquire condition X.

Risk analysis is similar to stereo typing. There is truth in stereo typing, in that one can find at least one example for the generalization. One could say their is a risk of being attacked by a purple skinned person, since there is a high rate of crime in this population. Does that mean we need to worry about all the purple skin people, because of the group risk due to the stereo type? If you increase the fear, people might buy this and decide to detain everyone with purple skin.

Or we could be honest and say, just because there are examples of purple skin people with this risk factor, we can not honestly pass this attribute to all the members of the class. We are not skillful enough to separate the group, so we spread the stereo type to all, just to be safe. The police cost has to go up, since we need to screen all the group for violence, just to be safe. The good members of the purple skins will need to pay the police to be screened to give them a magic star, so we can ignore them later.

How about doing it this way. If we create group medical stereo-type to spread the risk, even to those who will never actually get it, if they go for a screening and don't have it, it is free. This would not make economic sense, which is why the risk technique is used. If we did that, one would have to be more careful about stereo-typing and/or better narrow the risk to exact people to make it economically feasible; fewer feebies. This might help the system evolve its approach away from stereo typing.

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Health care costs...

In my younger days, the doctor used to come home when I, or my grandmother, or anyone was ill. Because being sick is obviously not simple to go to the doctor's place.

And whatever was its bill, was paid cash during his visit at home. A bill that perfectly reflected time and knowledge and expertise. Nothing cheap, nothing out of the ordinary amount.

And the doctor lived a very decent life with the compensation.

Now, There is no such 'normal' service. You go to the doctor's office on your own feet, or in worse case take an ambulance.

When you go to the doctor's office; the bill you are paying is also for the rental of the office (large enough to set several persons each waiting turns in rooms) , for the secretary salary, for the helper's salary, for the computer systems and extra gadgets to squeeze more time from the work day.

If you have medical insurance, you are ALSO feeding an army of paperpushers, the office rental for the insurance company, the hospital facilities with they hyper-inflated costs (more organizations with their paperpushers selling hyper-inflated equipment), a bunch of nurses and ancillary personnel salaries.

If you used the ambulance, there is another bill to feed another organization, driver, another nurse on board, more paperpushers, operative costs, equipment depreciation (all that aboard an ambulance has hyper-inflated costs too)

Plus whatever am forgetting...

Medical care turned all about pure greed, to wring the wallet of the sick to the maximum and beyond by creating more and more suckling outlets from an illness.

So probably the next step will be the birth of some new sort of insurance company to insure the ill can afford health insurance.

Meanwhile, the tireless advertisement effort from medicine manufacturers trying to convince the public that you may have such and such rare condition. And just to be safe, to convince you that if you do not have such rare condition, you are prone and at risk of developing such condition; so better take that $20/day pill for prevention. That$20 daily pill amount goes $0.1 to make the pill,$15 to pay television advertisements, \$5 to another bunch of greedy stockholders pushing for more revenue.

It is not your health care any more. It is their wealth care.

Miguel

Edited by Externet

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Maybe we need the government to step in, so the wait is less and help offset the costs.

As much as we would all love for Healthcare to be safely regulated and free for the masses, what the government is doing to healthcare is taking a system that has some flaws and completely destroying it. Government regulation means limitation. you see it in the news everywhere in this new bill that the senate just passed; limits on the number of tests one can run, limits on what kinds of tests can be run, taxes on "unnecessary" surgeries, and taxes on medicine and medical equipment (Thats right, taxes on medical equipment and medicine so hospitals can't get what they need) all to pay for this bill which doesn't really help the poor people who can't afford insurance but those who valued an expensive car, house or other material goods more than healthcare.

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So it is better that the limits are defined by the insurance companies?

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