Thursday, February 04, 2010

Thinking about Healthcare

I do think about health care fairly often, but I don't pull my thoughts together all that well. Last September my bird-brother Pete emailed a YouTube video link:

Here is a little song celebrating our position at #37 in the world in healthcare.

And I thought it was moderately's clearly a reference to the World Health Organization Assesses the World's Health Systems report saying, as of 2000, that

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance...

Well, okay then. Or maybe not. Many people have pointed out that the measures of performance are a bit odd; consider PolitiFact's quote of Glenn Whitman:

"Suppose, for instance, that Country A has health responsiveness that is 'excellent' for most citizens but merely 'good' for some disadvantaged groups, while Country B has responsiveness that is uniformly 'poor' for everyone," he writes. "Country B would score higher than Country A in terms of responsiveness distribution, despite country A having better responsiveness than Country B for even its worst-off citizens."

That's pretty odd. But what measure should we look for? Life expectancy is surely relevant, and that is one of the measures; more specifically they used Disability-adjusted life expectancy, defined as

The number of healthy years of life that can be expected on average in a given population. It is generally calculated at birth, but estimates can also be prepared at other ages. Healthy life expectancy has the advantage of capturing all causes of disability across a population and relating them to life expectancy defined by mortality.

Well, I guess. But what does this actually tell us about our health care system? We have high homicide rates for some groups, high accident for some groups...There are also less dramatic factors, mainly smoking and obesity as in

In those who were moderately obese (BMI 30 to 35, which is now common), the lifespan was reduced by 3 years. Severe obesity (BMI 40 to 50, which is still uncommon) reduced life expectancy by about 10 years; this is similar to the effect of lifelong smoking. Although severe obesity is more common in North America than in Europe, in both places it is much less common than moderate obesity, which has only a third of the effect on lifespan that smoking does.

Similarly we see Estimating health-adjusted life expectancy conditional on risk factors: results for smoking and obesity.

We have summary studies such as ScholarlyCommons - Samuel H. Preston and Jessica Y. Ho: Low Life Expectancy in the United States: Is the Health Care System at Fault? saying that

We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

It really doesn't seem particularly controversial. As Tierney of the NYT put it, talking about that study and others,

Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers.

So we have more high-risk people (becoming lower-risk with time, as smoking has declined) as input to the health care system. The more I look at the WHO rankings, the less useful I find them. I'm confident that US health care is terrible, in many ways; I'm not confident about comparing it with anything else.

I'd like to have a comparison for remaining life expectancy (or healthy life expectancy, or just mortality rate) for not-too-unfit geeky-boring 57-year-olds who have never smoked, never been drunk, never been significantly overweight, and who eat the kind of food I eat.

Of course, what I really want is to compare it with the future and say how much worse things are now than they will be. Maybe so: Next Big Future points out US Life Expectancy at Record High:

Age-adjusted death rates in 2007 decreased significantly from 2006 for 8 of the 15 leading causes of death...

That's progress, and it is part of a long-term trend. Back in 2002, the AAAS Science magazine described the Broken Limits to Life Expectancy:

For 160 years, best-performance life expectancy has steadily increased by a quarter of a year per year, an extraordinary constancy of human achievement. Mortality experts have repeatedly asserted that life expectancy is close to an ultimate ceiling; these experts have repeatedly been proven wrong.

Citing that article, I see economist Bryan Caplan saying that

in their most recent population projections, the UN has given up the assumption of a maximum life expectancy and assumes continuing improvements...

I do think it's likely that Kurzweil, de Grey etc are right in presenting The Methuselah Manifesto, whether or not its specific timescale is accurately presented by

“We are very close to the tipping point in human longevity,” asserted Kurzweil to the conferees. “We are about 15 years away from adding more than one year of longevity per year to remaining life expectancy.” This has been labeled by summiteer and life-extension guru Aubrey de Grey as longevity escape velocity.

That won't stop me from falling downstairs or being hit by a meteorite tomorrow morning, but it's interesting. I guess I haven't really changed my views much since writing Stemcell Cyborgs back in fall 2009, and so my primary concern with healthcare "reform" has to be the issue of innovation.

And personally, of course, with the effort to last long enough for innovations to work. My grandparents lived into their 80s, which sort of suggests a possible thirty years; if the "quarter of a year per year" linear improvement applied, that would stretch to forty; if Kurzweil is right, that's more than double what would be needed to make my will irrelevant. Ha. Well, anyway, I get bored with one exercise program and adjust it somewhat; three years ago I wrote on Exercise, Diet, and Self-Experimentation that

three times a week I do forty sit-ups, forty pushups, twenty minutes trotting up and downstairs for a total of 900-something feet up and the same down, and then twenty chin-ups or pull-ups on a doorway chinning bar.

Since then I've found that a long gap doesn't greatly affect the number of sit-ups etc that I can do, and there really doesn't seem to be any difference (from a maintenance point of view) between every-other-day and once-a-week, so this morning I did twenty chin-ups, then fifteen more a few minutes later, then ten more a few minutes after that; I'll get back to chin-ups (or pull-ups) next week. Tomorrow I'll be going up and down stairs in a similar fairly-high-intensity ten times per set, three sets separated by a few minutes. Maybe I'll be carrying weights for one of the sets.

Or on the other hand, maybe not.

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