An absolutely fantastic find. Thanks.

An echocardiogram doesn't necessarily help a patient directly per se, because it's not a 'treatment' procedure. It's used to accurately diagnose conditions in the heart without the need to open the chest, etc. They were a significant advancement in cardiology due to the non-invasive nature and should not be misunderstood as being useless.

It's important to understand what he probably means here: That he's talking about echos ordered when the condition of the patient is already known or can be more easily determined via other means.

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I have a feeling that our low life expectancy in the US is due to lifestyle more than health care. People here, on average, have much higher body fat and exercise far less (including walking) than those in other countries. These are both great ways to ensure that you die at a younger age than you would have otherwise, even with good health care.

I also suspect that this is one factor in the high per capita cost. Emergency care, especially when involving surgery, costs far more than standard care. When there are more people who are obese and sedentary there is generally a greater demand for those expensive emergency treatments. Many of the most costly diseases (diabetes, heart disease, cancer, etc) are strongly associated with unhealthy lifestyles, and therefore health care costs tend to correlate with such lifestyles as well.

Of course, diagnostic tools like electrocardiograms are not going to be effective if the patient doesn't care about the results. The test isn't going to cure them. A person might be upset to find out they have heart disease, but how likely will they be to give up cheeseburgers? My grandfather had a lung removed because of lung cancer, but not even that experience put a dent in his smoking habit.

Obviously there are lots of expensive medical procedures that have very little relation to lifestyle (treating accident victims for example), but I don't see how preventable health problems wouldn't inflate our per capita spending numbers. It may be true that treatments simply cost more here than anywhere else, but that isn't the whole story.

^ i agree. i cant tell you how many patients i see that have nothing else wrong with them that doesnt directly relate to their morbid obesity. my hospital started a wellness program for employees, which provides incentives for adopting healthy lifestyles. they started to supplement the costs of gym and weightwatchers memberships. and thats a great idea.

i would like to see data looking at obesity and obesity related illnesses compared to household income. its significantly more expensive to eat healthy than it is to eat junk all the time. and gym memberships arent really affordable if you make nothing. a typical us town is far too spread out and laid out too poorly for walking or biking anywhere. and i think incentives for adopting healthy behaviors and better health education should be part of any healthcare bill. commutes have been proven to be a major stress factor, widespread access to efficient public transportation would have numerous benefits, just one of them is a healthier population.

a friend of mine used to attend weight watchers meetings in the small town i live in, a woman actually had to ask if putting butter and gravy on cornflakes was fattening. WHAT? i think people might know less than youd think about nutrition and exercise.

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>> ^peggedbea:
a woman actually had to ask if putting butter and gravy on cornflakes was fattening. WHAT? i think people might know less than youd think about nutrition and exercise.


This is why they should add a nutrition curriculum to schools. Enough people honestly don't know anything about maintaining a proper diet and think that getting pickles on their double cheese burger is a valid alternative to fixing a salad.

This is a brilliant cogent argument - as is the continued discussion here! (tip my hat to you gents)


Unfortunately, I'm not sure it can stand up to the pure calculated logic of:

"Socialist nazi death panels will kill us all!!! Don't let the white hating kenyan eat my freedom!!!!"
(*random gunshots fired in the air*)

A couple of more thoughts on healthcare, wrt the data analyzed in this video:

(1) Using Florida as a comparison point skews the data because of the mean age of the population. There is a disproportionately large older population in Florida and they require more health care.

(2) While I sure there are a few doctors (more than likely actually hospitals) use echocardiogram tests as a money making mechanism, it, as well as other expensive are usually unneeeded tests, is also used as "defensive medicine" against malpractice suits. The measure of whether malpractice occurs is whether what the doctor could have done was within "the standard level of care" for the area in which he/she practices. Since this is not an objectively defined standard, doctors have to play it safe by ordering tests that may not be needed in case they happen to get the 1 in 10,000 patient for which that particular test produces actionable data.

>> ^BoneyD:
An echocardiogram doesn't necessarily help a patient directly per se, because it's not a 'treatment' procedure. It's used to accurately diagnose conditions in the heart without the need to open the chest, etc. They were a significant advancement in cardiology due to the non-invasive nature and should not be misunderstood as being useless.
It's important to understand what he probably means here: That he's talking about echos ordered when the condition of the patient is already known or can be more easily determined via other means.


That's a really good point. If he's trying to draw a line between frequency of using EKGs for diagnostics and "the survival of elderly people in the year following a severe heart attack"; that doesn't necessarily make any sense even as a correlation.

If diagnostic EKGs accomplish their goal; to identify those with heart damage so they can be targeted for preventative care, those borderline patients are taken out of the pool of patients that goes on to have heart attacks. Meaning that when we ONLY look at those who go on to have severe heart attacks, we're looking at a group of people with worse hearts relative to the sample you'd expect if no preventative care had been given.

But still, he's absolutely right in general that our health care spending is incredibly inefficient. So upvote for the first two graphs and how well they were presented.

It's much simpler.. The US spends more in total $$ and per capita then just about any "socialized medical" country.

ie. in the US more money is paid by just about everyone then in countries where healthcare is "free" or at least universal.

You are being robbed by insurance companies making huge profits and closing hospitals left and right.

Wish he had given more examples of superflous treatments, and more generalised examples of spending vs heathcare. but it wasnt bad.

The scientist is absolutely right. He could've also pointed out how much government involvement in healthcare has increased over all those years. That would explain why costs have been rising while quality and results haven't.

We really do need healthcare reform. It should start by reducing government involvement in healthcare.

The administrative overhead required in a private healthcare system is pretty crazy. Large hospitals in the US have entire floors/departments dedicated to dealing with insurance, whereas in Canada it's like one single guy in a small office somewhere.

^ If the private healthcare market wasn't so strictly and arbitrarily regulated, it would have much smaller administrative costs.

^
no, that's not the problem at all. higher costs for less effective treatment & poorer outcomes is endemic in the US. health providers are incentivized to order unneeded tests and procedures, as it increases their income. Practitioners in Canada, and I'm sure in other countries with effective socialized medicine programs, are paid based on the type of visit, not per order given.

I am so completely boggled at the closed-mindedness of segments of the American population to change - the American system doesn't work as well as numerous other nationalized healthcare systems. There are countless data to prove this fact.

It's much simpler.. The US spends more in total $$ and per capita then just about any "socialized medical" country. ie. in the US more money is paid by just about everyone then in countries where healthcare is "free" or at least universal. You are being robbed by insurance companies making huge profits and closing hospitals left and right.

You are making some false correlations here. Take a look at any market you want - say - personal care products. The US spends more on personal care than any country in the world. And yet we're still getting dirty. This is not because of evil "Big Toiletry" profits. It is simply a matter of the dynamics of macroeconomics.

EVERY market in the US suffers from the same phenomenon you're complaining about. Food, luxuries, textiles, housing, you name it. The US markets are bigger, and the overall costs are higher because that's the macroeconomics of the US standard of living and economy.

It untrue to claim that US health care costs are only high because of insurance company profits. Costs are high for a host of reasons including administrative costs, research & development, malpractice insurance, litigation settlements, insurance fraud, illegals abusing the system, high costs in the U.S. in general, as well as the array of lifestyle problems US citizens have. Insurance companies are part of the cost it is true, but it is a false argument to say that those costs would lower under a public option. If anything, the costs would probably increase because government overhead, oversight, and administration would be astronomically high. Replacing the insurance bureaucracy with an even BIGGER government bureaucracy is not going to drive down costs. Medicare and Medicaid are two 'public' systems in the US that conclusively prove that government involvement in medicine does not result in cheaper costs.

>> ^gtjwkq:
^ If the private healthcare market wasn't so strictly and arbitrarily regulated, it would have much smaller administrative costs.

Please attempt to offer more than prepackaged Conservative anti-reform sound bites.

If you intend to make the point that regulation is the cause of rising health care costs then supply some supporting evidence. If all you're going to do is make arbitrary hyperbolic statements then you're not doing anything to change anyone's opinions.

^ Not your regular conservative, libertarian. Not against reform, I'm 100% in favor of reforming by reducing government interference. Changing people's opinions is not my immediate concern, maybe helping them think, talk about alternatives, common sense?

More government interference implies in increased costs for the private sector to cope with added regulations. How is that an "arbitrary hyperbolic statement"?

If someone gave you hoops for you to jump through during your normal day-to-day activities, would they:

a) Make your life more fun for each added hoop you have to jump through

b) Make your life easier for each added hoop you have to jump through

c) Make your life harder for each added hoop you have to jump through