August 23, 2007
The Cancer Question
Andrew Sullivan is quite pleased that the US is #1 in cancer survival rates. So am I! Problem is, we don't know what that means. The US has the most aggressive tumor screening in the world. That means we find some tumors earlier, but we also find many tumors that would have been non-lethal, or proven so slow-growing that something else would have killed the individual before the cancer did. In those cases, our treatments are, at best, an enormous waste of money, and at worst, more damaging than the disease. The question is how many otherwise lethal cancers we're curing, not merely how many cancers we're curing (or slowing).
Moreover, simply having the highest survival rates isn't a particularly useful metric of whether we're getting good value for our money. Our 5-year cancer survival rate, according to the study Andrew links, is 62.9%. Italy's is 59%. Italy spends about $2,532 per person. America spends about $6,100. And these numbers, incidentally, are adjusted for purchasing power parity. Then there's the question of who our treatment is best for. Not the poor. Studies show significantly lower mortality rates for the low-income cancer patients in Canada than in the US. Is this all a good deal? Maybe. But Sullivan should explain why we should believe that.
At the end of the day, the question is never American health care: Good or bad. It's whether it can be better. It's whether we get good value for our dollar. It would be absurd if a system that spends twice what anyone else does didn't demonstrate superiority in some areas. The question is why so few, and why by such minor margins (a percent or two, in this case). It baffles me -- genuinely baffles me -- that conservatives seem so intent on defending an obviously bad deal. I don't know if it's a reflexive, for-what-the-left-is-against kind of thing, or whether they're worried about the specter of a single-payer system very few people support, but it leaves them clinging to scraps of evidence, and ignoring vast swaths of the story.
For more on the cancer question, see Jon Cohn's excellent column on the subject.
Seeing the US #1 in anything always draws a heavily nuanced article to knock 'em down a peg. Can't have that!
Posted by: The Traveler | Aug 23, 2007 10:12:09 AM
"whether they're worried about the specter of a single-payer system very few people support,"
Huh? I think a lot of us support a single-payer system as more efficient and less costly. In fact, I saw Sicko with a Republican doctor who, like so many of his brethren, has always been against "socialized medicine"... at least until the last couple years, when the insurance companies started strangling payments so that Medicare is his only reliable payer. (Aetna just cut payments on his surgeries to 50%-- unilaterally.) He walked out of the film and said, "Well, a single-payer system is the only one that makes sense to me."
Of course, I sensed a wee bit of "stick it to the insurance companies" in there. But really, they have behaved so terribly, screwed over so many of us who have paid so much in premiums, that I can't think of a better industry to drive out of business. They've done it to themselves, and now they're alienating physicians. Real good business sense there.
I've never met a Canadian who wants to move here and take their chances with our health care system. But I know plenty of Americans who hope that they can move there if they have health problems. It's not a perfect system, but it works pretty well, compared to ours.
Posted by: petra | Aug 23, 2007 10:39:27 AM
Yes, Traveler, the REAL problem is that our health care pundits on the left aren't patriotic enough!
Posted by: Tyro | Aug 23, 2007 10:45:20 AM
It baffles me -- genuinely baffles me -- that conservatives seem so intent on defending an obviously bad deal. I don't know if it's a reflexive, for-what-the-left-is-against kind of thing, or whether they're worried about the specter of a single-payer system very few people support, but it leaves them clinging to scraps of evidence, and ignoring vast swaths of the story.
The current system provides a lot of money to some Americans. Those Americans don't want that to change. They also make sure that many Americans who don't make lots of money off our system will continue to associate universal healthcare with dictatorial systems like Cuba and the old Soviet Union through constant use of the term "communism."
Posted by: Stephen | Aug 23, 2007 11:20:40 AM
I think it's the knee-jerk political response you note, Ezra, plus the knee-jerk ideological response that "because it is as it is, it is as it is meant to be."
Sullivan's view on this, I think, is "Capitalism has no downsides or failures-- and even if it does, you're a socialist, so screw you!"
Posted by: Elvis Elvisberg | Aug 23, 2007 11:31:54 AM
I love Erin Brokovich. I hope you have seen it. In it, Julia Roberts when asked by her lawyer boss how she thinks she will get the damning records they needed to build their case against PG&E responds with this wonderful line: "their called boobs Ed." She matter of factly points this out because Ed seems oblivious to how things works. Sure, he understood the techinical stuff. Sure, he understood process. But it was Erin (Julia's only good performance ever) who understood how to really get things done. He was an overthinker. How is this relevant here? I think Ezra is Ed. It's called belief Ezra.
Posted by: akaison | Aug 23, 2007 11:50:15 AM
The GOP has devolved into a cult of people whose sole objective is pissing off liberals.
This explains their issue positions, such as denying global warming BUT conceding that IF it is happening, we should not hesitate in exploiting the resources under the melting glaciers and polar caps AND moving quickly to nuclear power.
And it also explains their frequent accusations that Democrats are pro-terrorist or pro-losing wars, accusations that would have been considered absurd in prior political eras. It is simple projection. Since THEY reflexively oppose ANYTHING that Democrats support and THEY would oppose a Democratic Commander-in-Chief, even to the detriment of the country, THEY assume that WE would do the same.
Posted by: space | Aug 23, 2007 12:41:59 PM
The fact that male survival rates are so much higher in the US than other countries is a hint that something isn't kosher here. In general, male survival rates are heavily dependent on the smoking rates in the particular country (hence why England and Scotland rank so low). So the question is, are smoking rates in the US significantly lower than everywhere else in the western world? The answer is no -- in fact, they are a touch higher, if memory serves. I strongly suspect that the "something else" going on here is that the US has instituted widespread prostate screening on a much higher scale than anywhere else, and they are catching a ton of it early -- which would be great, except for the fact that prostate cancer is so slow to develop, that only a small percentage of early cancers will kill the person before something else does.
Similarly, the use of five year survival rates (and not ten year) can skew the results in favor of countries that catch cancers early but can't do anything about it. The quintessential example is lung cancer. Routine CT screening can detect lung cancer years before it causes death. But, at least with respect to the more aggressive types, that's all it can do -- it can't cure it or extend (very much) lifespan. So you have a wonderful survival time of five or six years (compared to a year or so without the screening), but the person dies at the same age anyway. Except he/she spents his last six or seven years (rather than last one year) living with knowledge of a terminal illness.
Posted by: Joe | Aug 23, 2007 1:43:09 PM
"It baffles me -- genuinely baffles me -- that conservatives seem so intent on defending an obviously bad deal."
Cue the music:
...core conservative values are money/power to the exclusion of all else.
Posted by: S Brennan | Aug 23, 2007 2:17:57 PM
I don't think conservatives are bent on "defending a bad deal" - what they're dong is knee-jerking a response to a liberal proposal they don't understand and find to be of a piece with their larger impression that liberals want government "to fix everything." You can tell this because even they know - many of them, anyway - that what we have for healthcare in this country has problems. What they're leery of is anything that sounds like socialism, or foreign or weird (which is why I'm liberal - yea, foreign and weird socialism, I say). But what I've almost never heard of, seriously, is a conservative healthcare expert. They don't seem to have them. And all of this goes back to something I've been trying to point out all along - we're having a very useful conversation about healthcare going on in this lefty blogverse, but not with everyone who needs to hear it. Lots and lots of people - ordinary people, as well as conservative policy makers - really don't understand our healthcare systems. They don't know how the things work, and they don't know what's broken or why. And until they do, we can't get buy-in on potential fixes because to do that, you'd have to agree there's a problem. And they're just not there. At least not from what I've seen. Sullivan, as we've discussed this week, comes at this from a very unique perspective that is as "I don't get it" as anyone on the right. Yes, it's great that we detect and treat more cancers early and successfully (and I'd dispute Ezra's take that the best place to question the stat is that some of the cancers wouldn't kill people - that's not going to matter to women who are happier to find their breast cancers early and have them treated well)... but that number is, as Ezra points out, distorted by combining the large segment of the population with insurance with the large segment of the population which doesn't. Combined the numbers look great; separately, they look horrible for the poor and uninsured. We need knowledgeable people to explain that, not to us, but to everyone else. Otherwise, we really can't move forward... boobs or no (though I agree with akaison's assessment).
Posted by: weboy | Aug 23, 2007 4:49:05 PM
To be fair, this is mostly among the conservative pundit class. I know many who not only admit there is something wrong with healthcare, but believe that govt in the solution. Clearly the polls that show upwards of 60 to 70 percent want govt action reflect this. what we see on this issue are true believers in their own rhectoric.
Posted by: akaison | Aug 23, 2007 5:04:30 PM
Posted by: judy | Oct 11, 2007 7:22:30 AM
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