Lower US life expectancy not due to healthcare

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Lower US life expectancy not due to healthcare

Postby athelas » Mon Aug 10, 2009 6:43 pm UTC

It is a common talking point that life expectancy in the US is lower than that in European countries and Japan, and this is a sign that the US system of healthcare is poor. This of course is over-simple to begin with, since different demographics have different health outcomes; if you use Scandinavia as an example, it's more fair to compare it to heavily-Nordic Minnesota. A paper published recently tries to separate the effect of healthcare vs. personal choices and demography, and finds that if anything, the American healthcare system has been more successful in mitigating the lower life expectancy.
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors.

This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role.

We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. 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.

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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Mon Aug 10, 2009 7:49 pm UTC

A quick counterpoint- if you view the health care system as the entire apparatus of life, do the lifestyle choices subsidized by the government have a role to play? In other words, should the reliance of the American food industry on corn (caused by corn subsidies) and the reliance of many American commuters and industries on automobiles (caused by subsidized highways, rather than mass transit) have a part to play in comparing health care systems?

I would argue no, both because it's not part of the compared solutions (people arguing for universal health care are often people that argue for expanded mass transit, but they rarely argue for them as a package deal) and there are significant other effects at play (ok, everyone should move to a tiny island nation powered by geothermal energy!).
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Re: Lower US life expectancy not due to healthcare

Postby Angua » Mon Aug 10, 2009 7:51 pm UTC

Vaniver wrote:(ok, everyone should move to a tiny island nation powered by geothermal energy!).
This will soon be me! Provided the island doesn't explode and the geothermal plant gets built
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Re: Lower US life expectancy not due to healthcare

Postby Kaiyas » Wed Aug 12, 2009 5:13 am UTC

Correct me if I'm wrong, but I always thought the low life expectancy was primarily linked to our higher infant mortality (which is in turn linked to the high number of preterm deliveries).
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Re: Lower US life expectancy not due to healthcare

Postby Zamfir » Wed Aug 12, 2009 6:45 am UTC

Kaiyas wrote:Correct me if I'm wrong, but I always thought the low life expectancy was primarily linked to our higher infant mortality (which is in turn linked to the high number of preterm deliveries).


That used to be the party line, yes. This is a new attempt.

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Re: Lower US life expectancy not due to healthcare

Postby C.B » Wed Aug 12, 2009 12:57 pm UTC

Couple of quick problems with the study in OP, maybe someone with knowledge can clear this up for me?

- This study deals with different diseases/conditions separately. Is it covering the majority of all diseases that ultimately kill people? (I mean, cancer is supposed to be the cause of a 1/3rd of all deaths, isn't it? Cancer is covered here, so do heart attacks and strokes account for the other 2/3rds?)

- Though it has good things to say about prostate/breast cancer screening, the study otherwise only includes people who were getting treatment. Does this therefore imply that the life expectancy discrepancy is down to people not being treated?


As an aside, there was a great Bill Bryson article some years ago* where he had gone over the statistics and worked out that as an American, he was twice as likely to die in a tragic accident than a Brit. He put it down to guns and seatbelts, IIRC.

*it'll be in Notes from a Big Country

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Re: Lower US life expectancy not due to healthcare

Postby Zamfir » Wed Aug 12, 2009 1:13 pm UTC

C.B wrote:- This study deals with different diseases/conditions separately. Is it covering the majority of all diseases that ultimately kill people? (I mean, cancer is supposed to be the cause of a 1/3rd of all deaths, isn't it? Cancer is covered here, so do heart attacks and strokes account for the other 2/3rds?)


The study says that together they cover 61% of all deaths. But their main point is that they want to separate factors that influence life expectancy through medical care from factors, like smoking or seatbelts, that are not directly related to the quality of health care, and they use diseases that are particularly dependent on the quality of health care. But it's a bit dubious what their results really prove beyond the observation that if you are treated for cancer or cardio disease, the US is not a bad place.

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Re: Lower US life expectancy not due to healthcare

Postby Jebobek » Wed Aug 12, 2009 1:54 pm UTC

Vaniver wrote:A quick counterpoint- if you view the health care system as the entire apparatus of life, do the lifestyle choices subsidized by the government have a role to play?
If you think the government should start taxing people hard for eating bad food at McDonalds, then I guess the entire system is not working hard enough.

Parents are looking at their clinically obese kids and wondering why a nutritionist just called their kid "undernourished". The nutritional advice they give can only do so much to prevent heart hardships in the future.

Healthcare could be better, but there is alot more lifestyle issues in America that could be better, too. So you could say that the entire US's "apparatus of life" is causing a lower US life expectancy, then blame the government I guess.
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Wed Aug 12, 2009 2:38 pm UTC

Jebobek wrote:So you could say that the entire US's "apparatus of life" is causing a lower US life expectancy, then blame the government I guess.
I don't blame the government (and a prefer a system that doesn't try to run people's lives for them). My point was just that if you expand "health care" to "everything the government does that impacts health," then the argument in the OP is weaker. I don't think that's a fair expansion, though.
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Re: Lower US life expectancy not due to healthcare

Postby Jebobek » Wed Aug 12, 2009 2:46 pm UTC

Whoops, I meant the "you, the audience" form of "you." Sorta gathered your stance in your second paragraph.
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Re: Lower US life expectancy not due to healthcare

Postby athelas » Thu Aug 13, 2009 3:51 pm UTC

Zamfir wrote:That used to be the party line, yes. This is a new attempt.
Do you have an argument?

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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Sun Aug 16, 2009 6:10 am UTC

athelas wrote:
Zamfir wrote:That used to be the party line, yes. This is a new attempt.
Do you have an argument?


You don't need an argument when you are directly answering a question raised by another poster. And it is very much on point to note when excuse-makers switch arguments, whether its AGW denialist switching from "the globe is warming" to "it's all caused by the sun" or apologists for Americans' shitty life expectancy switching from "it's infant mortality" to "it's lifestyle." It doesn't automatically make the new argument faulty, but it's relevant information.

The study itself comes not from a medical journal, or a journal of epidemiology, or healthcare statistics, but is a "working paper" from -- wait for it -- "National Bureau of Economic Research." Coming up next, what a electrical engineer thinks about climate change. Again, it's not wrong to get your data on what Americans are dying of and why from Milton Friedman et al, rather than, say, someone who studies public health, but it should be noted.

The uncomfortable reality the Chicago School is trying to explain away here is that Americans average 4 fewer years of healthy life than people in European countries practicing the far cheaper option of "socialized medicine." The accurate part of the paper is this: we don't know for sure why. We're fatter than many of these other countries, but we also drink less and smoke less. We have more homicides and car wrecks, but these can account only for a small part of the difference. So it isn't clear that lifestyle explains the difference, as some claim.

On the other hand, we have a demonstrably shitty healthcare system, with delays in care related to lack of insurance, mistakes in care related to a lack of communication and coordination between providers, and an overuse of scans, tests, and procedures, or which a lot has been written about the expense, but which also and more importantly shorten lives when they are used in excess of the need. Every 3,000 CT scans, on average, gives us one additional death from cancer. We perform 60 million CT scans a year.

This system is unique among wealthy nations and probably explains, in part, our lower life expectancy. However, we are unique in other respects as well. We are unique in the shoddiness of our safety net, the lack of worker protections, the unwillingness of our body politic to provide food and shelter to everybody, whether they are unfortunate or a screw-up or both. And those stresses, especially when applied to pregnant women and young children, probably explain some of the deficit in life expectancy as well. It's uncertain how much of this deficit would be remedied if we expand medical coverage whilst retaining our distinctive "red in tooth and claw" style of government.

At birth, someone living in the Netherlands can expect to live 2.35 years longer than someone born in the US, but at age 65, the difference is reversed, and someone living in the US can expect to live 0.4 years longer than someone living in the Netherlands.

Sources: CDC national vital statistics 2004, http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf and RIVM 2007 levensverwachting, http://www.rivm.nl/vtv/object_document/o2309n18838.html (in Dutch).


http://yglesias.thinkprogress.org/archi ... -facts.php

That's an interesting fact to interject into the discussion, since every American over sixty-five enjoys single-payer healthcare. It suggests we look back at the statistics for prostate and breast cancer and heart attacks and strokes and realize that by far, most of the people who suffer from those aliments are over sixty five. It would be interesting to look at what the younger folks -- who have not yet reached the umbrella of "socialized medicine" -- are dying of and how these statistics compare.
Last edited by EMTP on Sun Aug 16, 2009 6:38 am UTC, edited 1 time in total.
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Sun Aug 16, 2009 6:32 am UTC

EMTP wrote:On the other hand, we have a demonstrably shitty healthcare system, with delays in care related to lack of insurance, mistakes in care related to a lack of communication and coordination between providers, and an overuse of scans, tests, and procedures, or which a lot has been written about the expense, but which also and more importantly shorten lives when they are used in excess of the need. Every 3,000 CT scans, on average, gives us one additional death from cancer. We perform 60 million CT scans a year.
I agree those are problems (particularly the overuse of scans, tests, and procedures), but I'm not sure the government having more control of health care industry will fix those things. When given a complicated problem, I prefer the solution of "give it to everyone" over "give it to a panel of experts"- not because of a fear of experts or love of the 'real American,' but because I think that experimentation is better is dictation. Particularly when you look long and hard at the question of who does the dictation.

EMTP wrote:the unwillingness of our body politic to provide food and shelter to everybody
Hm? Food is definitely provided, and shelter is mostly provided. I imagine we provide subsidized / free housing on the same or higher level than other countries.
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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Sun Aug 16, 2009 6:48 am UTC

I agree those are problems (particularly the overuse of scans, tests, and procedures), but I'm not sure the government having more control of health care industry will fix those things. When given a complicated problem, I prefer the solution of "give it to everyone" over "give it to a panel of experts"- not because of a fear of experts or love of the 'real American,' but because I think that experimentation is better is dictation. Particularly when you look long and hard at the question of who does the dictation.


What is on the table at this point amounts to tighter regulation of the health insurance companies. Generic suspicion of "government control" doesn't really address the specifics of what is being proposed. No one is actually suggesting giving over medical decisions to "a panel of experts." Rather, what is being suggested is sensible stuff like spending a little money to find out if the treatment we are using are actually working. That's a good idea. We ought to be introducing an American version of "NICE" into this bill, as regards healthcare taxpayers pay for. But we're not. Hence all the arguments about shadowy "experts" denying people care rests on a slippery slope fallacy. Not to mention the fact that no government panel under any conceivable scheme of reform would affect anything other than what the government will pay for. You can always pay for your health care boondoggles yourself.

Hm? Food is definitely provided, and shelter is mostly provided. I imagine we provide subsidized / free housing on the same or higher level than other countries.


Spoken like someone who's never needed the help. You're wrong on both counts. http://siteresources.worldbank.org/SAFE ... Note25.pdf
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Sun Aug 16, 2009 7:09 am UTC

EMTP wrote:No one is actually suggesting giving over medical decisions to "a panel of experts." Rather, what is being suggested is sensible stuff like spending a little money to find out if the treatment we are using are actually working.
Forgive me if I'm not up on the current plan; I don't have the time to read frequently changing thousand-page bills. What is going to be done with the research done on the efficacy of procedures? And how is that different from current NIH grants?

The problem with government spending on efficiency is that governments rarely ask the off-the-wall questions, particularly when jobs are threatened. When dealing with patients who have suffered a heart attack, there can be countless studies on the comparative efficacy of particular treatments. But nobody will ask "hey, what happens if we replace doctors with a flow-chart nurses can understand?"- and surprisingly enough, what happens is better, faster, cheaper care. But the doctors complain bitterly about it. The hospital efficiency research I've seen has mostly been "how can we lay this hospital out better?" rather than "how can we replace fundamental aspects of this hospital?"- the second is where real progress happens, although it's incredibly unpopular.

EMTP wrote:We ought to be introducing an American version of "NICE" into this bill, as regards healthcare taxpayers pay for. But we're not.
How is NICE not a panel of experts? I mean, I'll believe you that the current bill doesn't include something like that, but I'm surprised at your claim that nobody is suggesting a panel of experts, except for you.

I mean, you go on to say that they won't deny people care, they'll just... deny them treatments. To the patients, I imagine that appears a lot like the same thing.

(I should say- if we're going to have government funded healthcare, then it should rely on actuaries who maximize the gains of quality of life / lifespan across all treatments, and that will necessarily involve denying treatments that are less cost-effective than other treatments, and not treating patients who do have some hope because the gamble isn't worth it to the public. That's what needs to happen anyway, but it's honest, and thus more efficient and probably more effective.)

EMTP wrote:Spoken like someone who's never needed the help. You're wrong on both counts.
You are correct that I have never needed government assistance for my food or shelter. However, I personally know people who do (and have second-hand knowledge of a wider group)- for example, my friend who uses food stamps got them immediately after applying (though the bureaucracy has managed to accidentally turn his card off a couple of times) and the amount he's provided is roughly three times what he eats. He doesn't require government shelter assistance because he gets all he needs from friends.
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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Sun Aug 16, 2009 7:55 am UTC

Vaniver wrote: Forgive me if I'm not up on the current plan; I don't have the time to read frequently changing thousand-page bills.


Forgive me if I don't think your "Faceless government "experts" seize control of healthcare" meme is a function of not knowing the details of the bills.

What is going to be done with the research done on the efficacy of procedures? And how is that different from current NIH grants?


What's your fear? That we might find out that certain treatments are useless or harmful and . . . horrors . . . might not chose to pay for them with taxpayer dollars? What a dystopian nightmare. Imagine living in a world where your government wouldn't pay for all the useless, ineffective medicine you could want. And then, the death panels. Seriously though, politicians hate making calls like that. So in reality, comparative effectiveness research would primarily be useful to doctors, much in the way the Ottawa ankle rules or the Canadian Head CT Guidelines are.

The problem with government spending on efficiency is that governments rarely ask the off-the-wall questions, particularly when jobs are threatened.


Different subject altogether. Doesn't really apply here. Comparing treatments to each other and to nothing is what medical researchers do. Comparative effectiveness research is not about efficiency. It's about efficacy. Similar words, different meanings.

How is NICE not a panel of experts? I mean, I'll believe you that the current bill doesn't include something like that, but I'm surprised at your claim that nobody is suggesting a panel of experts, except for you.


We are talking about the healthcare reforms being discussed by congress right now, are we not? Or is your claims that some of the people who like these reforms would also like panels of experts and hence we should oppose anything they are for?

I mean, you go on to say that they won't deny people care, they'll just... deny them treatments. To the patients, I imagine that appears a lot like the same thing.


Where do I say that? Nobody is being denied any treatments. I explained that clearly. The bills before congress don't restrict either work insurance companies can cover or what the government will cover. If someday that changed (as it should) you would still be able to take your own money out of your piggy bank and pay for whatever you want. It's pretty funny to hear people preaching the virtues of the unfettered free market on the one hand, and on the other equating "the government won't give it to me for free" with "I'm being denied treatment."

You are correct that I have never needed government assistance for my food or shelter. However, I personally know people who do (and have second-hand knowledge of a wider group)- for example, my friend who uses food stamps got them immediately after applying (though the bureaucracy has managed to accidentally turn his card off a couple of times) and the amount he's provided is roughly three times what he eats. He doesn't require government shelter assistance because he gets all he needs from friends.


Follow the link. The numbers refute your intuition completely. In the emergency room, I deal with hundreds of homeless and indigent patients every year. As a paramedic, I spent a great deal of time both in shelters and out on the streets. My father, an alcoholic, also sought public assistance repeatedly in the last years of his life. Housing and food are difficult to access for most of the people who need them and not remotely adequate to the need. We spend far less than other wealthy countries and we get what we pay for. This is the unfortunate reality. I'm glad your friend has the assistance he needs. And I can guess why. He has friends to help. Most of the people who are stuck in this population have lost, or never had, a group of finds and family who are there for them. You would not believe how fragile the life of even a healthy, hard-working person is without that backup. People generally start with a strike or two -- an addiction, or an abuse history, or just a screw-up family that went down together. Then they lose their social connections, and then they've had it. Often they come in suicidal with the pain of living like that. We put them on a hold and send them to the psych ward, where they will give them some meds and quickly cut them lose, but we have nothing to treat the underlying problem, which is that they aren't connected, or the connections aren't strong enough to pull them through.

Sorry for the digression. Anyway, our social safety net is shit. We spend less and we get less. And it seems the voters want it that way. Voters like to give to "deserving" groups -- kids, the elderly. I took care of a kid in the ED once with a rare hereditary disorder that cause recurring tumors. He got great care at Shriners' until he was 21. That worthy organization gives great healthcare to kids, and generous donors support them in that work. But when he turned 21, he wasn't a kid anymore, although the giant tumors growing out of his back didn't care about that. So, fuck him. Here he is in the ED, four years later at 25. No private insurance, of course, will touch him. But on the bright side, he only has to hang in there for forty more years -- then he'll be an old person, worthy of help again, and hence covered by Medicare.

Many voters, of course, don't know about people like him. But as the master said, they might know it.
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Re: Lower US life expectancy not due to healthcare

Postby Hawknc » Sun Aug 16, 2009 8:33 am UTC

EMTP wrote:What's your fear? That we might find out that certain treatments are useless or harmful and . . . horrors . . . might not chose to pay for them with taxpayer dollars? What a dystopian nightmare. Imagine living in a world where your government wouldn't pay for all the useless, ineffective medicine you could want. And then, the death panels. Seriously though, politicians hate making calls like that. So in reality, comparative effectiveness research would primarily be useful to doctors, much in the way the Ottawa ankle rules or the Canadian Head CT Guidelines are.

I feel like that might tangential to what Vaniver was quite reasonably asking, which is how your proposal is different to the current NIH grant process. (I say this knowing nothing about the current NIH grant process, maybe it's useless.)

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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Sun Aug 16, 2009 8:45 am UTC

Hawknc wrote:I feel like that might tangential to what Vaniver was quite reasonably asking, which is how your proposal is different to the current NIH grant process. (I say this knowing nothing about the current NIH grant process, maybe it's useless.)


How is it my proposal? It was part of the stimulus package. To my understanding, which is far from comprehensive, it differs from current NIH research in being a sum of money set aside specifically for comparative effectiveness research. There's a huge amount that needs doing. The NIH grants cover all kinds of research -- basic science, new therapies, etc. Like most of the stimulus package, it didn't involve doing something that had never been done before, but more funding for something that was already being done.
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Re: Lower US life expectancy not due to healthcare

Postby BlackSails » Sun Aug 16, 2009 10:17 am UTC

This is nothing new. Disease matched, US has much better outcomes than Europe.

The problem is we are much less healthy. So even if we have better treatment for a heart attack (we do, you cant even get out of hours cardiac cath in most of Europe- in America, at least near any medium sized city you will get it in under one or two hours), we have more heart attacks.

This is an example of Simpson's paradox.

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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Sun Aug 16, 2009 3:43 pm UTC

EMTP wrote:What's your fear? That we might find out that certain treatments are useless or harmful and . . . horrors . . . might not chose to pay for them with taxpayer dollars? What a dystopian nightmare. Imagine living in a world where your government wouldn't pay for all the useless, ineffective medicine you could want. And then, the death panels. Seriously though, politicians hate making calls like that. So in reality, comparative effectiveness research would primarily be useful to doctors, much in the way the Ottawa ankle rules or the Canadian Head CT Guidelines are.
If I have not made it clear, I like effectiveness research. I could hardly be an efficiency junkie and not. My point is that you're being inconsistent- out of one side of your mouth comes "we should set up panels to see what treatments are effective" and out of the other side comes "nobody is suggesting setting up panels to deny treatment."

EMTP wrote:Where do I say that? Nobody is being denied any treatments. I explained that clearly.
You don't say it, but it's the only conclusion I can draw from some of your statements. I mean, if we look at the lines "Not to mention the fact that no government panel under any conceivable scheme of reform would affect anything other than what the government will pay for. You can always pay for your health care boondoggles yourself." what can we see besides "the government will not pay for cost-ineffective treatment"?

As stated, I like taxpayer dollars not going towards cost-ineffective treatment. But I don't like people misrepresenting what they're pushing.

EMTP wrote:It's pretty funny to hear people preaching the virtues of the unfettered free market on the one hand, and on the other equating "the government won't give it to me for free" with "I'm being denied treatment."
I prefer a market with minimal fetters to one with no fetters, but as for the "denying treatment" claim I'm using the same language that's common for private insurers.

EMTP wrote:Follow the link. The numbers refute your intuition completely.
The numbers on non-contributory care. Of course America spends less of its GDP on government redistribution than Europe- that's not a bug, it's a feature. You'll also note that the percentage of our GDP the government spends on housing is twice as high as the next highest country, Denmark. [edit- I was wrong! See more in a later post.]

Disagreeing with your methodology is not the same as disagreeing with your goal. I don't think that making the social safety net monolithic is the best way to improve it- I think it has a vast number of negative side effects.
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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Sun Aug 16, 2009 7:54 pm UTC

Vaniver wrote:If I have not made it clear, I like effectiveness research. I could hardly be an efficiency junkie and not. My point is that you're being inconsistent- out of one side of your mouth comes "we should set up panels to see what treatments are effective" and out of the other side comes "nobody is suggesting setting up panels to deny treatment."


The fallacy in your thinking is in treating me like a representative of the White House or as a spokesperson for the legislation before Congress. I, personally, would like to see a NICE-style government board, but it is not part of any version of health care reform before congress.

You don't say it, but it's the only conclusion I can draw from some of your statements. I mean, if we look at the lines "Not to mention the fact that no government panel under any conceivable scheme of reform would affect anything other than what the government will pay for. You can always pay for your health care boondoggles yourself." what can we see besides "the government will not pay for cost-ineffective treatment"?

As stated, I like taxpayer dollars not going towards cost-ineffective treatment. But I don't like people misrepresenting what they're pushing.


That's funny, given your propensity for misrepresenting what other people are saying. You're ignoring the legislation being considered in favor of a straw man. I, too, would like the government to take aggressive steps in this direction. But the current legislation does not do that. Nor is failing to pay for something at all the same as "denying treatment," which implies forbidding the treatment. It would be more honest to call it "denying coverage," but, of course, opponents of healthcare reform don't like that language, since it makes it clear that it is in no way different from what private insurance companies do on a daily basis today.

Of course America spends less of its GDP on government redistribution than Europe- that's not a bug, it's a feature.


Wow, misrepresentation is really a problem for you. Of course, the statistics cited are not for "government redistribution" but for spending on the social safety net. A propos of your (false) claim that we provide as much food and housing support to those who need it as do other rich democracies. And if you'll refer to my posts above, you'll see that I realize this is intentional. This cruel and arbitrary system is indeed a "feature" for the voters who want it that way.

Since I've provided evidence to refute your claim, why don't you provide some evidence to support the idea that we provide as much food and housing support as these other countries?

You'll also note that the percentage of our GDP the government spends on housing is twice as high as the next highest country, Denmark (with disastrous long-term results, but no good deed goes unpunished).


Not unless you think we both live in the UK. You're reading the wrong line on the chart. UK 1.5, Denmark 0.7, US -. (Which I take to mean less than 0.05% of the GDP, since they rounded down.)

Disagreeing with your methodology is not the same as disagreeing with your goal. I don't think that making the social safety net monolithic is the best way to improve it- I think it has a vast number of negative side effects.


Let's start by agreeing on where we are. We spend far less than other rich democracies, and we get far less. Proposing a different way to address the problem is different from denying or downplaying the problem. "I don't want to my government to spend more on providing food and shelter to those who need it" is different from "We provide as much food and housing support to the indigent as anybody else." The former is the truth; the latter is the rationalization.
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Sun Aug 16, 2009 8:32 pm UTC

EMTP wrote:The fallacy in your thinking is in treating me like a representative of the White House or as a spokesperson for the legislation before Congress.
When I hear "nobody," I interpret it as "nobody" instead of "not the White House" or "not Democratic Congressmen." I apologize for misunderstanding.

EMTP wrote:Wow, misrepresentation is really a problem for you. Of course, the statistics cited are not for "government redistribution" but for spending on the social safety net.
The pdf you linked to focuses solely on non-contributory social safety nets. The Shriners you mentioned don't exist as far as the pdf cares- which to me seems like a problem in interpreting its conclusions.

Are you objecting to my use of the word "redistribution?" Because if you look at the pdf, the second paragraph begins with "The OECD countries redistribute a large share of their GDP through social protection (SP) programs, about 19% of GDP in the European Union, and 9% of GDP in the US." They're pretty explicit that they're dealing with redistribution (specifically, the redistribution to those undergoing hard times).

EMTP wrote:Not unless you think we both live in the UK. You're reading the wrong line on the chart. UK 1.5, Denmark 0.7, US -. Which I take to mean less than 0.005% of the GDP, since they rounded down.)
I apologize! I did read the wrong line on the chart. But I find it preposterous that we're spending less than seven hundred million dollars annually on public housing and other housing subsidies. I mean, that's ~1% of Fannie Mae's 2008 revenue (I realize the pdf used 2004 numbers, and I used more current numbers, so the numbers will be off by a little- but not by that much).

EMTP wrote:Let's start by agreeing on where we are.
First we would have to agree on who we are. Unlike government programs, private charity is hard to tally- and so it's difficult for me to provide statistics on the benefit done by private charity, when most of the private charities I'm affiliated with wouldn't show up!

I'm saying that public charity is, in general, less beneficial and less cost-effective than private charity. I think there are few, if any, charities that feel they are doing an adequate job to ameliorate their chosen social problem- and so it's hard to do comparisons, especially between a centralized and a decentralized system.
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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Sun Aug 16, 2009 9:21 pm UTC

Vaniver wrote:When I hear "nobody," I interpret it as "nobody" instead of "not the White House" or "not Democratic Congressmen." I apologize for misunderstanding.


Let's look at the quote:

What is on the table at this point amounts to tighter regulation of the health insurance companies. Generic suspicion of "government control" doesn't really address the specifics of what is being proposed. No one is actually suggesting giving over medical decisions to "a panel of experts." Rather, what is being suggested is sensible stuff like spending a little money to find out if the treatment we are using are actually working. That's a good idea. We ought to be introducing an American version of "NICE" into this bill, as regards healthcare taxpayers pay for. But we're not.


I'd say the context makes it pretty clear that "no one" refers to those drafting the legislation and not everyone in the world. At any rate, now we understand each other.

The pdf you linked to focuses solely on non-contributory social safety nets. The Shriners you mentioned don't exist as far as the pdf cares- which to me seems like a problem in interpreting its conclusions.


If you would like to provide some evidence this is so, please.

Are you objecting to my use of the word "redistribution?" Because if you look at the pdf, the second paragraph begins with "The OECD countries redistribute a large share of their GDP through social protection (SP) programs, about 19% of GDP in the European Union, and 9% of GDP in the US." They're pretty explicit that they're dealing with redistribution (specifically, the redistribution to those undergoing hard times).


But you didn't say "redistribution to those undergoing hard times." You treated the statistics as measures of wealth redistribution, which they are not. This changed the subject from the social safety net -- are we providing food and housing to those who need it? -- to wealth redistribution.

I apologize! I did read the wrong line on the chart. But I find it preposterous that we're spending less than seven hundred million dollars annually on public housing and other housing subsidies.


It would be less than $7 billion, I believe ($14 trillion * .05 * .01 = $7 billion). Does that figure sound more reasonable?

First we would have to agree on who we are. Unlike government programs, private charity is hard to tally- and so it's difficult for me to provide statistics on the benefit done by private charity, when most of the private charities I'm affiliated with wouldn't show up!


But it's not hard to track homelessness and hunger in America and compare them to homelessness and hunger in Denmark, or the UK, or all the other countries which spend more than we do. If the gap in being made up by private spending, which is more efficient, we should expect the results to be all the more tilted in favor of our capitalist paradise. In fact, America's a hellhole, results-wise. And as far as the spending we can track, we spend far less. Less spending, less results. That's the evidence in hand. If you have other evidence, please provide it.

I'm saying that public charity is, in general, less beneficial and less cost-effective than private charity.


Shouldn't you support your first assertion with something other than another (unrelated) unsupported assertion? The question was whether we provide as much food and housing support to the indigent as other countries. (We don't.) The most efficient way to provide that support is a completely separate issue. You could relate the two questions, if, for example, you wanted to say "We don't provide as much support for the indigent as other countries, but the way to change that is through private, not public, initiatives." Then your assertion bears on what we're talking about, although you still haven't supported it with any evidence.

I think there are few, if any, charities that feel they are doing an adequate job to ameliorate their chosen social problem- and so it's hard to do comparisons, especially between a centralized and a decentralized system.


What's wrong with looking at outcomes? Food insecurity, hunger, deaths from exposure, number of people sleeping in cars or sleeping rough -- outcomes data abounds. The data might not support the theory, but that doesn't mean comparisons are hard -- emotionally hard, maybe, if you're attached to the hypothesis, but not hard in a general sense.
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Mon Aug 17, 2009 12:06 am UTC

EMTP wrote:If you would like to provide some evidence this is so, please.
Evidence that what is so? That they're considering non-contributory programs only? It says so right in the pdf.

EMTP wrote:But you didn't say "redistribution to those undergoing hard times." You treated the statistics as measures of wealth redistribution, which they are not. This changed the subject from the social safety net -- are we providing food and housing to those who need it? -- to wealth redistribution.
But, it's still redistribution! If you oppose the methodology of wealth redistribution, the ends don't matter. If you support the ends of redistribution, you should be honest about the method- if "we" are providing food and housing to those who need it, then food and housing is going from us to them.

EMTP wrote:It would be less than $7 billion, I believe ($14 trillion * .05 * .01 = $7 billion). Does that figure sound more reasonable?
I was going off your .005%, which looks like it was a misplaced decimal. I still think the true amount of government expenditure on housing is more than $7 billion annually, although it's mostly in opaque ways which are hard to quantify (how much of Fannie Mae / Freddie Mac's activity should count? What's the dollar value of the various equal opportunity laws?)

EMTP wrote:But it's not hard to track homelessness and hunger in America and compare them to homelessness and hunger in Denmark, or the UK, or all the other countries which spend more than we do.
Do you know if there are other relevant factors (urbanization, ethnic breakdown, mean property value, etc.)? It seems unlikely, since most of those factors look like they would point in the opposite direction (unless urbanization is negatively correlated with homelessness).

EMTP wrote:What's wrong with looking at outcomes?
The primary problem with looking at outcomes in an economic comparison (which appears to be the way we're looking at this) is that there tends to be too much going on to accurately separate out causes.* The outcomes are, essentially, very noisy- and so there will be a significant number of false negatives and false positives. I do believe your data that the US has less government spending than other countries. I don't think you've provided data that we have worse outcomes- but even if that data exists, it doesn't recommend the non-American program by itself.

*For example, if property values in the US are significantly higher than property values in other countries, we could provide more subsidies and still end up with higher homelessness. I notice Japan has a "-" for Housing- how do its homelessness numbers compare?
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Re: Lower US life expectancy not due to healthcare

Postby Marquee Moon » Mon Aug 17, 2009 3:28 am UTC

Two points on the World Bank link:

First, as the report's text explains there are two main safety net models: the Anglo-Saxon model which focuses on 'targeted' benefits, and the European model which focuses on universal benefits. With this in mind, we should only be comparing countries that use the same broad model. The countries (and spending percentage) that follow the Anglo-Saxon model are:

Australia- 10.1
Canada- 8.4
Ireland (I assume)- 7.9
New Zealand- 11.6
United Kingdom- 13.7
United States- 8.0

The US still has a relatively low percentage, but it doesn't seem like such an outlier. EMTP, do you think other Anglo-Saxon model countries like Canada and Australia are not taking care of their poor?

Second, I think Safety Net Spending as a percentage of GDP is a bad measure, especially considering the country we're focusing on, the US, has the second highest GDP per capita on that list. Imagine two 'economies' with only ten people in them. Both have one person on 'social welfare', and they both receive about the same amount of food and shelter etc. But one 'economy' produces twice as much stuff as the other economy (because they've got robots or something). If we just look at spending as a % of GDP, the one with the small economy looks like it's spending more, even though both economies spend the same amount and both are taking care of their poorer citizen. Now, you might say that the people in the rich economy should give more since they have more to give, but I think that's a separate issue. I think what's more important and what's being discussed is the absolute standards of living of a country's poor, not the size of the rich poor gap. (sorry if I've misinterpreted)

I think a better measure would be safety net spending per capita. This has some imperfections as well, but well every measure does. This is at least better than the % of GDP measure. We can get a spending per capita "number" by multiplying the % of GDP numbers by GDP per capita. This is gonna give us a really rough number since we're multiplying estimates by estimates and I don't know if the world bank used PPP or what year they used or whatever. But I'm curious so I'm gonna do it anyway. Here's some numbers:

US- 374
NZ- 313.2
Australia- 360.6
Canada- 305.8
Ireland- 349.2
UK- 485

Iceland- 309.1
Japan- 310
South Korea- 67.2
France- 591.6
Sweden- 546
Germany- 566

The numbers are basically meaningless, but they can be compared. More positive means more spending per capita basically. Interestingly, the US 'beats' all non-European countries bar the UK, though Europe is still far ahead. Now these numbers are probably so inaccurate they're useless, but I do think the US was unfairly disadvantaged in the World Bank pdf because its relatively high GDP per capita.

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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Mon Aug 17, 2009 5:51 pm UTC

Vaniver wrote:Evidence that what is so? That they're considering non-contributory programs only? It says so right in the pdf.


Evidence that that is "a problem in interpreting its conclusions." Since we never have an infinite amount of perfect data, it's always possible to complain that the data doesn't include something that might change the picture. I'd like you to provide some evidence to back up your claims.

But, it's still redistribution! If you oppose the methodology of wealth redistribution, the ends don't matter. If you support the ends of redistribution, you should be honest about the method- if "we" are providing food and housing to those who need it, then food and housing is going from us to them.


But it's not all (total) redistribution, therefore it does not compare their redistribution to ours. It's false to conclude, on the basis of this information, anything about the total redistribution practiced by the countries, since of that, the social safety net is only a part. False equivalence of the specific and the general cases is misleading as well as factually incorrect. For example, imagine I were to say that those who oppose torture in interrogations are opposed to aggressive law enforcement. Misleading, yes? Yet torture is certainly aggressive law enforcement by anyone's definition. But the switch from the specific policy to one of the many general categories to which it belongs is a distortion.

I was going off your .005%, which looks like it was a misplaced decimal. I still think the true amount of government expenditure on housing is more than $7 billion annually, although it's mostly in opaque ways which are hard to quantify (how much of Fannie Mae / Freddie Mac's activity should count? What's the dollar value of the various equal opportunity laws?)


Wow, I corrected that after, like, 5 minutes. You've got quick eyes. Anyhow, do you have a dollar estimate? Again, I'd like to see you produce some evidence to support your assertion. You were quite confident in asserting that we provide food and housing support to the indigent at the same rates as European countries. Now you seem to be saying that all is shadow and mystery. Does that mean that, on further reflection, you're not sure?

Do you know if there are other relevant factors (urbanization, ethnic breakdown, mean property value, etc.)? It seems unlikely, since most of those factors look like they would point in the opposite direction (unless urbanization is negatively correlated with homelessness).


What does mean property value have to do with anything? Homelessness and hunger are worse here, or they are not. The overall wealth of the society is easy to measure. Again, it seems that arguments that challenge your favored policies are being held to a very different standard of proof from your own intuitions, which you seem to believe don't require any factual support at all.

I do believe your data that the US has less government spending than other countries. I don't think you've provided data that we have worse outcomes- but even if that data exists, it doesn't recommend the non-American program by itself.


It's not my responsibility to provide all the data and present it to you for your critique. I have provided some good evidence, you have provided none at all. In practice, I think the fact that you are already furiously spinning the results with a laundry list of supposed confounders, and the caveat that even if the data supports which I'm saying, it doesn't suggest anything about policy, amply demonstrates that you know very well what the data will show. Homelessness is worse, hunger is worse, poverty is worse.

I notice Japan has a "-" for Housing- how do its homelessness numbers compare?


Why don't you do some research and tell me?

Marquee Moon wrote:Two points on the World Bank link:

First, as the report's text explains there are two main safety net models: the Anglo-Saxon model which focuses on 'targeted' benefits, and the European model which focuses on universal benefits. With this in mind, we should only be comparing countries that use the same broad model.


Why? That doesn't follow at all. The question was how different countries deal with hunger and homelessness. By your logic, if some caregivers treat patients using allopathic ("Western") medicine, while others use leeches and prayer, the results of the leeches-and-prayer doctors should only be compared to each other, not the allopathic healthcare workers.

In fact, the health outcomes between the two groups are significantly different (1), whilst the economic competitiveness of the two systems is, by some measures, roughly the same(2):

HEALTHY LIFE EXPECTANCY (HALE)

Canada 72
Australia 73.2
UK 71.7
US 70
NZ 69.2

Average: 71.2

(Note we are the second-worst in the Anglo-Saxon group)

Netherlands: 72
Swiss: 72.5
Italy 72.7
Spain 72.8
Belgium: 71.6
Greece: 72.5
Sweden: 73
Austria: 71.6
France: 73.1
Germany 70.4
Norway 71.7
Denmark: 69.4

Average: 71.9

The non-Anglo-Saxons live longer, healthier lives. (1) http://www.photius.com/rankings/healthy ... able2.html)


As to competitiveness, the AS countries constitute 20% of the "Stage Three" countries cited in the "Global Competitiveness Report." And two of them -- the US (1) and Canada (10) are in the top ten in its competitiveness rankings, joining countries with very different approaches like Sweden, Norway, and Denmark.

So the take home -- touching back on the comment that start the discussion of hunger and homelessness -- is that the AS countries have weaker social safety nets, and this, quite possibly, is part of the reason why their citizens suffer shorter, sicker lives than their European counterparts (as you may recall, I suggested this in order to point out that healthcare reform, by itself, may not erase the gap in life expectancy between us and countries with a more robust welfare state.) I include the information on economic competitiveness for general interest, as one of the questions that arises when discussing countries with extensive social safety nets is whether they put those countries at a competitive disadvantage.

Sources:

Aided by Safety Nets, Europe Resists Stimulus Push

http://www.nytimes.com/2009/03/27/world ... wanted=all

Thriving Norway Provides an Economics Lesson

http://www.nytimes.com/2009/05/14/busin ... rugal.html

The Global Competitiveness Report 2008-2009

http://www.weforum.org/pdf/GCR08/GCR08.pdf


The countries (and spending percentage) that follow the Anglo-Saxon model are:

Australia- 10.1
Canada- 8.4
Ireland (I assume)- 7.9
New Zealand- 11.6
United Kingdom- 13.7
United States- 8.0

The US still has a relatively low percentage, but it doesn't seem like such an outlier. EMTP, do you think other Anglo-Saxon model countries like Canada and Australia are not taking care of their poor?


All countries spend pretty heavily on old age pensions (possibly because old people as a group tend to vote in large numbers, as opposed to, say, the homeless). If you take that out of the picture, the divergence in practices becomes more apparent:

United States: 2.8
UK: 6.0
NZ: 6.9
Canada: 3.6
Ireland: 5.5
Australia: 6.0

It's not a perfect correction, because there's no question that old age pensions indirectly reduce homelessness and hunger. However, it does show that once people are homeless or hungry, there's a significant divergence in practices between us and even the other countries you singled out.

Second, I think Safety Net Spending as a percentage of GDP is a bad measure, especially considering the country we're focusing on, the US, has the second highest GDP per capita on that list. . . I think what's more important and what's being discussed is the absolute standards of living of a country's poor, not the size of the rich poor gap. (sorry if I've misinterpreted)


What we're discussing is the provision of food and housing to the indigent. GDP seems to me to be a pretty good yardstick. Outcomes data is also important, and also reflects poorly on the US. We spend less, and we get less.

Now these numbers are probably so inaccurate they're useless,


I agree. And, again, if you control for old age pensions and look more narrowly at support for the indigent, the difference is more prominent.
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Re: Lower US life expectancy not due to healthcare

Postby Sharlos » Mon Aug 17, 2009 10:01 pm UTC

Just as a note, in australia, all citizens have to vote. Although admittedly I don't know if homeless people vote much as it's usually tied to your address and requires jumping through a few hoops if you don't have one.

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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Mon Aug 17, 2009 10:28 pm UTC

EMTP wrote:Evidence that that is "a problem in interpreting its conclusions." Since we never have an infinite amount of perfect data, it's always possible to complain that the data doesn't include something that might change the picture.
The problem in interpreting its conclusions is that you've presented that data as showing that we have less spending and less results, when the data shows only that we have less government spending, and tracks neither results nor non-government spending.

EMTP wrote:You were quite confident in asserting that we provide food and housing support to the indigent at the same rates as European countries. Now you seem to be saying that all is shadow and mystery. Does that mean that, on further reflection, you're not sure?
I only made a comparison for housing- and made clear my lack of hard data on the subject (imagining something is different from being quite confident in my world!). It would not surprise me greatly if other countries provide much more than America does, but I expect that we provide similar levels of free and subsidized housing. I don't think that you've provided evidence that we fall far behind- and so so far, my opinion is mostly unchanged.

EMTP wrote:What does mean property value have to do with anything?
The pricier homes and apartments are, the easier it is to be unable to afford a home.

EMTP wrote:Again, it seems that arguments that challenge your favored policies are being held to a very different standard of proof from your own intuitions, which you seem to believe don't require any factual support at all.
I admit to that flaw in my reasoning, because most people appear to have that flaw in their reasoning. But I work at correcting it- and change my intuitions when the facts recommend it. But I would be remiss to not wait for sufficient facts.

EMTP wrote:It's not my responsibility to provide all the data and present it to you for your critique.
It is if you want to say that you've provided the data.

EMTP wrote:Why don't you do some research and tell me?
It's defined differently in Japan than in other countries (it's "sleeping rough" instead of not having an abode) and because the rent for apartments tends to be more expensive than staying continually at a hotel- whereas in most countries the reverse is true. Anyway, according to government statistics reported by the Boston Globe Japan has around an eighth of the homelessness that the US has. It appears to be caused, at least in part, by lower rates of drug dependency- and without further research, I can't say what role mental illness plays (a few decades back, many mental institutions in the US were closed, which led to a rise in homelessness; I don't know what the state of mental institutions is in Japan). Suicides, especially related to economic conditions, are significantly higher in Japan than in the US- perhaps there are less homeless people because Japanese society drives them to kill themselves?* Government support appears entirely directed at getting street people off the streets, not from humanitarian concerns.

*Numbers: the homelessness rate in the US is roughly .00112, while in Japan it's .00015 (that's roughly one out of every 900, or one out of every 6900). The suicide rate is .00022 in the US, and .00051 in Japan (that's roughly one out of every 4500, or one out of every 2000). src I can't get their numbers to match up well, though- I'm getting an annual incidence of suicide equal to .00024 from 33,000 deaths a year in a country of 127,000,000. But anyway, if you assume that homelessness is static and suicide is dynamic (that is, the number of "slots" for homelessness people is constant and suicide removes people from those slots), which are pretty poor assumptions, you end up with it only taking 3 years for the difference in suicide rates to make up for the difference in homelessness rates.
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Re: Lower US life expectancy not due to healthcare

Postby Oort » Mon Aug 17, 2009 11:14 pm UTC

Wait - they're only looking at two types of cancer and using them to judge the entire health care system? Not a good idea.

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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Tue Aug 18, 2009 12:49 am UTC

Vaniver wrote:The problem in interpreting its conclusions is that you've presented that data as showing that we have less spending and less results, when the data shows only that we have less government spending, and tracks neither results nor non-government spending.


I presented the World Bank data as showing spending, not results. In fact, I proposed looking at results much later, when you claimed there was no way to know how much of the need was being met. The idea that the gap demonstrated by those figures is eliminated when you factor in private contributions is your assertion, unsupported by any evidence of your own. As to results, as I said, your pre-exemptive excuses for the disparity in results between ourselves and others I think amply demonstrates that you know very well what such figures show. You are always welcome to cite data supporting your assertion that our level of support is the same.

I only made a comparison for housing- and made clear my lack of hard data on the subject (imagining something is different from being quite confident in my world!). It would not surprise me greatly if other countries provide much more than America does, but I expect that we provide similar levels of free and subsidized housing.


Again, with no evidence to support your claim and figures amply demonstrating that the government provides far less free and subsidized housing. So basically, this is a declaration of faith on your part. Or, since it's a product of your imagination, as you say, perhaps it would be more correct to describe it as a fantasy.

I don't think that you've provided evidence that we fall far behind- and so so far, my opinion is mostly unchanged.


It's not my responsibility to change the minds of people whose minds are made up, but rather to show the weakness of your argument, resting as it does on discarding inconvenient facts in favor of reassuring intuitions. I've made an argument, call it good or bad. You've made no argument, only a series of assertions backed up by your feelings. Data, even if incomplete, beats feelings, whether you, personally, are persuaded.

I admit to that flaw in my reasoning, because most people appear to have that flaw in their reasoning. But I work at correcting it- and change my intuitions when the facts recommend it. But I would be remiss to not wait for sufficient facts.


But it's common courtesy, as well as good persuasion, to go and seek some facts yourself and share them with the group. Some people choose instead to employ a strategy I've seen many times on the interwebs; they lie back on the ropes, encouraging those who disagree with them to seek out facts and data to support their arguments, and then they find fault with the data, while providing nothing of their own. It isn't a persuasive rhetorical tactic. I'm glad to see you move away from it below.

It is if you want to say that you've provided the data.


You asserted we provide as much or more food and housing support to those who need it. That's your assertion, and you haven't supported it. It's all on you. Of course, I can delve into hunger and homeless rate in the US and other countries, but you've openly admitted that you have prepared an arsenal of rationalizations to deflect such comparisons:

I still think the true amount of government expenditure on housing is more than $7 billion annually, although it's mostly in opaque ways which are hard to quantify (how much of Fannie Mae / Freddie Mac's activity should count? What's the dollar value of the various equal opportunity laws?)

Do you know if there are other relevant factors (urbanization, ethnic breakdown, mean property value, etc.)? It seems unlikely, since most of those factors look like they would point in the opposite direction (unless urbanization is negatively correlated with homelessness).

I don't think you've provided data that we have worse outcomes- but even if that data exists, it doesn't recommend the non-American program by itself.


Why not take your turn at presenting evidence supporting your claims, and let the rest of us take a turn at explaining the evidence away.

It's defined differently in Japan than in other countries (it's "sleeping rough" instead of not having an abode) and because the rent for apartments tends to be more expensive than staying continually at a hotel- whereas in most countries the reverse is true. Anyway, according to government statistics reported by the Boston Globe Japan has around an eighth of the homelessness that the US has.


We spend less, and we get less. The article cited says one tenth as much ("The homeless in Japan are rare - about 10 times more rare than in the United States, according to government studies in both countries."), and you say one eighth. How come? The portrait of homelessness in Japan in also worth citing:

Hamahara eats free fresh food - rice, fish, meat, and vegetables. Because of strict Japanese hygiene laws, lunch boxes are discarded by convenience stores about 15 hours after they are prepared.

"If I am lucky, I get really good food, much better than at a restaurant," said Hamahara, who has befriended neighborhood convenience store employees.

He bathes, combs his hair, and washes his clothes in the park's clean public restroom. With the two brooms and dustpan that he keeps at his side, he tidies up the restroom and the park every morning at dawn, often with park employees.

Most days, children, along with nannies and parents, invade the park. Hamahara finds peace in the sounds of their play but keeps his distance. He does not talk to children, fearing he might frighten them or their guardians.

He has chosen his neighborhood well. The park is in Nishi-Azabu, where houses and apartments often rent for $10,000 a month or more. And the bench where he sleeps is next to a fancy supermarket that is guarded at night by private security guards. Hamahara said the guards are kind to him, which makes his sleep restful.

Police officers have never bothered him, he said, and no one has stolen or disturbed his possessions: an umbrella, a hand-held fan, a winter jacket, and clothing he keeps in a large cardboard box marked "Kleenex." When Hamahara needs money, he goes to a construction site and offers himself as a day laborer, making about $90 a day.


Rather different from homelessness over here.

It appears to be caused, at least in part, by lower rates of drug dependency- and without further research, I can't say what role mental illness plays (a few decades back, many mental institutions in the US were closed, which led to a rise in homelessness; I don't know what the state of mental institutions is in Japan).


We can say that drug dependency and homelessness are correlated, but I would be careful in saying one causes the other. The causality likely flows in both directions.

Schizophrenia, a common cause of homelessness, is steady worldwide at about one percent. As an aside, some researchers think that it wasn't deinstutionalization which led to homelessness of the mentally ill, but, rather, the collapse of the outpatient programs that were successfully caring for the mentally ill in the community. I haven't investigated those claims myself.

Suicides, especially related to economic conditions, are significantly higher in Japan than in the US- perhaps there are less homeless people because Japanese society drives them to kill themselves?* Government support appears entirely directed at getting street people off the streets, not from humanitarian concerns.


The number of suicides is unlikely to affect the number of homeless persons, since the rate of complete suicides is between one and two orders of magnitude smaller than the number of people on the streets.

On what basis do you attribute motives to Japanese society? That seems quite thin, as well as beside the point.

*Numbers: the homelessness rate in the US is roughly .00112, while in Japan it's .00015 (that's roughly one out of every 900, or one out of every 6900). The suicide rate is .00022 in the US, and .00051 in Japan (that's roughly one out of every 4500, or one out of every 2000). src I can't get their numbers to match up well, though- I'm getting an annual incidence of suicide equal to .00024 from 33,000 deaths a year in a country of 127,000,000. But anyway, if you assume that homelessness is static and suicide is dynamic (that is, the number of "slots" for homelessness people is constant and suicide removes people from those slots), which are pretty poor assumptions, you end up with it only taking 3 years for the difference in suicide rates to make up for the difference in homelessness rates.


The number of people in the US homeless at any point in the preceding year is estimated to be around .01. Total per night is estimated at about .002 (http://www.endhomelessness.org/files/21 ... _final.pdf). The figure in the article for US homelessness is quite low.

Two things about your hypothesis about the Japanese homelessness rates and suicides. First, there's no reason to think the homeless people are the ones killing themselves or that people are killing themselves to avoid homelessness. Some people, doubtless, do, but what proportion of the total? Seems like a stretch.

Second, Japan clearly has a very small homeless population, which would seem, if the anecdote you cited is representative, to enjoy safer public spaces and easier access to food. This is probably why their spending is quite low on the World Bank chart; whether owing to their family structures or other welfare spending or to unlucky people offing themselves before they get to the streets, the problem is smaller and so the response is smaller. This would tend to support, rather than undercut, the idea that other wealthy countries do more to address homelessness and hunger, with the caveat that if the problem is far smaller to begin with, you aren't likely to spend as much.
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Tue Aug 18, 2009 3:37 am UTC

EMTP wrote:Of course, I can delve into hunger and homeless rate in the US and other countries, but you've openly admitted that you have prepared an arsenal of rationalizations to deflect such comparisons:
That is because these situations, and the statistics that describe them, are complicated. And so I try to understand them in a complicated way rather than a simple way.

EMTP wrote:The article cited says one tenth as much ("The homeless in Japan are rare - about 10 times more rare than in the United States, according to government studies in both countries."), and you say one eighth. How come?
Because I did the math myself rather than trust the journalist- and came up with a more precise number. Eight is around ten- but if I know it's closer to eight than ten, I might as well say eight.

EMTP wrote:Rather different from homelessness over here.
Possibly because there are less homeless? I mean, if you took 7/8ths of the homeless off the streets, the others would find themselves with far more resources.

EMTP wrote:We can say that drug dependency and homelessness are correlated, but I would be careful in saying one causes the other. The causality likely flows in both directions.
There are countless stories (including people I know) who lost everything (including their home) due to drug dependence, and a large number of the homeless in America are dependent on drugs. The same does not seem to be true in Japan, for reasons I do not know. But if there is less of a drug problem in Japan, we should expect less of a homelessness problem.

As you point out, most situations are spirals rather than one-way streets, and perhaps if more and more Japanese become homeless (and stop killing themselves) Japan will develop more of a drug problem.

EMTP wrote:The number of suicides is unlikely to affect the number of homeless persons, since the rate of complete suicides is between one and two orders of magnitude smaller than the number of people on the streets.
In Japan, according to the numbers I've found, roughly 50% more people kill themselves each year than are on the streets.

EMTP wrote:On what basis do you attribute motives to Japanese society? That seems quite thin, as well as beside the point.
I am not ascribing motives; I am pointing out the frequent observation that Japanese society tends to be high-stress, particularly for failures, and has a history of approving of suicide rather than disapproving (compare seppuku to burying suicides with their faces towards Hell).

EMTP wrote:Total per night is estimated at about .002 (http://www.endhomelessness.org/files/21 ... _final.pdf). The figure in the article for US homelessness is quite low.
Looking at your source, the number for unsheltered homeless is comparable to the number of homeless cited in the Boston Globe article. Perhaps they chose that to make the number appropriate for comparison with the Japanese number (which I'm almost positive is unsheletered homeless)?

EMTP wrote:First, there's no reason to think the homeless people are the ones killing themselves or that people are killing themselves to avoid homelessness.
Except that losing your job often results in suicide more frequently in Japan than in other countries, and a rise in job-related suicides coincides with the financial crisis.

EMTP wrote:This would tend to support, rather than undercut, the idea that other wealthy countries do more to address homelessness and hunger, with the caveat that if the problem is far smaller to begin with, you aren't likely to spend as much.
I would suggest that it shows cross-country comparisons require an in-depth look at the countries involved, because there are often many connected factors- when looking at homelessness in Japan, you have to know about its recent economic history (the Lost Decade is cited by many as the beginning of the homelessness problem in Japan) and its culture, to see how different things interact. It also shows how comparisons of outcomes without knowing what the all the inputs are cause problems; if we compared Japan and the UK, for example, we would probably see that the country with the higher government spending on housing had the worse homelessness problem. (By the way, homelessness in the UK is estimated to be 4 per 1000, which is double your estimate for the US. Spend less get less, eh?)
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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Tue Aug 18, 2009 5:36 am UTC

That is because these situations, and the statistics that describe them, are complicated. And so I try to understand them in a complicated way rather than a simple way.


But none of that complexity is apparent when you're asserting your own intuitions, whether about food and housing support or the relative efficiency of private and public undertakings. Your complex understanding only surfaced with the prospect of evidence that didn't fit your hypothesis. You appear in the Japanese case, for example, to have been so determined to explain away the fact that their homelessness problem is an order of magnitude less severe than ours, that you didn't even pause for breath before discharging entirely novel and unsupported speculations about suicide reducing homelessness.

Someone with a genuinely complex understanding I would have expected to respond with something like: "They have many fewer homeless people than in the United States. Some of that may be related to their social safety net, but it might be related to other things, like family support, or suicide." You spent no time at all on the inconvenient side of the fact you had found. So I'm not seeing complexity as much as what appears to be an impulse to obfuscate in the face of disconfirming data.

I had a little time to research some statistics on homelessness. All numbers are proportion of the total population sleeping rough/unsheltered:

.0002 of Austria

.0002 Germany

.00009 Finland

.00008 France

.00009 Greece

(Source: "03 Review of Statistics on Homelessness in Europe" at http://homelessness.samhsa.gov/(S(ejnuu ... 45jex0rfbn))/DisclaimerPopup.aspx?Url=http://www.feantsa.org/files/transnational_reports/EN_StatisticsReview_2003.pdf)

Taking your figure for US homeless living unsheltered, our number is:

.00112 United States

Similar to the comparison with Japan, the number of homeless completely without shelter is more than ten times greater in the US than in France, Greece or Finland, and about five times greater than in Austria or Germany. That difference is not small, and suggests a pattern: the United States has far more homeless people without shelter than other wealthy democracies. We pay less, and we get less.

And how fares Britain, the nation most generous with housing support according to the World Bank? The report above doesn't give a clear figure for Britons sleeping rough, but this article (http://www.independent.co.uk/news/uk/th ... 10912.html) gives a government estimate: 1,180 people among Britain's 60 million citizens.

.00002 United Kingdom

They spend 1.5% of their GDP of housing support; They have one fifty-fifth the number of people we do sleeping out of doors. They spend more, and they get more. You don't have to like it or want it for the United States, but those are the facts. We have more homelessness, more poverty, and more hunger, too. Which may, to return to my original point, be part of why we live shorter, sicker lives, not just our healthcare system.
Last edited by EMTP on Tue Aug 18, 2009 8:50 am UTC, edited 1 time in total.
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Re: Lower US life expectancy not due to healthcare

Postby lowbart » Tue Aug 18, 2009 8:34 am UTC

Dead people don't make good consumers.
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Re: Lower US life expectancy not due to healthcare

Postby Vaniver » Tue Aug 18, 2009 5:03 pm UTC

EMTP wrote:But none of that complexity is apparent when you're asserting your own intuitions, whether about food and housing support or the relative efficiency of private and public undertakings.
That's because those are conclusions, not arguments. If you want to get into a discussion about the incentives faced by private and public organizations, we can move over to SB.

EMTP wrote:You appear in the Japanese case, for example, to have been so determined to explain away the fact that their homelessness problem is an order of magnitude less severe than ours, that you didn't even pause for breath before discharging entirely novel and unsupported speculations about suicide reducing homelessness.
Novel I'll agree with- and I included the word "perhaps" to signify that it was speculation. But I'm not sure where "unsupported" comes from.

EMTP wrote:Someone with a genuinely complex understanding I would have expected to respond with something like: "They have many fewer homeless people than in the United States. Some of that may be related to their social safety net, but it might be related to other things, like family support, or suicide." You spent no time at all on the inconvenient side of the fact you had found. So I'm not seeing complexity as much as what appears to be an impulse to obfuscate in the face of disconfirming data.
What social safety net? The additional 1.2% of GDP that the government provides to the elderly? That might have an impact in getting the elderly off the streets (it seems like it will for the person the Globe found to interview), and so does deserve a part of the comparison- but in the US there are programs specifically targeted at getting the homeless off the streets (whether it be into shelters or into homes) which are absent in Japan.

I would appreciate it if you contested the evidence I provided for my 'unsupported' explanation, rather than just insulting it.

EMTP wrote:All numbers are proportion of the total population sleeping rough/unsheltered:
Where'd you find old population numbers? I guess with Europe's population growth it barely matters if you compare 1997 numbers to 2009 numbers (for Austria, for example).

EMTP wrote:And how fares Britain, the nation most generous with housing support according to the World Bank? The report above doesn't give a clear figure for Britons sleeping rough, but this article (http://www.independent.co.uk/news/uk/th ... 10912.html) gives a government estimate: 1,180 people among Britain's 60 million citizens.
From the Independent article: "Although homeless charities welcomed the recent Government initiatives to house vulnerable people, they said that the report did not reflect the true number of people sleeping on Britain's streets, which was far higher."
Finding other numbers (here's where I got the 4 per 1000) hasn't proved particularly helpful, as they don't seem to separate out unsheltered and sheltered.

But it does appear that higher government expenditures in other countries result in less people sleeping on the streets. That should be applauded; but I am mildly worried that the total estimated number of homeless in the UK is .004, and the total estimated number of homeless in the US is .002 (from the pdf you linked earlier). Perhaps the geographic differences between the countries play a large role in housing affordability; perhaps the government support gets rid of unsheltered homeless but creates chronic sheltered homeless; perhaps the US number is an underestimate, perhaps the different economies of the countries play a large role. But detailed comparisons between two countries tell us little, and I am unprepared to do a detailed comparison of many countries, or accept a simple comparison of many countries.
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Re: Lower US life expectancy not due to healthcare

Postby EMTP » Tue Aug 18, 2009 7:56 pm UTC

Vaniver wrote:Novel I'll agree with- and I included the word "perhaps" to signify that it was speculation. But I'm not sure where "unsupported" comes from.


You didn't cite, for example, any evidence connecting suicides to homelessness or vice versa. You alluded to work-related suicides later, but haven't cited a source. You did say "perhaps" but you didn't consider any other, more conventional explanations for the ten-to-one disparity.

What social safety net? The additional 1.2% of GDP that the government provides to the elderly? That might have an impact in getting the elderly off the streets (it seems like it will for the person the Globe found to interview), and so does deserve a part of the comparison- but in the US there are programs specifically targeted at getting the homeless off the streets (whether it be into shelters or into homes) which are absent in Japan.


They aren't any such programs in Japan? I find that surprising. Where are you getting that?

Where'd you find old population numbers? I guess with Europe's population growth it barely matters if you compare 1997 numbers to 2009 numbers (for Austria, for example).


THat was my thought. I used wikipedia. Given both the margin of error in counting the homeless and the order-of-magnitude difference in the outcomes, I didn't think small changes in population would substantively affect the figure.

From the Independent article: "Although homeless charities welcomed the recent Government initiatives to house vulnerable people, they said that the report did not reflect the true number of people sleeping on Britain's streets, which was far higher."


Yes, I read that. Unfortunately, that applies to all these statistics. No one has a hard count, and everybody agrees the numbers for American homeless, for example, are understated. There is no reason to think these numbers are more or less accurate than any of the other counts.

Finding other numbers (here's where I got the 4 per 1000) hasn't proved particularly helpful, as they don't seem to separate out unsheltered and sheltered.


Two reasons I settled on unsheltered to do comparisons: one, there's a clear definition for it, at least, and it doesn't involve multiple different definitions of "shelter," temporary vs permanent housing, etc. Also, it measures people without housing support, since it's unmet need we're talking about.

But it does appear that higher government expenditures in other countries result in less people sleeping on the streets. That should be applauded; but I am mildly worried that the total estimated number of homeless in the UK is .004, and the total estimated number of homeless in the US is .002 (from the pdf you linked earlier).


The best numbers I have for American homelessness (total) are 800,000 - 2.5 million, or .003 -- .009. It would make sense, although this is purely speculative, that in a country like Britain, where saying to the government "I'm homeless" is likely to get you an apartment, is going to count more of the homeless than in a country in which support is more scarce.

Perhaps the geographic differences between the countries play a large role in housing affordability; perhaps the government support gets rid of unsheltered homeless but creates chronic sheltered homeless; perhaps the US number is an underestimate, perhaps the different economies of the countries play a large role. But detailed comparisons between two countries tell us little, and I am unprepared to do a detailed comparison of many countries, or accept a simple comparison of many countries.


Leaving you with the original assumption. You would appear to be describing a system of evaluation which makes it very difficult, if not impossible, to overturn your assumptions about the world in any significant respect. I suggest, when you have the opportunity, that you talk to people who have lived in these countries and lived in ours. They pay higher taxes and, because of a generous social safety net, suffer far less poverty, homelessness, hunger and other social ills. You are the first person I've ever encountered who seriously disputes this. Typically the debate centers on the price they pay (both the literal price in taxes and regulations and other alleged negative effects, such as reduced innovation or less social mobility) in return for sheltering their population from the extremes of destitution. That they do so is widely acknowledged.
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