Saturday, August 15, 2009

Fun with death statistics

Two somewhat related points about thinking about death rates. One fun, one slightly more serious.

1. I was in the chiropractor's waiting room today, reading some health magazine. They had an article about various habits that are potentially lethal: smoking, drinking, obesity, driving, sex, etc. I'm sorry I forget which blurb had this little gem, but they were talking about some risk group (obese people? heavy drinkers? But definitely not an age group) : "Group X is 44% more likely to die by any cause than Group Y." So watch out fat/drinking/whatever people: you have a 144% chance of dying some day!!!!

2. Did a silly and wandered over to Megan McArdle's page and read her most recent piece on healthcare. I've been following her writings via John Halbo's rebuttals at Crooked Timber and guess I thought I might see what comes from the horse's mouth. As far as I can figure, her argument is that national healthcare will kill all medical innovation, so by covering the uninsured today, we are killing untold millions into the future by preventing the discovery of whatever medicine or technique would have saved their lives had we only seen the light and not reformed the US healthcare system. Her evidence was that:
If the innovation spurred by the private sector could save 1% of the people who currently die each year, the number of people we'd be killing along with the private sector would necessarily be hugely larger than the number of people we'd save by implementing such insurance, since the most grotesquely exaggerated estimates released by interest groups pin the latter figure at around 0.8% of deaths in America (a much smaller number than the number who are estimated to be killed by access to the system--nosocomial infections and treatment side effects). That's even before you consider the people in other countries who would be saved by these advances.
But there are all sorts of logical mistakes contained in this argument. Starting with that 0.8% figure: according to National Coalition on Health Care (yes, one of those interest groups), in 22,000 "excess deaths" can be attributable to lack of insurance in the 25-64 age group. If one takes the CDC's estimates of total deaths in the US and do the math, you do indeed come up with 0.8% (or a bit more, but I may be comparing the wrong years). But is this the right statistic? Some portion of those deaths are those who, like my dearly departed grandfather, lived to 100+ and died well and happy. A big part of the moral offense of the uninsured is that these are young people dying unnecessarily. Less than 25% of the deaths in the US in 2006 were in the age group 25-64. None of this is to say that deaths after 64 don't matter, but I think it is important to keep the scale consistent. These 22,000 deaths are 3.7% of their age group's mortality. So even if you were to be very pessimistic about the number's accuracy, and were to cut it in half, you still have 1.5% of this younger age group dying prematurely due to lack of insurance. And this is just the uninsured, not the underinsured who die unnecessarily sometimes as well.

The comparison statistic of 1% of lives saved (deaths postponed) is, as far as I can tell, delivered directly from McArdle's butt. (pe-ew!) So there is no way on thinking properly about the best statistic to use: number of life-years saved versus life-years lost. You'd have to kill a lot of 99 year olds with lost innovation to make preventing the deaths of this group amoral from a utilitarian perspective.

Then, of course, is the notion that all innovation would come to a screeching halt. I find it bizarre to think that we are that inept at problem solving, and further that the current R&D system is so fabulous. Money drives lots of choice for erectile dysfunction and cholesterol drugs, not so much rapid rates of brand new life savers. I expect that the bulk of medical research that is really adding significant life-years to the US is done in the research labs of universities and the NIH. Megan sneers, but I sneer back.

And then, finally, she commits the sin of partial equilibrium analysis. Yes, research on pharmaceuticals in the US might just decline some. And yes, currently the rest of the world free-rides on our research, funded by our paying far more for our drugs than anyone else (though, as an expat, I should say YOU are paying more for your drugs--mine are quite cheap, thank you!) But, if the US money train stops, do you think Australia and France will just say "darn it! I guess we'll never see another medical advance again!"? Really? Maybe something good, like getting the rest of the world to chip in some, would come of our finally refusing to put up with it all.

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