For some reason, I’m thinking about health care a lot these days (No, I’m fine, thank you for asking: except for needing to lose a few pounds to get to race weight, I’ve never been better).

I was over hanging around Darren Barefoot’s comment on the new film Sicko. This is roughly what I said there:

Nobody wants to say it so much, but as bad as the health care system in the US is (for a minority of its citizens, it should be said, as opposed to the well-covered ones), no country’s medical care system (at least the parts where the US differs substantially from the rest of the world) makes much of a difference.

What separates the developed world life expectancies from undeveloped-world life expectancies is mostly stuff like child immunization, clean drinking water, and effective treatments for diarrhea (ORT, which is pathetically cheap and incredibly effective).

What separates Cuba (and other nations, mostly in the “developing” category) from the US is probably the availability of enough, but not too much food (and not a lot of meat). Thus the average Cuban is on a calorie-restricted but not starvation diet.

The average American or Canadian or European diet? Not so much. Or rather, too much.

Meanwhile, the health care spending makes people healthier in relatively marginal ways: the rare young cancer patient benefits if we can extend their life by 30+ years, but they are rare. We can give you knee surgery and hip replacements, but those don’t make you live longer, they just make you able to play golf at age 60.

Unfortunately, all these marginal treatments are really pricey. As has been noted in the field, the last six months of a patient’s life are often the most expensive, medically speaking. This is because, well, we can’t always be sure they’re going to die, but without medical intervention we’re pretty sure they will.

Then they do, and all we have to show for our dramatic medical intervention is a lot of public health expenses.

Regarding the issue of the value of marginal spending on health care, see this slightly leftish discussion and this rather libertarian discussion. Both lean heavily on a government-supported RAND study that took a sample group of 7700 uninsured Americans, and gave them one of five types of insurance, ranging from free care, to HMO-style care, to a group that had a 95% co-pay with a capped maximum annual out-of-pocket cost (in essence, the subject would have been sheltered from catastrophic medical costs, but would have to pay virtually all of their routine doctor-visit costs).

There was almost no difference in their health outcomes. The free-care group showed a bit better control of hypertension, and had better vision (I suspect this means they kept their eyewear prescriptions up to date). Marginal value of health care and all that.

A serious examination of modern health care systems needs to be clear-eyed about what they can and cannot do for the money.