A personal anecdote on why the facts don’t really matter
Recently, I wrote three posts on why human reasoning has not evolved to pursue truth. Rather our minds were designed to argue a ‘side’ irrespective of the facts. In a sense, the facts don’t really matter.
See:
- Do The Facts Really Matter?
- Confirmation bias as a feature, not a bug: The facts don’t really matter
- How Political Bias Alters Economic Understanding
I came face-to-face with this phenomenon earlier today. My wife, a trained Montessori teacher and school director, was trying to show me some results from studies about video games and anti-social behaviour. She often claims that studies demonstrate that increased video game usage is highly correlated with perceived anti-social behaviour in boys. I am always very sceptical of these studies because I remember playing a decent number lot of video games and I know my friends did as well and I never considered any of us to be anti-social (well almost any of us).
So, she read me this from a presentation handout from the recent American Montessori Society (AMS) conference in Chicago called “Boys Will Be Boys”. The handout reads:
“Every investigator who has correlated the amount of time that a child or adolescent or young adult spends playing video games with that student’s academic performance has found a negative correlation.” – Sax
“The strength of the evidence linking video games to antisocial behavior is every bit as strong as the evidence linking second-hand smoke to lung cancer, or lead paint poisoning in infancy to lower IQ scores.” – Sax
My reaction: Bollocks! Not true, total rubbish. At least that is what I was telling myself. She knows how I react to these findings so she expected as much. But I know full well she’s right:
Confirmation bias, where we look for data points to bolster our argument, is a feature not a bug. It helps us to win arguments irrespective of the facts on the ground. In essence, the facts don’t really matter.
So I admitted to her that I was biased because of my own life experiences and that I was willing to cede the point. I did make some mitigating qualifiers in defense of video games, of course; it’s hard to completely capitulate. But after a few weak arguments, I conceded the point.
My take on the matter: confirmation bias is a heavy, heavy behind the scenes influencer of everything we do and every values-related opinion we have. If someone argues against my values (i.e. the innate brilliance of boys who played Donkey Kong, Dig Dug, Pac Man or Tempest), they are likely to get a BS response based on arguments (like the huge hand-eye coordination benefits of gaming) rooted in confirmation bias. I am no different than anyone else.
So I was thinking about this when I came across this chart from an old post of mine on the correlation between healthcare spending and life expectancy. Take a look:
The US is a huge outlier here. How do you explain this chart? And don’t give me the BS response based on your pre-conceived value judgments. I’m on to that.
Healthcare spending and life expectancy: a comparison of graphs – Andrew Gelman, Columbia University
You forgot Joust, Defender, Galaga, 1942, Tetris and Asteroids. If you included those, you might have won the argument with your wife.
It’s not just about Hand-Eye coordination. It is also applicable to logical/strategic capacity of the treatment.
Perhaps Video-games make people into better tradesmen or stock-traders? Maybe the whole Anti-social argument is a statistical red-herring?
As for the outlier, what causes it to be as such? What are the differences in the determinants that underlie the variables? Perhaps that good ol’ “Free-market” nonsense? As Steve Keen has shown, the formulae that govern the “Perfect Competition” model are BS. If that is the case, the excessive privatization of American Health care is probably the principal cause. There’s no cap on American Health expenditure, right?
But it is not the only factor. One should account for the Consumption function variable, as well. The nuances of C probably have some effect here.
I was definitely thinking of Galaga. I was crap at Defender though. As for healthcare, and I tend to think rent-seeking has something to do with it.
Real men played Frogger.
Real men played Frogger.
Real men played Frogger.
Real men played Frogger.
You forgot Joust, Defender, Galaga, 1942, Tetris and Asteroids. If you included those, you might have won the argument with your wife.
It’s not just about Hand-Eye coordination. It is also applicable to logical/strategic capacity of the treatment.
Perhaps Video-games make people into better tradesmen or stock-traders? Maybe the whole Anti-social argument is a statistical red-herring?
As for the outlier, what causes it to be as such? What are the differences in the determinants that underlie the variables? Perhaps that good ol’ “Free-market” nonsense? As Steve Keen has shown, the formulae that govern the “Perfect Competition” model are BS. If that is the case, the excessive privatization of American Health care is probably the principal cause. There’s no cap on American Health expenditure, right?
But it is not the only factor. One should account for the Consumption function variable, as well. The nuances of C probably have some effect here.
I was definitely thinking of Galaga. I was crap at Defender though. As for healthcare, and I tend to think rent-seeking has something to do with it.
Real men played Frogger.
just because you have confirmation bias doesn’t mean you’re wrong. i’m still skeptical of the data behind those claims.
Well said! I didn’t go into exactly what I said but I basically said I think those statements were too categorical and that correlation doesn’t equal causality. We both agreed then that parents need a more nuanced approach, especially in dealing with kids who are more at risk because of what is classified as ADD.
Bottom line: if your kid is doing well in school and seems well adjusted I don’t see any reason to dictate terms on his gaming.
just because you have confirmation bias doesn’t mean you’re wrong. i’m still skeptical of the data behind those claims.
Well said! I didn’t go into exactly what I said but I basically said I think those statements were too categorical and that correlation doesn’t equal causality. We both agreed then that parents need a more nuanced approach, especially in dealing with kids who are more at risk because of what is classified as ADD.
Bottom line: if your kid is doing well in school and seems well adjusted I don’t see any reason to dictate terms on his gaming.
Digressing from the main focus of the piece on video games to the question of lower life expectancy in the US, the answers are pretty obvious. Some of the key causes are:
1. Obesity, smoking and other lifestyle choices. These choices have been enabled in the US by its greater wealth over the past 60 years compared to other countries, and as other countries get richer they are experiencing the same issues. It’s not just that we’re more naturally inclined to be unhealthy slobs than other people, we just got there first. Hopefully people in other countries (and today’s Americans) will learn from this example, and put more effort into staying healthier.
2. Heterogeneity of the american population in income, lifestyle, and health history. Wealthy, well-educated Americans live as long as people in other leading countries. Unfortunately, we also have many poorer Americans, including many immigrants, who have lived much more physically demanding lives. Even more unfortunately, race is one way of approximating this dichotomy. White Americans live five years longer than black Americans, on average. This difference is down from eight years in the recent past, but we still have a long way to go.
3. Dramatic disparities in allocation of healthcare dollars. No matter what Michael Moore says, the wealthiest half of Americans get better healthcare than anyone else in the world. Anyone. The poorest 20% get much lower quality healthcare, delivered iregularly and inefficiently, and this drags down those life expectancy numbers. It’s a national disgrace.
Adjusted for homicide and for motor vehicle accidents (neither one of which is very amenable to healthcare solutions), US life expectancy is higher than other OECD nations. See for example Mark Perry’s comments at https://mjperry.blogspot.com/2007/11/beyond-those-health-care-numbers-us.html.
Getting US life expectancy up won’t be enough to make up for the #healthcare spend differential. If you were to do a regression based on spend and life expectancy, at the present spend level, US life expectancy – normalized for those factors – would have to be near 90 judging from the chart.
The US not only has a lower life expectancy than would be predicted, but a much higher spend. Any other suggestions?
Ed, I certainly agree that adjusting life expectancy for homicides/motor vehicle accidents does not decrease the healthcare spend differential, but it dramatically lessens the paradox of appearing to spend so much for worse outcomes. Again, the lower life expectancy is not a result of healthcare, but these other outliers (why the US is an outlier with regard to homicides and accidental deaths is of course way off topic, but nonetheless it is) do explain the apparently poor life expectancy.
Other factors at work on the “spend” side would include the heterogeneity of the US population as noted by another commenter, the very anormally high doctors incomes in the US, and the nature of some of that spend: Americans have soem of if not the best cared for and straightest teeth in the world and I suspect a greater spend on lasix and other eye surgeries and cosmetic procedures.
You can’t get around the fact that America spends too much for healthcare. And I am not convinced it is because we can. However, here’s a mitigating factor: these data are purchasing power parity so they overstate the US spend because Europe’s economies have lower PPP exchange rates than real exchange rates.
In my view, there are systemic factors at work. What those are is what should be central in our healthcare debates.
That said, here is a three-pronged rationale as to what COULD accounts for the differences from a non-systemic perspective:
1. Purchasing power parity
2. Real GDP per capita differentials at real exchange rates
3. Socioeconomic factorsI see a chart like this though – and the only rational response I can have is that the U.S. is an outlier because every other country fits the dataset. Find the major data points unique to the U.S., and you will probably find the difference (it’s not socioeconomic divide, obesity, and other social differences because the same issues are at play in the UK and Canada to lesser degrees). The differences to every other OECD country I can come up with are 1. murder rate2. lack of coverage3. lack of single payer4. provision by company instead of individual
5. Fee for service expensing
If anyone on this thread has other factors, I’d love to hear them.
Bottom line for me is that it’s still the cost – and the opportunity cost – that is the problem.
(1) The heterogeneity issue is probably far more significant than appears to be being accepted here. This blog post https://www.coyoteblog.com/coyote_blog/2009/08/us-medicine-best-in-the-world.html shows 5 year survival rates for the US and for selected European countries, with the US rates shown in aggregate and separately for whites and blacks. In aggregate, survival rates in the US exceed those of the European countries shown across the board. The survival rates for US blacks however trail those of US whites in almost every category shown, often showing a very significant disparity. The high US survival rates would be consistent with our higher health care expenditures. The disparity between whites and blacks may be a result of socioeconomic factors, or of health care focus and protocols that has focused on treatments that seem to work for whites but has not focused on treatments that work for blacks (why there would be a difference I do not know, but see for example this study: https://www.sciencedaily.com/releases/2005/06/050627061421.htm).
(2) Life expectancy at birth is also misleading in that infant mortality in the US is measured differently than in most other countries, and again there is a racial disparity in the US. I do not have time to find a source here, but anyone openminded and interested should be able to locate some commentary.
(3) If your cognitive bias leads you to dismiss the idea that “we spend more because we can”, then facts probably will not help you. We also spemd far more per capita on automobiles than other countries, and on education (with questionable results), but there does not seem to be a general outcry about our transportation system or our education system like there is about our healthcare system.
(3) Cosmetic surgery and Lasix may provide another powerful clue as to why our healthcare costs are so high: Prices for these operations have generally been dropping while other health care costs have been rising. One possible explanation is that these costs are generally paid out of pocket by the person receiving the benefit, unlike our third-party payer system for most health care.
(4) It also may be that marginal increases in life expectancy for advanced countries are far more expensive than for countries farther down the life expectancy scale. Our highest-in-the-OECD life expectancy (adjusted for homicides and motor vehicle accidents, but not for differences in infant mortality measurements) may be significantly more expensive than countries not far behind because the treatments necessary to extend life expectancy from already very high levels (such as for cancer treatment, which is very expensive to treat) are very costly.
(5) As I mentioned before, the incomes of US doctors are an outlier in comparison to other OECD countries.
Obviously the entire issue is very complex, and I am sure there exist factors beyond those mentioned so far in this blog and the comments. I will close by noting that I enjoy your blog writing and generally find you to be quite well-informed and rational in your posts.
Digressing from the main focus of the piece on video games to the question of lower life expectancy in the US, the answers are pretty obvious. Some of the key causes are:
1. Obesity, smoking and other lifestyle choices. These choices have been enabled in the US by its greater wealth over the past 60 years compared to other countries, and as other countries get richer they are experiencing the same issues. It’s not just that we’re more naturally inclined to be unhealthy slobs than other people, we just got there first. Hopefully people in other countries (and today’s Americans) will learn from this example, and put more effort into staying healthier.
2. Heterogeneity of the american population in income, lifestyle, and health history. Wealthy, well-educated Americans live as long as people in other leading countries. Unfortunately, we also have many poorer Americans, including many immigrants, who have lived much more physically demanding lives. Even more unfortunately, race is one way of approximating this dichotomy. White Americans live five years longer than black Americans, on average. This difference is down from eight years in the recent past, but we still have a long way to go.
3. Dramatic disparities in allocation of healthcare dollars. No matter what Michael Moore says, the wealthiest half of Americans get better healthcare than anyone else in the world. Anyone. The poorest 20% get much lower quality healthcare, delivered iregularly and inefficiently, and this drags down those life expectancy numbers. It’s a national disgrace.
Adjusted for homicide and for motor vehicle accidents (neither one of which is very amenable to healthcare solutions), US life expectancy is higher than other OECD nations. See for example Mark Perry’s comments at https://mjperry.blogspot.com/2007/11/beyond-those-health-care-numbers-us.html.
Getting US life expectancy up won’t be enough to make up for the #healthcare spend differential. If you were to do a regression based on spend and life expectancy, at the present spend level, US life expectancy – normalized for those factors – would have to be near 90 judging from the chart.
The US not only has a lower life expectancy than would be predicted, but a much higher spend. Any other suggestions?
Ed, I certainly agree that adjusting life expectancy for homicides/motor vehicle accidents does not decrease the healthcare spend differential, but it dramatically lessens the paradox of appearing to spend so much for worse outcomes. Again, the lower life expectancy is not a result of healthcare, but these other outliers (why the US is an outlier with regard to homicides and accidental deaths is of course way off topic, but nonetheless it is) do explain the apparently poor life expectancy.
Other factors at work on the “spend” side would include the heterogeneity of the US population as noted by another commenter, the very anormally high doctors incomes in the US, and the nature of some of that spend: Americans have soem of if not the best cared for and straightest teeth in the world and I suspect a greater spend on lasix and other eye surgeries and cosmetic procedures.
You can’t get around the fact that America spends too much for healthcare. And I am not convinced it is because we can. However, here’s a mitigating factor: these data are purchasing power parity so they overstate the US spend because Europe’s economies have lower PPP exchange rates than real exchange rates.
In my view, there are systemic factors at work. What those are is what should be central in our healthcare debates.
That said, here is a three-pronged rationale as to what COULD accounts for the differences from a non-systemic perspective:
1. Purchasing power parity
2. Real GDP per capita differentials at real exchange rates
3. Socioeconomic factorsI see a chart like this though – and the only rational response I can have is that the U.S. is an outlier because every other country fits the dataset. Find the major data points unique to the U.S., and you will probably find the difference (it’s not socioeconomic divide, obesity, and other social differences because the same issues are at play in the UK and Canada to lesser degrees). The differences to every other OECD country I can come up with are 1. murder rate2. lack of coverage3. lack of single payer4. provision by company instead of individual
5. Fee for service expensing
If anyone on this thread has other factors, I’d love to hear them.
Bottom line for me is that it’s still the cost – and the opportunity cost – that is the problem.
(1) The heterogeneity issue is probably far more significant than appears to be being accepted here. This blog post https://www.coyoteblog.com/coyote_blog/2009/08/us-medicine-best-in-the-world.html shows 5 year survival rates for the US and for selected European countries, with the US rates shown in aggregate and separately for whites and blacks. In aggregate, survival rates in the US exceed those of the European countries shown across the board. The survival rates for US blacks however trail those of US whites in almost every category shown, often showing a very significant disparity. The high US survival rates would be consistent with our higher health care expenditures. The disparity between whites and blacks may be a result of socioeconomic factors, or of health care focus and protocols that has focused on treatments that seem to work for whites but has not focused on treatments that work for blacks (why there would be a difference I do not know, but see for example this study: https://www.sciencedaily.com/releases/2005/06/050627061421.htm).
(2) Life expectancy at birth is also misleading in that infant mortality in the US is measured differently than in most other countries, and again there is a racial disparity in the US. I do not have time to find a source here, but anyone openminded and interested should be able to locate some commentary.
(3) If your cognitive bias leads you to dismiss the idea that “we spend more because we can”, then facts probably will not help you. We also spemd far more per capita on automobiles than other countries, and on education (with questionable results), but there does not seem to be a general outcry about our transportation system or our education system like there is about our healthcare system.
(3) Cosmetic surgery and Lasix may provide another powerful clue as to why our healthcare costs are so high: Prices for these operations have generally been dropping while other health care costs have been rising. One possible explanation is that these costs are generally paid out of pocket by the person receiving the benefit, unlike our third-party payer system for most health care.
(4) It also may be that marginal increases in life expectancy for advanced countries are far more expensive than for countries farther down the life expectancy scale. Our highest-in-the-OECD life expectancy (adjusted for homicides and motor vehicle accidents, but not for differences in infant mortality measurements) may be significantly more expensive than countries not far behind because the treatments necessary to extend life expectancy from already very high levels (such as for cancer treatment, which is very expensive to treat) are very costly.
(5) As I mentioned before, the incomes of US doctors are an outlier in comparison to other OECD countries.
Obviously the entire issue is very complex, and I am sure there exist factors beyond those mentioned so far in this blog and the comments. I will close by noting that I enjoy your blog writing and generally find you to be quite well-informed and rational in your posts.
My ex-wife who is a doctor tells me the same thing. My son and I sitting in front of our X-box disagree. She has an impressive collection of papers to bolster her argument. Thus I had to upgrade my intellectual arsenal and now I’ve an equal big stack of papers which refute her claim. For instance:
Video gaming: Chasing the dream
Video games: The skills from zapping ’em
An no, we didn’t separate because of different opinions about video games ;-)
My ex-wife who is a doctor tells me the same thing. My son and I sitting in front of our X-box disagree. She has an impressive collection of papers to bolster her argument. Thus I had to upgrade my intellectual arsenal and now I’ve an equal big stack of papers which refute her claim. For instance:
Video gaming: Chasing the dream
Video games: The skills from zapping ’em
An no, we didn’t separate because of different opinions about video games ;-)
“academic performance”
How much gaming did Bill Gates and Michael Zuckerberg do? And how was their academic performance?
Reading a lot about college grads unemployeed and underemployed.
I want my epitaph to readI “shouda studied less and partied more”
“academic performance”
How much gaming did Bill Gates and Michael Zuckerberg do? And how was their academic performance?
Reading a lot about college grads unemployeed and underemployed.
I want my epitaph to readI “shouda studied less and partied more”
Schumpeter once argued — pretty sure it was in the Marx section of ‘Capitalism, Socialism and Democracy’ — that economists’ arguments always stem from their own personal idiosyncrasies. I think Schumpeter was wrong about most things — not to mention extremely unreflective (I’m convinced he was a closet Marxist in denial) — but I think he was largely right about this.
Confirmation bias is inevitable. We will always try to argue in favour of what we believe. The key is to ensure that we do not fall into solipsism. We must — if we are to be honest — allow the world to prove us wrong time and again. To go one further, we should always be actively seeking out the flaws in our arguments as much as possible.
(P.S. I often like to point out that if we apply Schumpeter’s argument to him we find an interesting correlation. Schumpeter suffered from some sort of manic depression (i.e. bipolar disorder). And he was also the prophet of creative destruction and the necessity of the business cycle. Hmmmm…)
I’ve often criticised your psychological pieces as they appear to me to be too strongly influenced by behaviorist voodoo.
It should be pointed out that my gripes with behaviorism — and
hence, your psychological posts (barring this one) — can be shown
to be in keeping with this confirmation bias argument.
If we all have an innate tendency toward confirmation bias, we will
inevitably see this appear most strongly when it comes to building
pictures in our heads of other people and their personalities. It’s
well known that even if someone LOOKS like another person that we
dislike we will attribute these same negative aspects of the
personality to that person. (This is, broadly speaking, what
psychoanalysts used to call ‘transference’). [https://en.wikipedia.org/wiki/Transference]
Psychological evaluation of another person then becomes the most
emotionally loaded act imaginable. Far more so than detached economic
argument (for some… although you’d have to wonder about this for others
who seem to think of the economy as an extension of their ego…).
Much psychology then becomes a mirror-relation (an ‘Imaginary
relation’ to use the current psychoanalytic parlance), in that it’s
simply a process of building imaginary ‘pictures’ in our head of what
makes others tick — and yet these pictures more often than not stem
from our own innate biases. Most of the time these ‘pictures’ are
constructed more so out of ‘pictures’ from our own past or aspects of
our own personalities.
Schumpeter once argued — pretty sure it was in the Marx section of ‘Capitalism, Socialism and Democracy’ — that economists’ arguments always stem from their own personal idiosyncrasies. I think Schumpeter was wrong about most things — not to mention extremely unreflective (I’m convinced he was a closet Marxist in denial) — but I think he was largely right about this.
Confirmation bias is inevitable. We will always try to argue in favour of what we believe. The key is to ensure that we do not fall into solipsism. We must — if we are to be honest — allow the world to prove us wrong time and again. To go one further, we should always be actively seeking out the flaws in our arguments as much as possible.
(P.S. I often like to point out that if we apply Schumpeter’s argument to him we find an interesting correlation. Schumpeter suffered from some sort of manic depression (i.e. bipolar disorder). And he was also the prophet of creative destruction and the necessity of the business cycle. Hmmmm…)
I’ve often criticised your psychological pieces as they appear to me to be too strongly influenced by behaviorist voodoo.
It should be pointed out that my gripes with behaviorism — and
hence, your psychological posts (barring this one) — can be shown
to be in keeping with this confirmation bias argument.
If we all have an innate tendency toward confirmation bias, we will
inevitably see this appear most strongly when it comes to building
pictures in our heads of other people and their personalities. It’s
well known that even if someone LOOKS like another person that we
dislike we will attribute these same negative aspects of the
personality to that person. (This is, broadly speaking, what
psychoanalysts used to call ‘transference’). [https://en.wikipedia.org/wiki/Transference]
Psychological evaluation of another person then becomes the most
emotionally loaded act imaginable. Far more so than detached economic
argument (for some… although you’d have to wonder about this for others
who seem to think of the economy as an extension of their ego…).
Much psychology then becomes a mirror-relation (an ‘Imaginary
relation’ to use the current psychoanalytic parlance), in that it’s
simply a process of building imaginary ‘pictures’ in our head of what
makes others tick — and yet these pictures more often than not stem
from our own innate biases. Most of the time these ‘pictures’ are
constructed more so out of ‘pictures’ from our own past or aspects of
our own personalities.
Unrestrained rent seeking and diet !
Unrestrained rent seeking and diet !
I think your right to be sceptical of research and particularly social science research because it comes with its own set of biases. Of course eventually you have to settle on some world view less you end up in a sea of relativity the trick is to at some point (if needed) be able to admit your wrong – that’s not so easy.
On the healthcare charts here’s my bias based hunch – the US model (unlike many of the others) leaves 40 million plus people without decent preventative health care, that’s going to hit the averaging metrics.
I think your right to be sceptical of research and particularly social science research because it comes with its own set of biases. Of course eventually you have to settle on some world view less you end up in a sea of relativity the trick is to at some point (if needed) be able to admit your wrong – that’s not so easy.
On the healthcare charts here’s my bias based hunch – the US model (unlike many of the others) leaves 40 million plus people without decent preventative health care, that’s going to hit the averaging metrics.
Read The Spirit Level: Why Greater Equality Makes Societies Stronger by Richard Wilkinson and Kate Pickett
Read The Spirit Level: Why Greater Equality Makes Societies Stronger by Richard Wilkinson and Kate Pickett
Still not buying the video game thing. I think there is a distinct possibility that more antisocial kids (which is as much a genetic issues as it is a environment issue) are more apt to play video games. Thus, what the studies might be showing is something much more blatantly obvious than the conclusion the researchers want us to believe, that is, antisocial kids play more video games. Frankly, that’s the more logical conclusion. It seems like the very definition of antisocial.
As for the healthcare stuff though. I think the evidence is obvious that your right. The key is that outcomes suck in the United States. It’s not really important why they suck to know the system needs fixing. All you need to know is that they suck, which they do.
“Why” is the question you ask when you want to fix it, but you have to mentally be at the point where you are able to admit they suck.
I agree when I said in the comments that correlation does not equal causality. The problem I have with the statement on anti-social behaviour and academic achievement is that it doesn’t necessarily lend itself t a remedial course of action – unless one assumes causation. I would argue (and did) that there’s more to it than that.
To me, it is the nexus of anti-social behaviour, gaming and poor academic performance which should make a parent think about cutting down on the games. But why assume the games are creating the behaviours? My wife still needs to convince me on that score.
Still not buying the video game thing. I think there is a distinct possibility that more antisocial kids (which is as much a genetic issues as it is a environment issue) are more apt to play video games. Thus, what the studies might be showing is something much more blatantly obvious than the conclusion the researchers want us to believe, that is, antisocial kids play more video games. Frankly, that’s the more logical conclusion. It seems like the very definition of antisocial.
As for the healthcare stuff though. I think the evidence is obvious that your right. The key is that outcomes suck in the United States. It’s not really important why they suck to know the system needs fixing. All you need to know is that they suck, which they do.
“Why” is the question you ask when you want to fix it, but you have to mentally be at the point where you are able to admit they suck.
I agree when I said in the comments that correlation does not equal causality. The problem I have with the statement on anti-social behaviour and academic achievement is that it doesn’t necessarily lend itself t a remedial course of action – unless one assumes causation. I would argue (and did) that there’s more to it than that.
To me, it is the nexus of anti-social behaviour, gaming and poor academic performance which should make a parent think about cutting down on the games. But why assume the games are creating the behaviours? My wife still needs to convince me on that score.
My guess is the bulk of the difference can be explained by: 1) high percentage of spending is on last year of life, 2) heterogeneous population (big rich/poor divide), 3) higher input costs (doc fees, drugs), 4) sedentary car-based lifestyles and crappy food, 5) absence of rationing mechanisms.
My guess is the bulk of the difference can be explained by: 1) high percentage of spending is on last year of life, 2) heterogeneous population (big rich/poor divide), 3) higher input costs (doc fees, drugs), 4) sedentary car-based lifestyles and crappy food, 5) absence of rationing mechanisms.
Per usual, this chart doesn’t indicate correlation between money spent and life expectancy. You could push all of the European type results way out to the right as well, but it surely would not send them up the chart. And you could easily push US to the left without creating much vertical difference either. Still, whats up with those Hungarians? Motto: Die fast, Don’t care! Seriously, this chart might correlate culture to lifespan. Americans do seem to want to live forever, so they just hurl the thing they value most at the effort. (“We did all we could. We spared no expense.”)
And maybe it would be interesting to look at the data on pet care. I would be willing to bet that US would be an even crazier outlier in that area.
Or run the graph of spending on pizza correlated to the quality of pizza eaten in these nations. Get Hungary off the bottom, move US down and slightly off chart to the right?
No, there is something beyond the headline arguments going on here, I think.
Maybe looking at anything in isolation focuses the tendency to bias.
That’s total bollocks. As I said, the facts don’t really matter if they violate one’s pre-conceived value judgments. Talk about confirmation bias. Of course, this chart shows correlation between healthcare spend and life expectancy. As the chart source writes:
“Actually, though, once you remove the U.S., there’s a strong correlation between spending and life expectancy, and this is super-clear from the scatterplot.”
https://www.stat.columbia.edu/~cook/movabletype/archives/2009/12/healthcare_spen.html
The question is why– Lack of full coverage, lifestyle, eating habits, socioeconomic disparity, rent seeking, fee-for-service, or some other factors?
I agree with you that more healthcare does not necessarily mean better healthcare.
Johnsan, life expectancy is largely the same all over, once you get past childhood. I think that the point here is the cost of medical care. As an aside, compared to Europe and Japan, the US doesn’t look so hot when one compares infant mortality.
How can that be? It’s because folks here in the US cannot afford decent pre-natal care. Google it for yourself.
Per usual, this chart doesn’t indicate correlation between money spent and life expectancy. You could push all of the European type results way out to the right as well, but it surely would not send them up the chart. And you could easily push US to the left without creating much vertical difference either. Still, whats up with those Hungarians? Motto: Die fast, Don’t care! Seriously, this chart might correlate culture to lifespan. Americans do seem to want to live forever, so they just hurl the thing they value most at the effort. (“We did all we could. We spared no expense.”)
And maybe it would be interesting to look at the data on pet care. I would be willing to bet that US would be an even crazier outlier in that area.
Or run the graph of spending on pizza correlated to the quality of pizza eaten in these nations. Get Hungary off the bottom, move US down and slightly off chart to the right?
No, there is something beyond the headline arguments going on here, I think.
Maybe looking at anything in isolation focuses the tendency to bias.
That’s total bollocks. As I said, the facts don’t really matter if they violate one’s pre-conceived value judgments. Talk about confirmation bias. Of course, this chart shows correlation between healthcare spend and life expectancy. As the chart source writes:
“Actually, though, once you remove the U.S., there’s a strong correlation between spending and life expectancy, and this is super-clear from the scatterplot.”
https://www.stat.columbia.edu/~cook/movabletype/archives/2009/12/healthcare_spen.html
The question is why– Lack of full coverage, lifestyle, eating habits, socioeconomic disparity, rent seeking, fee-for-service, or some other factors?
I agree with you that more healthcare does not necessarily mean better healthcare.
Johnsan, life expectancy is largely the same all over, once you get past childhood. I think that the point here is the cost of medical care. As an aside, compared to Europe and Japan, the US doesn’t look so hot when one compares infant mortality.
How can that be? It’s because folks here in the US cannot afford decent pre-natal care. Google it for yourself.
If one reads the comments in the note on the sourced page, it is enlightening. Regarding guns, murders decrease healthcare costs. So that won’t bring the US in line. Even when we control healthcare data for lifestyle differences, we cannot get the US in line with the rest of the OECD. Here is the dataset used to make the scatter, if anyone wants to monkey around with it. It has a lot of relevant data you don’t see here:
https://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls
https://www.oecd.org/statisticsdata/0,3381,en_2649_37407_1_119656_1_1_37407,00.html
The easiest conclusion to make on this is that the US is demonstrably different than the rest of the OECD regarding healthcare spend vs. life expectancy. (Without parsing more, I wouldn’t make any further statements.) The question again is why. Just looking at the data, the life expectancy numbers are in line with other OECD numbers. It is the cost that is the critical factor in getting the US more in line.
If one reads the comments in the note on the sourced page, it is enlightening. Regarding guns, murders decrease healthcare costs. So that won’t bring the US in line. Even when we control healthcare data for lifestyle differences, we cannot get the US in line with the rest of the OECD. Here is the dataset used to make the scatter, if anyone wants to monkey around with it. It has a lot of relevant data you don’t see here:
https://www.irdes.fr/EcoSante/DownLoad/OECDHealthData_FrequentlyRequestedData.xls
https://www.oecd.org/statisticsdata/0,3381,en_2649_37407_1_119656_1_1_37407,00.html
The easiest conclusion to make on this is that the US is demonstrably different than the rest of the OECD regarding healthcare spend vs. life expectancy. (Without parsing more, I wouldn’t make any further statements.) The question again is why. Just looking at the data, the life expectancy numbers are in line with other OECD numbers. It is the cost that is the critical factor in getting the US more in line.
My take on the graph is that health care spending and life expectancy are only related to the extent that health care spending goes to the provision of health care for humans and not to bureaucratic overhead, CEO compensation, dividends, monopoly rents, legislated markets, etc. Robert Wilkinson’s work on the effect of GDP/capita on overall morbidity/mortality found that beyond a limit (don’t remember the number, but it’s low, many or most developing countries exceed it by a significant margin) GDP stops having an effect on health outcomes, and the effect of inequality takes over. The US has one of the highest GINI coefficients in the graphed group, in part, perversely, because of the expense of the healthcare system inflicted upon the sick. Whatever your biases, if you’re American, and assuming you don’t work for an HMO or for a pharma major, it’s impossible to come away from that chart with any conclusion other than “we are getting bent over a barrel”, as far as I can see.
er, that’s Richard G. Wilkinson.
My take on the graph is that health care spending and life expectancy are only related to the extent that health care spending goes to the provision of health care for humans and not to bureaucratic overhead, CEO compensation, dividends, monopoly rents, legislated markets, etc. Robert Wilkinson’s work on the effect of GDP/capita on overall morbidity/mortality found that beyond a limit (don’t remember the number, but it’s low, many or most developing countries exceed it by a significant margin) GDP stops having an effect on health outcomes, and the effect of inequality takes over. The US has one of the highest GINI coefficients in the graphed group, in part, perversely, because of the expense of the healthcare system inflicted upon the sick. Whatever your biases, if you’re American, and assuming you don’t work for an HMO or for a pharma major, it’s impossible to come away from that chart with any conclusion other than “we are getting bent over a barrel”, as far as I can see.
er, that’s Richard G. Wilkinson.
The graph looks about right given how the medical equipment market works globally:
https://www.npr.org/templates/story/story.php?storyId=120545569
My bias is that for MRI machine manufacturers to sell to Japan at such low prices and still be a viable business, they need to be able to over-charge the Americans — in effect, the US is subsidising the rest of the developed world’s healthcare. To ensure the NHS has a future, I hope America never gets true single-payer socialised healthcare.
Jim Beal, wait times are irrelevant if one cannot afford health care. I think that affordability is the point of the chart.
Jim Beal, wait times are irrelevant if one cannot afford health care. I think that affordability is the point of the chart.
Two points: 1) longevity has little to do with health care spending; rather longevity is more dependent on life style choices, diet, exercise, smoking, etc; 2) see https://politicalcalculations.blogspot.com/2007/09/natural-life-expectancy-in-united.html for a correction to your above graphic that eliminates fatal accidents from the comparison (more driving in the US causes deaths at younger ages that lower our average).
The fatal accidents you speak of are not all ‘accidents’. A large number of those fatal INJURIES are homicides. And there have been a number of comments on that in this thread. Again, I think the numbers on longevity are not that bad for the U.S. irrespective of controls. It is the healthcare spend which is out of line with the rest of the OECD.
Two points: 1) longevity has little to do with health care spending; rather longevity is more dependent on life style choices, diet, exercise, smoking, etc; 2) see https://politicalcalculations.blogspot.com/2007/09/natural-life-expectancy-in-united.html for a correction to your above graphic that eliminates fatal accidents from the comparison (more driving in the US causes deaths at younger ages that lower our average).
The fatal accidents you speak of are not all ‘accidents’. A large number of those fatal INJURIES are homicides. And there have been a number of comments on that in this thread. Again, I think the numbers on longevity are not that bad for the U.S. irrespective of controls. It is the healthcare spend which is out of line with the rest of the OECD.
The graph looks about right given how the medical equipment market works globally:
https://www.npr.org/templates/story/story.php?storyId=120545569
My bias is that for MRI machine manufacturers to sell to Japan at such low prices and still be a viable business, they need to be able to over-charge the Americans — in effect, the US is subsidising the rest of the developed world’s healthcare. To ensure the NHS has a future, I hope America never gets true single-payer socialised healthcare.
Did the scientists adjust for the type of game played. One might expect that Grand Theft Auto might result in different outcomes than Myst (on old school favorite). Obviously all video games are not fungible. My experience with social scientists in general is that their. statistics knowledge is poor, especially when dealing with multi-variate systems
Did the scientists adjust for the type of game played. One might expect that Grand Theft Auto might result in different outcomes than Myst (on old school favorite). Obviously all video games are not fungible. My experience with social scientists in general is that their. statistics knowledge is poor, especially when dealing with multi-variate systems
In the US, we spend nearly $1,000 per capita each year on prescription drugs.
Most other countries, even those with comparable GDP per capita, spend far less on these drugs because their single payer system aggregates purchasing power.In essence, the US is subsidizing new drug research for the rest of the world.
I have a hard time with these “the US is subsidising the world” arguments. If we looked at the demand for prescription drugs, medical equipment or other healthcare related expenditures as being global, that might be accurate.
For example, an analogous argument could be made in US secondary schools and colleges where the wealthy students ‘subsidise’ the tuition cost of the less wealthy, allowing the overall price to be lower. But clearly, the supply (price) and demand for school services at one school could be seen and modeled as one market.
But, with drugs, that’s not the case as you rightly state. The demand for drugs is purposefully balkanised in order to price-fix. It is akin to what airlines do with business travellers and vacationers or what movie studios try to do with DVD region zoning. The drugs companies actually want this because a global market for drugs would reduce overall price.
Americans bear the cost of this more than any other nation. So I see this not as “the US is subsidizing new drug research for the rest of the world” but more “the US is subsidizing new drug company profits for the rest of the world”. Drug companies want to make money. So they will conduct the research necessary to produce the drugs that allow them to do so, regardless of whether we have a balkanised or more efficient market for drugs.
In the US, we spend nearly $1,000 per capita each year on prescription drugs.
Most other countries, even those with comparable GDP per capita, spend far less on these drugs because their single payer system aggregates purchasing power.In essence, the US is subsidizing new drug research for the rest of the world.
I have a hard time with these “the US is subsidising the world” arguments. If we looked at the demand for prescription drugs, medical equipment or other healthcare related expenditures as being global, that might be accurate.
For example, an analogous argument could be made in US secondary schools and colleges where the wealthy students ‘subsidise’ the tuition cost of the less wealthy, allowing the overall price to be lower. But clearly, the supply (price) and demand for school services at one school could be seen and modeled as one market.
But, with drugs, that’s not the case as you rightly state. The demand for drugs is purposefully balkanised in order to price-fix. It is akin to what airlines do with business travellers and vacationers or what movie studios try to do with DVD region zoning. The drugs companies actually want this because a global market for drugs would reduce overall price.
Americans bear the cost of this more than any other nation. So I see this not as “the US is subsidizing new drug research for the rest of the world” but more “the US is subsidizing new drug company profits for the rest of the world”. Drug companies want to make money. So they will conduct the research necessary to produce the drugs that allow them to do so, regardless of whether we have a balkanised or more efficient market for drugs.
I am will to face the danger of being hissed off the stage, I’ll venture a guess as to why our huge expenditures get us some of the worst (as well as a little of the best) health care in the world. We need to introduce some competition in the health care industry-this could be based on reported quality of care. People already do this when the seek care at a well known facility that has a known quantity rating on well treated patients-the Mayo Clinic or the Cleveland Clinic.
My source for this is Redefining Health Care: Creating Value-Based Competition on ResultsMichael E. Porter and Elizabeth Olmsted Teisberg
Louisiana’s Medicare system spends over $8000 per beneficiary -highest in the -2001 data-yet has some of the worst outcomes in the world. The health care providers in that state are killing the people entrusted to their care. Health care premiums are running up another increase, almost %9 for 2011-previously %7-this is more than the rate of inflation which has been another feature of healthcare. Back to the problems as I see it for cost over-runs and failures to deliver any kind or reasonable bang for the buck when looking at time, money and effort spent. 1. An increasingly toxic environment makes it more difficult to stay healthy-the American government nuked us with bomb tests in the 1950’s and 60’s, and then nuclear power plants leaked radiation all over us. Toxic substances dumped everywhere: water is toxic, air is toxic and the soil is toxic. Almost impossible for anyone to stay healthy and more people are getting sick and seeking more expensive treatments (cancer ) than ever before as toxicity levels continue to build up. 2. Quality of care is abysmal-we know more about the $kill level of a ballplayer then we know about the quality of care routinely given out by our family clinic and ER.3. With the encouragement of insurance companies who kow tow to so called common medical practices, huge dollars go to unnecessary mammograms, colonoscopies (just to mention two services ) that patients don’t really need to stay healthy. This is termed over utilization.4. Under utilization is the opposite sin, potential patients avoid care to avoid high deductables, coinsurance amounts or fear being charged higher premiums if they report illnesses. Also, fear of insurance policies in general, caused by confusion or lack of understanding, causes some to avoid seeking care. In the long run we all pay hugely for both under and over utilization, the former especially as last ditch efforts to make up for lost time in care costs much more than regular care over a long period of time.
I am willing to face the danger of being hissed off the stage, I’ll venture a guess as to why our huge expenditures get us some of the worst (as well as a little of the best) health care in the world. We need to introduce some competition in the health care industry-this could be based on reported quality of care. People already do this when they seek care at a well known facility that has a known quantity rating on well treated patients-the Mayo Clinic or the Cleveland Clinic.
My source for this is Redefining Health Care: Creating Value-Based Competition on ResultsMichael E. Porter and Elizabeth Olmsted Teisberg
Louisiana’s Medicare system spends over $8000 per beneficiary -highest in the -2001 data-yet has some of the worst outcomes in the world. The health care providers in that state are killing the people entrusted to their care.
Concerns about costs are legitimate–Health care premiums are running up another increase, almost %9 for 2011-previously %7-this is more than the rate of inflation which has been another feature of healthcare. Back to the problems as I see it for cost over-runs and failures to deliver any kind or reasonable bang for the buck when looking at time, money and effort spent.
1. An increasingly toxic environment makes it more difficult to stay healthy-the American government nuked us with bomb tests in the 1950’s and 60’s, and then nuclear power plants leaked radiation all over us. Toxic substances dumped everywhere: water is toxic, air is toxic and the soil is toxic. Almost impossible for anyone to stay healthy and more people are getting sick and seeking more expensive treatments (cancer ) than ever before as toxicity levels continue to build up.
2. Quality of care is abysmal-we know more about the $kill level of a ballplayer then we know about the quality of care routinely given out by our family clinic and ER.
3. With the encouragement of insurance companies who kow tow to so called common medical practices, huge dollars go to unnecessary mammograms, colonoscopies (just to mention two services ) that patients don’t really need to stay healthy. This is termed over utilization.
4. Under utilization is the opposite sin, potential patients avoid care to avoid high deductables, coinsurance amounts or fear being charged higher premiums if they report illnesses. Also, fear of insurance policies in general, caused by confusion or lack of understanding, causes some to avoid seeking care. In the long run we all pay hugely for both under and over utilization, the former especially as last ditch efforts to make up for lost time in care costs much more than regular care over a long period of time.
There are other reasons we spend so much effort and time and money on health care and receive so little back (no, I did not mention the big bad insurance companies because they are only pawns in the game run by professional practitioners, facility and health care system administrators who run some of the gigantic care giver groups in the country)
We spend tons but not in the right way or in the right places. On top of that we don’t measure the quality of care based on patient outcomes so we don’t know the good providers from the really bad ones. One botched run of care, one messed up diagnosis, one missed opportunity to treat and cost over runs begin to mount when attempts to repair the situation are done causing one patient’s care to cost more than a hundred or even a thousand others.