Comments on: Should Medicare Subsidise Your High Holidays Seat?

By: Chaim

Chaim — Mon, 04 Jan 2010 13:59:18 +0000

Most preventative medical programs are not cost effective – see here

Smoking cessation is – here, here, here
Exercise is free (nearly) and clearly cost effective..

The point is that obesity and smoking usually cause a slow death over many years with much morbidity and loss of productivity… Society does not have the benefit a “quick death”. It is not moral but economic..

Widespread screening by mammograms, prostate screening are clearly political causes….

By: frosh

frosh — Mon, 04 Jan 2010 10:13:50 +0000

Hi Liz,

I can’t recall seeing that episode – but I am a little disconcerted at having had the same thought as Sir Humphrey

By: Rachsd

Rachsd — Mon, 04 Jan 2010 10:07:18 +0000

Something that I am interested in is the theological / philosophical implication of religion being good for you: on the one hand, it is clear that this does not lend any additional credibility to the truth or otherwise of any particular religion given that the health benefits do not vary by creed.
Nonetheless, there is an interesting question of whether, if religion is good for you this demeans religion (as Liz suggests in her final paragraph) – if being religious is rational (in that it is good for your health), this might explain why humans are attracted to religion and thereby undermine divinity / transcendence. On the other hand, perhaps the benefits of religion demonstrate the compassionate nature of religious tradition, which would support the idea of a compassionate divinity.

By: frosh

frosh — Mon, 04 Jan 2010 10:03:31 +0000

Hi Sam,

Such an analysis falls outside my area of expertise.

At any rate, I think such policy decisions should probably not primarily be made on economic grounds, but rather on moral grounds. But even this throws up some questions.

For example, I think it is morally correct that the government has publcised the health dangers of smoking. But surely everyone in our society has now been adequately informed of these dangers. Is the argument for continuing to spend large sums of money on advertsing the dangers of smoking an economic or a moral one?

If it is moral, I'd counter that the tax payer only needs to do so much to inform people of now obvious health issues. It has long since passed that point. If people still wish to take up smoking now, well...

If it is economic, then maybe there is an economic benefit from this advertsing, but as we've discussed, there is some question over this too.

By: Sam

Sam — Mon, 04 Jan 2010 06:32:56 +0000

Hi Frosh

Difficult to determine whether it is less costly for governments for people to allow poor lifestyle choices to shorten their lifespans or vice versa.
It has been ascertained that a disproportionately large expenditure is made on a patient that has been very ill in the last 6 months of life.

I know that you are expert in stats, but the design of an analysis to answer the question might be too complex (taking into account all the variables) to produce a meaningful result. What do you think?

I do work in the health industry and don’t know the answer, but I suspect that it is costly for governments either way. Nowadays people live a long time with high blood pressure, diabetes and arthritis all of which probably require multiple medications and regular doctor visits.

By: Chaim

Chaim — Sun, 03 Jan 2010 13:03:04 +0000

Frosh:

It is the difference in cost between the treatment of the chronic illnesses over decades (Diabetes, hypertension, heart disease, strokes, emphysema) which in most cases do not kill you right away but cause extensive morbidity and treatment costs at an earlier age and the increased chances of dying at 85 suddenly from an heart attack or cancer (very expensive but in most cases shorter duration of treatment) – if you lead a healthier lifestyle.

Especially when we also have lower expectations of outcomes and more chance of just making people “comfortable” at older ages – “Grandpa had a good long life and he is tired and wants to die” i.e. less heroic effort at treatment s and more cheaper palliative care..

Also productive work years are increased if most of your life is healthy plus less sick pay etc

By: Liz

Liz — Sun, 03 Jan 2010 07:16:11 +0000

Frosh,
You have to watch Yes, Minister….you would love I am sure.
At any rate, you’ve just come up with one of their exact plots….
http://en.wikipedia.org/wiki/The_Smoke_Screen_(Yes,_Prime_Minister)
cheers
Liz

By: frosh

frosh — Sun, 03 Jan 2010 06:38:43 +0000

I know this is slightly off the topic, but since the title of the article relates to health economics, I do wonder if there is a false economy with some health promotion.

Allow me to play devil’s advocate:

On one hand we are told to exercise, abstain from smoking (and yes, I do exercise, and I have never smoked) and eat a balanced diet etc. We are told these things will make us live longer and healthier. I have no reason to believe this to be untrue.

However, we are also told that this will save the public health system considerable money. Meanwhile, we are also told that the public health system is struggling under the weight of population that is living longer, and thus there is a far higher incidence of gerontological illnesses.

So, when it comes to keeping people healthier and living longer, is it a case of save money now, but pay money later?

Let me add a couple of caveats to this.

1) I have no expertise in health economics – only posing a question.

2) I am not questioning the moral and social imperative of keeping healthy and living longer – I’m just questioning whether there is really a significant economic benefit to the health system.

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