His arguments strongly suggested that he was trying to push the declining life expectancy on the ACA, If the conversation had started with "It's good that the ACA got more people coverage, but our overall healthcare system doesn't help even the members of the lower-class who can afford it. The base of Obamacare must be expanded upon with a stronger system that would improve life expectancy," I would have agreed from the start.

Posted by tangplay on 6/15/2020 5:01:00 PM (view original):
His arguments strongly suggested that he was trying to push the declining life expectancy on the ACA, If the conversation had started with "It's good that the ACA got more people coverage, but our overall healthcare system doesn't help even the members of the lower-class who can afford it. The base of Obamacare must be expanded upon with a stronger system that would improve life expectancy," I would have agreed from the start.

Completely agree.

He didn’t do that though. And everyone else is biased and dumb while he changes horses midstream. Makes sense.

Posted by dahsdebater on 6/15/2020 5:01:00 PM (view original):

Posted by tangplay on 6/15/2020 4:44:00 PM (view original):
So maybe we can agree on the idea that Obamacare was a positive because more Americans gained access to healthcare, but more improvements must be actually needed to the healthcare system in order to ensure that health outcomes actually rise with more care?

I don't think we agree on this. We apparently have different ideas of what constitutes an inherent good; mine seems to be much more practical. This concept that something could be good if it worked doesn't impress me very much. If it's demonstrably true that healthcare outcomes aren't improving as a result of extending insurance coverage, then I don't think extending coverage is "a positive." At best, if we think the administrative costs end up getting balanced somewhere else in the system, it's "a net neutral."

I do think that we probably are talking past each other at this point. I'm not convinced the ACA is a significant stepping stone towards a functional single-payer system. If you think it is, then I can see supporting it. I assume at some point in the next few decades we'll manage to set up a single-payer system.

The goal of Obamacare was to give more Americans access to healthcare. It succeeded in this regard. If we are to actually improve life expectancy, we probably need to start from a base of "Americans have coverage."

But yes, universal healthcare/some form of single payer is the goal for the future. I do see ACA as a stepping stone.

Either way, I'm less worried with the past and more on the future. If we can generally agree on a path forward, I'm comfortable with that. If you do believe that healthcare doesn't improve life outcomes, I'm curious what solutions you have for this problem.

Posted by dahsdebater on 6/15/2020 5:01:00 PM (view original):

Posted by Uofa2 on 6/15/2020 3:23:00 PM (view original):

Posted by dahsdebater on 6/15/2020 2:56:00 PM (view original):
Look, I'll stop beating around the bush because I have a meeting at 3. In general when I have this discussion and people cite "research" about "deaths of despair," they're usually talking about popular/news sites summarizing Woolf et al. It is very clear that this article was written with an agenda, because it also summarizes its own data in this way - falling life expectancy is due to deaths of middle-aged white Americans because of drug- and alcohol-related causes. And if you look at percentage changes, this narrative actually works. But if you look at the supplementary information for the article you'll notice that the biggest increases since 2010 in actual total deaths in this age group, drugs are out in front, but they're followed not by alcohol and suicide but diabetes and heart disease. Unfortunately since I'm away from work I don't have journal access to download the actual numbers atm. But I know diabetes and heart disease were 2nd and 3rd in net increase in deaths among the age group the authors cite as the source of declining life expectancy. Their "death of despair" conclusions are largely driven by personal bias. The reality is that a huge factor is worse outcomes from managed health issues.

Which, really, is not surprising given the 30% decline in visits to PCPs I referenced above.

Yes, it’s everyone else’s conclusions that are being driven by a personal bias.

Feel free to look at the actual data and explain to me how I'm wrong.

I dunno man, which argument are you making now?

Could the ACA do more? Sure. Is it a failure? Nope. Is it a reason for the drop in life expectancy? A .1 drop? With the opioid crisis and obesity and suicide rates through the roof? Seems like a pretty crazy leap in logic to me.

Posted by Uofa2 on 6/15/2020 5:05:00 PM (view original):

Posted by tangplay on 6/15/2020 5:01:00 PM (view original):
His arguments strongly suggested that he was trying to push the declining life expectancy on the ACA, If the conversation had started with "It's good that the ACA got more people coverage, but our overall healthcare system doesn't help even the members of the lower-class who can afford it. The base of Obamacare must be expanded upon with a stronger system that would improve life expectancy," I would have agreed from the start.

Completely agree.

He didn’t do that though. And everyone else is biased and dumb while he changes horses midstream. Makes sense.

Where did I "change horses?"

What were the first and second horse?

Posted by dahsdebater on 6/15/2020 12:16:00 PM (view original):

Posted by tangplay on 6/15/2020 12:15:00 PM (view original):
Dahs - can you explain your theory for why the ACA caused a reduction in life expectancy?

I don't need to. The data support my position. You need very good reasons to reject the obvious hypothesis, not to accept it.

after evidence is brought to reject the hypothesis, you say

“I don't blame the ACA for reduced life expectancy.“

no no, not changing horses. totally didn’t completely change the nature of your argument at all.

To be fair, I don't think he ever explicitly blamed the ACA for the reduced life expectancy. He just implied it heavily.

Posted by dahsdebater on 6/15/2020 11:33:00 AM (view original):
Here are the facts:

1) The US had increased life expectancy >1 year every decade from 1900-1910
2) Global indices of first-world countries indicate that the rest of the world is continuing to experience the same slow but steady increase in survival we've seen since the '70s (see, for example, this). And the US lags behind most other developed nations. So you can't argue we're bumping into some natural limit.

What changed in this country in this decade?

We managed to increase life expectancy in the 30s. This decade has seen solid overall economic growth, coupled to a decline in survival for the first time in the CDC dataset. It is very clear - if the objective of healthcare is fundamentally to keep people alive, the ACA is an abject failure.

He more than heavily implied it.

Posted by dahsdebater on 6/13/2020 2:42:00 PM (view original):
Already posted most of my thoughts on this here. Just about everything I've seen defending the ACA based on actual outcomes is anectdotal. I'm glad Bob is alive. He seems like a good guy. I understand he's convinced this is only true because of the ACA. Maybe he's right. But in the broad picture, outcomes have not improved. We have great statistics on death in the US, by age, cause, and in many cases also wealth. They do not paint a rosy picture of the ACA. Which is why, so many years in, defenders are still talking about "coverage," as if somehow this had superseded actually keeping people alive and well as the primary goal of the healthcare system.

I realize you can't always expect people to click links, but I did start out by saying I had a more detailed account of my thoughts in Dino's thread in the SLB forums. Where I said this - on the linked page - on February 18:

It is an absolute objective fact that morbidity and mortality rates amongst the bottom 25% of Americans increased (got worse) following the passage of the ACA. This was because of the opioid crisis, not the ACA. But trends since then are clearly no better than pre-ACA. It's absolutely not keeping people alive or healthy any more effectively than the preceding healthcare system. And it increased total healthcare spending, largely by introducing lots of new administrative overhead. What's good about that?

Coverage is not an inherent good. The popular defense of the ACA based on numbers of people covered is an obvious fallacy.

I think I've been entirely consistent with this. Honestly, nothing you've argued is really convincing that the ACA isn't a factor in the increasing mortality - it remains true that more of the increase in mortality in people below Medicare age is from managed health issues than external factors. But it really doesn't matter. What is clear is that the ACA has not improved healthcare outcomes for low-income Americans, at least in an aggregated statistical sense. With that being the case, I think it's clearly a failure - it's eating up hundreds of billions of tax dollars to not help the American people. And before you downplay that number again, think about how you'd react to a $200 billion bump in military spending. It's a lot of money. Granted, some people who know a lot more about the financial aspects of the healthcare system than I do have argued that this expense will soon be made up, or is already being made up, elsewhere in the system. I assume there is at least some truth to this. As a matter of political philosophy, I'd rather the money not come from taxes, but that's not a real practical consideration. What is, however, is the uncertainty that the expansion of low-compensation plans has placed on PCPs and especially emergency care. It's now the case that a lot of ER docs and some PCPs in large healthcare groups (HMOs, big hospital systems, etc.) produce negative values; that is, their salary and the salary of attached personnel, equipment, etc. exceed the proceeds of their billing. It's really not clear how this could impact our healthcare system, but it's a somewhat scary prospect, and something that surprisingly few people seem to be aware of/concerned about. As overall margins for hospitals go down there is going to be increasing pressure to reduce staffing in ERs. That's not going to be good for anybody.

You do contradict yourself within your own statement, though.

It is an absolute objective fact that morbidity and mortality rates amongst the bottom 25% of Americans increased (got worse) following the passage of the ACA. This was because of the opioid crisis, not the ACA.

Honestly, nothing you've argued is really convincing that the ACA isn't a factor in the increasing mortality

Like, I hope you can understand why your constant focus on the increasing mortality rate coinciding with the ACA's passage got that message across to us?

Regardless, I think we've played out the arguments here. I still would like an answer to my other question:

If you do believe that healthcare doesn't improve life outcomes, I'm curious what solutions you have for this problem.

Ha. Wow.

Yeah, just answer tang's question.

I don't know what the solution is at the moment. In the long run probably a single-payer system, but there are a lot of complications with the transition.

In the short term I don't have a solution. That doesn't mean I have to support the broken, non-functional attempt at a solution we have now.

Great. So I would argue that one of the steps to get to single-payer, would be to get as many Americans healthcare coverage as possible, even in private insurance. The ACA achieved that step. In this way, it's a positive.

I'm not sure how you could argue that the ACA took us farther away from single-payer in the long run.

Who cares? Defund the police.

Healthcare is pretty important.