Extreme Health Care

Kevin Drum is skeptical that America does more in extremis than other healthcare programs:

Boy, I'd sure like to see some backup for that.  If by "extraordinary" Megan means the most extreme 0.001% of procedures, then maybe she's right.  Maybe.  But nothing I've read about Western European healthcare systems makes me believe that there's any substantial difference between the way they treat severe illnesses and the way we do it.  And no systematic difference in success rates for such treatment either.  Nor should this come as a surprise, since most extreme medicine is practiced on older patients, who are covered by a public plan both here and in Europe.

If only Kevin had a subscription to The Atlantic--very reasonably priced at 19.95 a year--he would have found a hint in Virginia Postrel's article about Herceptin and early stage breast cancer, which we ran in March.  That article is about New Zealand, but the controversy over Herceptin was not limited to the Southern Hemisphere; Britain had a famous case involving the expensive cancer drug, in which a woman successfully used a combination of legal and media pressure to force the NIH to provide her with the drug for her early-stage breast cancer (she has since died).  Early stage HER2 positive breast cancer is hardly a 0.001% event--25% of breast cancers have the HER2 trait, and those tend to be the more aggressive kinds of cancer.  The drug had already been offered for early stage cancers in the US for years, even though no one had definitive proof that it worked.

This may be why--contrary to what Mr. Drum has apparently read--cancer survival rates in Europe lag those in the US.  (Although this is complicated:  we catch cancer earlier, because we're screening-test-mad, and some cancers just hang out for decades without killing you).  At the highest macro level, life expectancy, Europe generally outperforms us.  But it's not clear how much of that is health care, and how much things like our murder rate, and our famously sedentary lifestyles.  When you drill down into many diseases, we outperform them.  And many argue that we outperform them on hard-to-measure "lifestyle" issues:  how fast your torn ACL gets repaired, how quickly (or whether) you get a hip replacement, etc.  Such quality of life issues are nearly impossible to measure, though this hasn't stopped many people from trying.  But I don't really trust the figures they generate.

Europe gets a great deal out of all of this.  We figure out what works, then they adopt it.  But we get a great deal too--we get earlier access to controversial treatments, and our future generations get all the treatments we've discovered so far..