Reading on The Happy Hospitalist re: his take on what Obama’s plan would mean in terms of cost per QALY, I noticed something: his stats were appalling. When called on it gently, he confidently reiterated his error, and the commenter backed down.

Clearly, we as doctors need more training in statistics so we can a. spot these sorts of errors and b. be confident in correcting them.

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Let’s look at the numbers. Let’s round up for easy numbers. 20,000 deaths a year are attributed to lack of insurance. Obama is trying to brainwash the public into believing we need to spend one trillion dollars in public money over the next 10 years to cover everyone. Let us use easy math and assume a linear function over time. That means an additional 100 billion dollars a year are required to insure the entire nation..And in the process we will save 20,000 lives a year. That’s 100 billion dollars a year to save 20 thousand lives. That means Obama wants to spend 5 million dollars to save one life for one year. That’s a Quality-adjusted Life Year of 5 million dollars..

The QALY is based on the number of years of life that would be added by the intervention. Each year in perfect health is assigned the value of 1.0 down to a value of 0.0 for death. If the extra years would not be lived in full health, for example if the patient would lose a limb, or be blind or be confined to a wheelchair, then the extra life-years are given a value between 0 and 1 to account for this..

Let’s assume every year 20K lives are saved. And each year you just add another 20K lives. […] And at the end of 10 years, using your logic (which does make sense in theory) 200K lives would have been saved if everyone had insurance for 10 years.

Now, lets do a back track. Lets take away the insurance that all these people had for the last 10 years and lets look at year 11

Using your logic, all 200K people + an additional 20K people would die if you took away their insurance to the level 11 years prior.[…]

But if you save a life, you MUST add that person-year to each year.[….] If you take away the insurance at the end of ten years, you really do still have the accumulated person-years saved, which incidentally works out to (using your 20K for easier math) 200K (the people saved in the first year who live 10 years) plus 180K (saved in the second year who live nine years) plus… you get the idea, working out to 1.1M person years. Then people start dying again, but more slowly, because they have had ten whole years of extra care..

redrabbit, let’s just assume lives saved. Even better. 5 million dollars to save one life. Same conclusion.Your conclusion would assume after 10 years that removing insurance would kill 200K lives. That’s not what the statistic says. It says 20K lives..

No, Happy, that was your conclusion. My conclusion was that 1.1 million person-years would be saved over ten years, in this case equal to about 200 thousand people. I also stated that people would again begin dying once insurance was taken away, but not all at once.Maybe at a rate of about the same or less than previously, so these people keep on living, and maybe 20 thousand die (assuming same as before insurance, right?), but you still have an accumulated group of live people who continue to be alive. So the savings of people and person-years actually will continue to accumulate.I thought that was clear from my math, but I guess not.

So, at 11 years, having cancelled the whole programme at 10, because Happy was elected POTUS, we still have a savings of 1.28 million person-years. At 12 years, even with the 20 thousand people a year dying again, still saving 1.44 million person-years, at 13 years still benefitting by lessee 1.56 million person-years. Still 120 thousand people alive who would have died otherwise.

Doesn’t sound very much as though your Dr. Happy really cared to know the truth: “Public option is bad! Nyah, nyah!”

Either that or he’s a fairly egregious narcissist.

By:

Epictetuson 2009 September 15at 12:31

This argument took place on his blog. You’re just seeing my side of it.

But, IMHO, you’re right on both points….

By:

redrabbitslifeon 2009 September 17at 10:30