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Dan Ariely on the Government and Healthcare

Question: Should the government be responsible for universal healthcare?


Dan Ariely: Absolutely. So the . . . As you start realizing – and I’m realizing more and more over the years – our inabilities, mine included, you realize more and more that somebody has to take a role. Somebody has to take responsibility. So think about healthcare. Is this really the right system for a free market? If you’re . . . If you’re a free market fanatic, of course you will say yes. But how many people, for example, are going to shop when they have heart attacks? Not many. Seventy percent of the income for any hospital comes from the ER. These are not people who are shopping and comparing prices. Should these forces, when there’s actually a monopoly, be left for people . . . people’s decision? Well the other thing. Preventative healthcare is so crucial. It’s so crucial. I mean we can talk about diabetes, asthma. There is no reason for anybody to go to ER anymore about asthma. The medications are fantastic. But ER visits to the hospital for asthma are in charge of about 97 percent of the cost. I mean if you just take your inhaler on time everything will be fine. But people don’t. They fail repeatedly. Now diabetes is the same thing. Early detection is incredibly crucial because you can control it. If you don’t detect it early you have to cut people’s limbs off. I mean there’s blindness. There’s all kinds of consequences. Now we as a society are paying these consequences many times. Is it . . . Is it the case that you should just leave it for people to do what is the best for them? If you understand that people can’t do it, then you have to think about a different system.


Topic: Irrational Healthcare Policies


Dan Ariely: Yeah.  So . . . So I think that, you know, healthcare is crazy the way we do it.  And just give you some numbers.  Hospitals don’t recover about a third of their bills, okay?  That means that we have the most expensive national healthcare in the world.  Why?  Because people who are sick and don’t have money can’t go to a doctor.  So what they do – they wait until they’re very sick and they go to the ER.  That’s a crazy system.  Now in some sense we’re all paying through it from insurance, but a third of the bills of hospitals are never paid?  That’s an incredible subsidy, and something that could have been done much cheaper under a national healthcare.  So that’s one.  I think savings . . . retirement saving is a big problem, and in many ways.  One . . . One approach in which it’s very difficult is that the government is giving us clues about what’s the right amount of saving.  They tell us if you put $15,000 in your 401K, you’re fine.  If you put $3,000 in your Roth IRA you’re fine.  You are not fine.  If you’re my age – 40 – and you just start saving, you will never make it.  You will never make it.  So in some sense it’s very hard to figure out how much we need to save.  But the government is giving us hints, and these hints are wrong.  That’s . . . That’s another . . . another thing.  And then, you know, there’s all kinds of other small things, but I think those are two of the big ones.


Recorded on: Feb 19 2008



The expert on irrationality, Dan Ariely, on why healthcare costs are out of control.

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  • Does AI—and, more specifically, conscious AI—deserve moral rights? In this thought exploration, evolutionary biologist Richard Dawkins, ethics and tech professor Joanna Bryson, philosopher and cognitive scientist Susan Schneider, physicist Max Tegmark, philosopher Peter Singer, and bioethicist Glenn Cohen all weigh in on the question of AI rights.
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A new hydrogel might be strong enough for knee replacements

Duke University researchers might have solved a half-century old problem.

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  • Duke University researchers created a hydrogel that appears to be as strong and flexible as human cartilage.
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Hints of the 4th dimension have been detected by physicists

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Predicting PTSD symptoms becomes possible with a new test

An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

Image source: camillo jimenez/Unsplash
Technology & Innovation
  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.