It is estimated that 15 percent of the total increase in health care costs (representing $10 billion in 2001) is attributed to government mandates and regulations. Indeed, the “Health Insurance Portability and Accountability Act (HIPAA) alone will add billions of dollars in new compliance costs to the healthcare system.”[PriceWaterhouse]

Woolhandler S, Himmelstein D; Paying For National Health insurance – And Not Getting It; Health Affairs (21) July/Aug 2002, pp.89-95.

PriceWaterhouseCoopers, "The Factors Fueling Rising Healthcare Costs," April 2002; pp.1-13

So, Steve hasn’t actually argued that the raw number comparison is misleading....

No...I haven't. I have instead argued that they might be misleading, although I am pretty sure they are misleading.

He suggests that may be the case, but then fails to offer the slightest data to show what, if any, adjustments to these numbers would be more accurate.

Why should I do Matthew's homework for him? I don't get paid to dredge up such data and do the analysis. Matthew on the other hand does get paid to write articles. So does Krugman, Matthew's source. Krugman gets paid to do nothing other than sit in his office and do research similar to this. Why isn't he doing it? Could it be because it could undermine his point?

This would be a good thing for either Matt or Krugman to look into, but I doubt they'll do it because it is so much easier to write a superficial pieces of crap and get paid the same amount of money.

By that measure, the American worker had not done as badly, but still, we had gone from best well paid, to about 9th. Considerably better, yes, but still indicating a large relative decline over a short period of time.

In other words, my position stands. We probably wont see a savings of $2,500/year. Maybe there will be a savings, but we don't no for sure until a more serious analysis is done.

So, Steve’s total of alleged possible confounding effects could cut the apparent cost difference in half, and yet not change the basic conclusion already reached on a naive basis from the data as shown.

Really? I thought my final concluding comments were,

This kind of brain dead comparison across countries isn't really that helpful. The implication of these simpleton posts is that if we simply switched to the same system as the French we could save $2,500/year and that isn't chump change for most of us. But does this have to be the case? Does it even have to be the case that we'd save $1/year? This is ultimately the real question (from a utilitarian/money stand point) and these kinds of moronic posts don't even come close to answering this question.

Gee, guess I really didn't write that. Tell me O' Sage, what exactly did I write?

For he hasn't shown even ball park guesstimates of what the correction factors from these considerations might be, let alone that they fully account for the differences shown in costs.

Might they? Sure, I guess. Might they not? Possibly. And Steve himself agrees that it may or may not make enough difference to close this apparent cost factor gap.

So, Steve hasn't actually argued that the raw number comparison is misleading, and only wrongly, for various reasons, seems to show at least a cost disadvantage to our health care delivery system. He suggests that may be the case, but then fails to offer the slightest data to show what, if any, adjustments to these numbers would be more accurate.

Not that I blame him. Digging through the weeds to try to get quantitative numbers on such factors would surely be a lot of work.

But since he declines to do this, no less than those he criticizes for ignoring these adjustment factors, he hasn't shown they've erred in relying on this comparison.

An example from the past: in 1980, the American industrial worker was the most highly paid in the world. By about '89, that figure had slipped to where we were no longer even in the top ten, but at the bottom of the second ten, about 18th, 19th highest paid.

Critics made the point that since necessities like food and clothing were so much cheaper here, American workers were doing better than a gross comparison would indicate. So the comparison of workers was done on what was called a purchase parity basis, not only what one earned, but how far that went, after necessities were paid for at prevailing (and differing) national prices.

By that measure, the American worker had not done as badly, but still, we had gone from best well paid, to about 9th. Considerably better, yes, but still indicating a large relative decline over a short period of time.

So, Steve's total of alleged possible confounding effects could cut the apparent cost difference in half, and yet not change the basic conclusion already reached on a naive basis from the data as shown.

Funny -- professionals (doctors, accountants, lawyers, etc.) rarely try to pull that kind of thing on me; when they do, something on my face must start flashing like a B.S. detector, 'cause they almost invariably trail off into CYA mode in the other direction.

But I've been told I have a "don't @#$! with me" kind of face...

I suspect that the number that go overseas for treatment is at least as high as vice versa. I’ll do some digging.

If you could, try to avoid counting those who go overseas for plastic (okay, silicone) boobies. Seems to me like that could bias the results.

Too many people go to see a doctor, the doctor orders a couple of tests and because they only have to come up with a $20 co-pay, fail to even ASK what all those tests will cost and if they are truly needed.

Michael, have you ever actually attempted this strategy? I have on several occasions citing chapter, verse, and specific CDC studies. The typical response is that the doctor draws himself up to his full height and tells you to go to hell (in the nicest possible way of course).

Victor, what a great set of questions. You are an actuary aren't you? I can answer the first couple of questions.

a) If you want health care, can you get it?

That depends on lot on where you are. In major metropolitan areas anyone can get the health care they need. How it gets paid for is another question entirely. In rural areas health care may be very hard to come by.

b) Are you pleased with the services when provided? Do you think they were worth the money?

The last health care I was pleased with that I received is when I was wheeled into the hospital unconscious and bleeding 25 years ago (it's pretty hard to be a rational optimizer under those circumstances, BTW). They did a great job. Since then, however, I've been physically and psychologically abused nearly every time I've sought health care and had actionable malpractice committed on me twice. It's always been very, very overpriced.

c) Do doctors come to the US to train, or do doctors go abroad to train?

Approximately 20% of all doctors practicing in the United States were trained overseas. In some areas (NYC, for example) it's over 30%. In some specialties it's over 40%. I think that probably dwarfs the number of doctors who train here and then return home to practice (or even that stay here to practice). It's actually extremely difficult for foreigners to get into US medical schools.

d) Do patients come to the US for services, or do patients go abroad for services?

It used to be mostly coming over here but the tied is turning. I suspect that the number that go overseas for treatment is at least as high as vice versa. I'll do some digging.

I question, therefore, whether trying to quantify such an entity is relevant.

But if you insist on trying, here are some questions:

a) If you want health care, can you get it?
b) Are you pleased with the services when provided? Do you think they were worth the money?
c) Do doctors come to the US to train, or do doctors go abroad to train?
d) Do patients come to the US for services, or do patients go abroad for services?
e) (and here we start to go down the slippery slope of poorly defined tests) ... for a given procedure on patients with given risk factors, what is the "success" rate?
f) If you are 65 years old, what proportion of the population has had a successful knee replacement? Hip replacement? Age 70? Age 80?
g) What is the conditional life expectancy for nationals? (i.e., ignoring immigrant populations that were not able to partake of the nation's healthcare system in the 1950s, say)
h) Given a particular set of risk factors, what is the infant mortality (i.e, for an otherwise healthy baby delivered by a healthy mother, etc.)

None of these are terribly dispositive, however, and I am left again feeling that one's priors cannot be disproved based upon the answers to any of those questions.

Regardless, the aggregate dollar volume is not even one of the questions in my list. What was the exchange rate at the time? What proportion of income does that represent? Does that represent personal preferences or demographics or fundamental cost differences? Even if you say that our paperwork costs are 25% higher than in other countries, this does not mean we are wasteful. We have different privacy restrictions, different reimbursement systems that encourage extra hospital admin but also leave at least some flexibility for growth, etc. We have to pay doctors more in this country to get them to take the job, we have a litigation system that, relatively speaking, favors the plaintiff. Therefore, all of this "waste" does provide us with things that we value, even if the relationship is not readily apparent ...

I guess you can argue that those who defend the status quo aren't trying to answer those questions, but neither are the critics of the status quo. I don't know why the burden of proof should therefore rest on the "defense" in this argument.

I also think that the approach taken in Thacker's post above is helpful. But I don't think you can in general prove or disprove prior beliefs regarding the quality of US health care because you cannot clearly identify a testable hypothesis that completely describes the question.

For example, I’d really like to see some statistics that actually demonstrate that the U. S. health care system is genuinely excellent. Too many (I’m not saying you, Steve) of the opponents of change in the status quo rely solely on bland assertions.

Thanks Dave. You're right, I do think the current system has lots of problems and there is much room for improvement. The problem is I am not convinced that socializing medicine is the way to go. It could, at least in theory, be a rotten way for the U.S. to go...or using another countries system could be really good.

The statistics do, at least, point out that our supposedly “private” healtcare system is actually paid for by quite a bit of public funds.

We don't have a private system. Note that about 45% of the spending is from the government. Could that government spending plus the current legal and regulatory institutions be part of the problem? I'm willing to entertain that notion if those on the Left would be willing to entertain the notion that we need more market incentives might also help.

Here's an article written without much heat about it. Notice that our over 65s spend considerably much more than France's as well, in the same proportions as our younger ages groups do when compared to similar age groups in France. And our over 65s have primarily government-run health care, like in France. Is there any reason then to expect that expanding Medicare to everyone would lead to a change, then?