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Why Does USA Outspend G7 on Healthcare?

Tyler Cowen points to this interesting graph of health care spending as a percentage of GDP in the G-7 countries:

He asks, “What happened in 1980?”   It’s a good question.   While the US expenditure was higher than average the whole period and was accelerating quickly before 1980, we started to depart radically from the norm that year, had another explosion the the late 1980s/early 1990s and another one circa 2000.  Presumably, the prescription drug benefit largely explains the most recent spike.  But what of the earlier ones?

Despite the chart creator’s use of presidential photographs as lines of demarcation, I don’t think the occupant of the White House is the most significant variable.  But I don’t know what is.    One of Cowen’s commenters suggested that it’s the use of expensive imaging devices, which strikes me as plausible.  Another suggests the introduction of HMOs, adding an additional middle man.

jameyer, who posted the graphic back in February along with some related ones on life expectancy, doesn’t address this issue but he observes,

  • The US spends a factor of two more than other countries and yet has the lowest life expectancy. The surprising trend among G7 countries is that higher health care costs correlates with lower life expectancy.
  • The US spends a factor of two more than other countries and yet has the highest infant mortality rate. The surprising trend among G7 countries is that higher health care costs correlates with higher infant mortality.
  • [A]mong the G7 countries, public spending on health care leads to good results and high private spending correlates with poor outcomes. If we can move more in line with our G7 counterparts we would save 1 trillion dollar a year, live 2.5 years longer and suffer 10,000 fewer infant deaths per year.

Life expectancy is by no means perfectly correlated with the quality of a healthcare system since cultural and economic factors intrude heavily.  Most notably, poverty, homicide, and accidental death can really skew the numbers.    And, even if we had a European-style public health system, we’d still spend more than they do because of our massive size and relatively low population density.

Still, the American belief that we’ve got the best health care system in the world and are therefore getting our money’s worth is increasingly hard to defend.

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About James Joyner
James Joyner is the publisher of Outside the Beltway, an associate professor of security studies at the Marine Corps Command and Staff College, and a nonresident senior fellow at the Atlantic Council. He's a former Army officer and Desert Storm vet. He has a PhD in political science from The University of Alabama. Views expressed here are his own. Follow James on Twitter.

Comments

  1. john personna says:

    What caused the 1990-2000 plateau?  That might be the way to flip it from problem to solution.
     
    “And, even if we had a European-style public health system, we’d still spend more than they do because of our massive size and relatively low population density.”
     
    The bulk of Americans live in cities, therefore the bulk of consumption and cost is in cities.
     

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  2. James Joyner says:

    The bulk of Americans live in cities, therefore the bulk of consumption and cost is in cities.

    But we have a hundred million or more Americans scattered higher and yon who need a hospital within a short ambulance ride.  And said hospitals need to have something approaching state of the art equipment.  That’s a massive infrastructure requirement that has to be financed.

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  3. john personna says:

    The US has a lower percentage of rural residents than France or Spain, but higher than Denmark or the UK.
     
    http://www.nationmaster.com/graph/peo_per_liv_in_rur_are-people-percentage-living-rural-areas

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  4. Anon says:

    Note that the Y-axis is percent GDP.  So, the curve could also be explained by changes in GDP growth.

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  5. PD Shaw says:

    What Anon said; I’m not sure percentage of GDP growth is a useful metric here. 

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  6. john personna says:

    Right Anon, we normally expect GDP to be related to population in the same way health care costs are related to population.  A change in the relative relationships can move the curve.
     
    In the 90’s presumably GDP and health care costs moved in parallel because they each maintained a constant relation to the demographics.

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  7. john personna says:

    “I’m not sure percentage of GDP growth is a useful metric here.”
     
    I’d call a steady state “success” in controlling costs.
     

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  8. PD Shaw says:

    I think this is a more useful chart to consider.  It seems to indicate that the big leap in healthcare expenses followed Medicare, and then since 1980 it’s generally been increasing at a rate of +2% CPI.
    http://theglitteringeye.com/?p=9326
     

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  9. Steve Plunk says:

    It’s been acknowledged that health care at the beginning and end of life make up the largest portion of costs.  Infant mortality has long been explained to be the result of those we try to save versus other countries and our longevity deficiencies are more life style related than the quality of health care available.  Those two measures are misleading.
     
    We spend more because we demand more of our system.  Private rooms, individual care, follow up care that includes home nursing, counseling, personal hygiene, and more.  All of that provided 24/7.  We also see our hospitals competing for patients and duplicating services that drives up cost.  Ever notice how today’s hospitals also have community wellness centers and other social service programs that drive up costs?  It seems we want more and health care providers want to give more.
     
    We also need to look at pricing for services and prescription drugs.  Pricing is set mostly on what the market will bear.  Identical drugs cost less in foreign countries because the sellers look at what the market will pay and then set costs to maximize revenues.  It’s the same with services.  You charge what ever you can because there will always be unmet needs that have to be subsidized by those who pay.
     
    Those are just a few of the reasons we pay more.  Until some of these are addressed we can never just look at the insurance portion and think that’s where the solutions are to be found.

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  10. john personna says:

    So Steve, did we keep a cap on those in the 90’s?  Or kept them in line with earnings?  Wouldn’t that be a clue that we could again?
     
    Note that spending $10 trillion per year on health care might be fine, if somehow we could get GDP to $100 trillion.

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  11. PD Shaw says:

    The big jumps around 1981 and 2001 appear to reflect recessions.  The flat periods are the 90s where the U.S. enjoyed pretty consistent 4-7 percent GDP growth (the tech bubble) and the 3-6 percent GDP growth in the mid 200s (the housing bubble).
    What this tells me is that the U.S. fiscal house is addicted to growth.  If growth in the overall economy can be maintained higher than the rate of healthcare inflation, we’ve got no problems.  Bubble anybody?

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  12. tom p says:

    go here for some even more instructive graphs:
    http://www.ifhp.com/documents/IFHPPricereportfinal.pdf
    The avg cost is hard to read on each chart but what I find most interesting is the range of costs for a given procedure, such as an abdominal CT-scan: from $164 – $1564…  What is up with that?
    Also I think I found that site via Kevin Drum.
     

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  13. rodney dill says:

    It leaves a lot to be explained. The stated measure of quality is the overall life expectancy, not the best quality care that can be provided in a timely manner to those that purchase more costly plans. You can achieve greater average life expectancy by providing free preventative coverage in this country to those that opt out or can’t afford it at the expense of removing some questionable high cost care.
    I’d also like to know if any cost components are related to lobbying, litigation, etc… in the model.
    I’m not trying to say one way is better or not, but it may be an apples and oranges comparison.
     

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  14. tom p says:

    Ever notice how today’s hospitals also have community wellness centers and other social service programs that drive up costs? 

    Steve, those things exist because they reduce costs (it’s called preventive care).

     

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  15. We spend more because we are wealthier and choose to spend more.  Why is that so hard to believe or undersdtand?  This isn’t a policy issue as much as a question of whether people are allowed to be free to choose what they spend their money on.  Check how much we spend on food or entertainment compared to these other countries for instance and let me know what you find out.

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  16. MarkedMan says:

    Steve, If you think that the US healthcare system provides more and better coverage than, say, the Netherlands, I’m not sure what to say.  It doesn’t.  Much more is covered, and its covered for everyone. One very, very significant difference is the overhead cost.  Insurance companies make about 10-12% profit, so with the people covered by private insurance you have the profit, plus their overhead.  Don’t believe what they say about the overhead being limited to 6-7%, they have a very odd definition of overhead.  Now add on to that the cost of administration in your doctor’s office.  How much floor space and how much staff is devoted to administering health insurance? The total overhead cost is somewhere between 25 and 40%. In the European countries, even those with private health insurance (yes, it does exist, although it is much more highly regulated than here) the overhead is in the single digits, often the low single digits. We could knock a good chunk off that differential if we could bring our own overhead down to the low single digits.
    They also: 1) cover everyone, 2) do not have anyone on staff who’s job it is to find ways to deny you coverage.  No one there gets a bonus if they figure out how, after paying into an insurance plan for years, they find a way to cancel your policy when your ten year old is diagnosed with leukemia.
    In general, people in the US have absolutely no clue how disfunctional the American health care industry is in the finance and delivery of that healthcare, because they are fed an endless supply of stories comparing the best of our healthcare system to the worst of the worst of the European systems.
    I had a colleague who’s son was in a terrible accident. 40+ broken bones, ruptured organs, 28 hours in the first surgery.  The son recovered pretty well, he can walk and mentally he is fine, but my colleague spent every morning, every lunch hour and every evening for months on the phone with the insurance company as they tried every trick in the book to disallow as much of the care as he could (one typical example: an out of network specialist was approved and consulted a half dozen times. When his son went back home, they brought him back to that specialist as followup. All payment was denied. They should have realized his status had changed when he was discharged and therefore the out of network specialist needed to be re-approved.)

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  17. James Joyner says:

    @charles austin

    We spend more because we are wealthier and choose to spend more.

    But we’re not getting more, at least in terms of outcomes.
    It’s true, though, that our GDP/capita is substantially higher than the other G7 states, either in raw numbers or PPP adjusted.

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  18. john personna says:

    James, again looking at those glorious 90’s … would it be true that our life expectancies rose in that decade, even as our spending as a percentage of GDP remained stable?

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  19. john personna says:

    “When his son went back home, they brought him back to that specialist as followup. All payment was denied. They should have realized his status had changed when he was discharged and therefore the out of network specialist needed to be re-approved.)”
     
    To me, this is why none of us should have to deal with it.  That is not civilized.
     
    The sad thing is that most voters can discount stories like that because they are healthy, and haven’t experienced them yet.
     

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  20. anjin-san says:

    I don’t think the 13K charge for a colonoscopy two years ago was a result of my “choosing to pay more”. It’s a 45 minute routine procedure. I think it is a result of the provider gouging because the system is set up to allow them to do so.
    Not a big deal for me, I have excellent insurance. But that can alway change.

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  21. tom p says:

    My wife is from Spain. Her mother has had breast cancer, leukemia, 2 heart attacks and more, but never had to worry about losing her house. The health care they get is very good and a fundemental right for everyone (it is in the constitution) and yet they spend a hell of a lot less than we do on anything.
    Why does Lipitor cost $31 in Spain but a $129 in the US? Nexium $50 there but $185 here? Plavix $80 there but $152 here? (and there are other countries that get these drugs for even less than Spain) Same drug.
    Are the Spaniards better negotiators? Or are they just that much smarter than us?

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  22. john personna says:

    On the other hand, Spain is broke.

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  23. Franklin says:

    such as an abdominal CT-scan: from $164 – $1564…  What is up with that?

    anjin-san has the answer:
    I don’t think the 13K charge for a colonoscopy two years ago was a result of my “choosing to pay more”. It’s a 45 minute routine procedure. I think it is a result of the provider gouging because the system is set up to allow them to do so.
    I had a CAT scan a couple years back, charged at $2000+ (the “uninsured” price, apparently), my insurance company gave them something like $300-400, IIRC and it was settled.  The system is messed up.

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  24. Drew says:

    I think PD Shaw comes closest to the answer:  we have a relatively inelastic demand for health care services due to the third party payer system, and in periods of high GDP growth, the ratio simply flattens.  
     
    Second, all these “wellness programs,” physical therapy, treating every little sniffle or ache and pain come with dubious cost effectiveness, and didn’t used to be part of the expenditure mix.  Again, nobody eats hamburger on an expense account.  And that’s a core problem in our system.     

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  25. M1EK says:

    “But we have a hundred million or more Americans scattered higher and yon”
     
    No, we really don’t; this is a common misconception. The typical person’s surroundings in the USA looks like metropolitan areas, not Montana. It’s more like single-digit millions of Americans (at most) scattered hither and yon.

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  26. James Joyner says:

    M1EK:
    Look at this map.  The vast sea of America has very low population density.  It’s not like there are only hospitals near the hotspots.
    It’s true that America isn’t primarily rural farmland anymore.  Most of us (85% or so) live in “urban” areas.  But the vast majority of those places look like Mayberry, not Manhattan.
    Goodness, getting down to places like Phoenix, you see population densities down to under 3000/square mile.

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  27. john personna says:

    You’ve got a “feely” argument, James.  Look at the map you say, and see how it feels.  Never mind the national comparisons I posted above.
     
    “in periods of high GDP growth, the ratio simply flattens.”
     
    That’s all we really need.  And the average for the 90’s look pretty close to the long term average:
     
    http://lambentdev.com/bizblog/images/realGDPbyDECADE.jpg
     
    If the image link doesn’t work, the enclosing article is here:
     
    http://www.lambentdev.com/bizblog/?p=12
     

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  28. john says:

    “The US spends a factor of two more than other countries and yet has the highest infant mortality rate.”
    That’s not true. It only appears that way because of the way other countries define a live birth. Any child born with a heart beat in the US is considered live, while in other nations, certain weight and age requirements must be met to be considered a “live” birth. In England I believe hte cutoff is 22 weeks; any child born before 22 weeks is not considered live.
    So the “highest infant mortality rate” is really comparing apples to oranges.

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  29. george says:

    Not sure the poplation density really works – Canada’s density is much less than that of the US, but they still spend less. 

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  30. James Joyner says:

    Canada’s density is much less than that of the US, but they still spend less.

    Certainly true.  And it may simply be that state-run medicine is that much cheaper.  But I just don’t know enough about their system to know what the other variables are.  Do they have hospitals as conveniently located as ours?  As well equipped?

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  31. Drew says:

    1.  John is correct.  Further, and a bit cruder, but when a pregnant Mexican woman goes out in the desert and has a baby who does not make it, its not in the stats.  If you do not believe these things, you are naive. 
     
    2.  But jp, the nineties benefitted from two bubbles: dot-com, and the initial stages of housing (Q3 1996 forward.)  It ain’t that easy.  I just don’t think that GDP growth will save us from artificial demand because of a de-coupling of consumer demand and price.
     
    3.  Everyone.  When you quote stats that other countries spend less, you must recall that they restrict access.  We can debate whether such restrictions are good or bad, but the restriction is inarguable.

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  32. john personna says:

    Drew, my chart shows that the 90’s edged up in GDP from the 70’s and 80’s, but not by that much.  The thing that is killing us is that the 00’s were so bad.
     
    On point 3, yeah, we’ll have to restrict access.  Or perhaps the better way to say it is “restrict differently” since we do, now.

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  33. wr says:

    Drew — Are you saying that we don’t restrict access? How many millions lack any kind of health insurance? Do you really believe that their access to health care isn’t limited, despite the requirement that emergency care be offered them?

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  34. PD Shaw says:

    wr, health insurance is not healthcare

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  35. ptfe says:

    Drew and John: you’re both wrong re: “live births” and “infant mortality.”
     
    http://www.cdc.gov/nchs/data/databriefs/db23.htm
     
    To summarize the summary:
     
    “Infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.”
     
    And if we scroll down, we find the following juicy quote: “The U.S. infant mortality rate was still higher than for most European countries when births at less than 22 weeks of gestation were excluded. … When births at less than 22 weeks were excluded, the U.S. infant mortality rate dropped from 6.8 to 5.8 infant deaths per 1,000 live births in 2004 (2).” From the accompanying chart, we find that the UK rate is 4.9 and that the US has moved from 30 of 31 to 28 of 31, ahead of recent Communist states of Hungary, Poland, and Slovakia. I guess if you’re satisfied leading the NFC West of medical systems, that’s pretty good.
     
    Even accounting for the number of premature births in the US, the Europeans still win: the highest infant mortality of 37+ week babies is 2.3, compared to 2.4 in the US (same reference). So no matter how you slice it, the assertion that Europeans are padding their numbers to get ahead of the US is simply wrong.

    In the future, please bother to spend the five minutes it takes to verify something before you start into it. I’m not an expert in this topic, but it literally took me longer to write this post than to find and parse the CDC report refuting your comments. I mean, come on…at least put in some effort of checking facts rather than regurgitating something someone once told you that you’d like to believe is true.

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  36. Crust says:

    James, I don’t understand this claim:

    [E]ven if we had a European-style public health system, we’d still spend more than they do because of our massive size and relatively low population density.

    What does the size of the country have to do with (per capita) health care costs?  I could see how population density might possibly be relevant on the margins, though e.g. Canada is sparser (and has similarly lower costs and better outcomes as in Europe), so that doesn’t seem like a particularly germane caveat either.

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  37. James Joyner says:

    What does the size of the country have to do with (per capita) health care costs?

    Most of the G7 would fit inside Alaska’s borders.  Alaska has about half a million people.  I’m guessing that Alaska nonetheless has hundreds of hospitals.

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  38. Crust says:

    Oops, James, I see you already went back and forth with other commenters on the density, issue, sorry for not checking first. Also it occurs to me that maybe by “size” you meant geographical area (I took you to mean population) and this was just a lead in to your point about density; since that interpretation makes more sense, I suspect that’s what you meant.  In short: please ignore my previous comment.

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  39. Drew says:

    ptfe –
     
    Before you start lecturing people, you ought to learn how to read. 
     
    I didn’t say anything about “Europeans padding their numbers.”  Second, you ought to use your brain to actually interpret and think about data.
    Did you note that the overall statistic is bogus because of the higher percentage of pre-term US births?  This is a simple weighted average concept.
    Did you note the superior US rates at all gestation periods less than 37 weeks?  How could it be that be that the US has a superior record <37 weeks………..but somehow falls off the cliff at >37 weeks?  How could that be?  A competant US health care system for premies, but an incompetant health care system for babies > 37 weeks? Only Bozo doctors get the full term babies?  Yeah, that makes sense.  What do you think.
    How about what a more rational and analytical mind (and one not clouded by an obvious political agenda) might suppose:  a system that actuarily nurses along troubled pregnancies better than anyone else will be faced with a full term population that actuarily is inevitably going to have greater difficulties, and a higher mortality rate?  Perhaps?
     
    You said you gave this 5 minutes thought?  It shows.   
     
     
        

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  40. MarkedMan says:

    john personna says:
    Wednesday, December 1, 2010 at 12:13

    On the other hand, Spain is broke.”
    But not because of health care costs.  Remember – they spend half of what we do, have comparable outcomes and cover everyone. They have managed health care costs much, much better than the US.
    What they have is a mismatch between what they spend in all parts of government and what they take in in taxes.  Kind of like the US.  If we, or they, actually charged the taxes these things costs, maybe people would be willing to have less of them.  But since we have 99% of Republicans and 50% of Democrats who believe ‘we shouldn’t pay our bills and that makes me fiscally conservative, damn it’ (I know, they describe it differently, but that’s the reality), the taxpayers don’t really know the price of what they are getting.  So of course they want more.

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  41. PD Shaw says:

    “They have managed health care costs much, much better than the US.”
    Let’s be careful about what that might mean.  I don’t have figures for Spain, but GPs in France make the U.S. equivalent of $84,000 (2004), while in the U.S. it’s $146,000 (2003).  The GP generally serves as the gatekeeper to specialists, testing and drugs.  For specialists, average salary is $144,000 in France (2004) and $236,000 in the U.S. (2003).
    Since the European OECD countries all experience significant annual healthcare cost inflation, (in fact, I believe it’s higher in the U.K. than the U.S. currently), it’s not clear that adapting another system would solve or problem, let alone adjust prices down to European levels.

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  42. Steve Verdon says:

    The US spends a factor of two more than other countries and yet has the lowest life expectancy. The surprising trend among G7 countries is that higher health care costs correlates with lower life expectancy.

    The US spends a factor of two more than other countries and yet has the highest infant mortality rate. The surprising trend among G7 countries is that higher health care costs correlates with higher infant mortality.

    [A]mong the G7 countries, public spending on health care leads to good results and high private spending correlates with poor outcomes. If we can move more in line with our G7 counterparts we would save 1 trillion dollar a year, live 2.5 years longer and suffer 10,000 fewer infant deaths per year.

    Yeah, cause everyone knows that correlation implies causation.  Jesus, I can’t believe I had to type that.
     

    But we’re not getting more, at least in terms of outcomes.

     
    How do we know?  Have we controlled for say homicides and automobile deaths in the life expectancy numbers?  No, probably not.  Do we drive more than many other countries?  If the answer is yes, then shouldn’t we control for that?  I hear we are one of the most violent, again if true we should control for that?  Regarding infant mortality rates, to what degree does diversity of the population play and what about education levels?  Do all G7 countries use the same definition of a live birth?  Using gross statistics that are tangentially related to health care is probably not the best metric.  On top of it, as the creator of the chart notes, the more a country spends the lower the life expectancy…his implication is that more spending on health care is killing people.  Hence my comment about correlation in causation.  Maybe the relationship is the other way around, I don’t know.

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  43. Steve Verdon says:

    BTW, I’ll note that the first two linked “related posts” are mine that deal with some of the bullshit associated with life expectancy and using it as a measure of health care success…both point to actual research done that can be found at the NBER.

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  44. steve says:

    “3.  Everyone.  When you quote stats that other countries spend less, you must recall that they restrict access.  We can debate whether such restrictions are good or bad, but the restriction is inarguable.”
     
    It is arguable. You are thinking of the NHS. Care in other OECD countries is not restricted nearly as much as is ours, which is restricted by price. Most European countries do not restrict access the way portrayed by certain parts of the media. Get a passport and go visit those countries.
     
    Steve

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  45. george says:

    Using life expectancy is iffy, but its the best measure out there right now.  But the differences in life expectancy are so low that for all intents and purposes its more or less equal between the G7 countries, especially if it is true that more Americans die from accidents and violence (not sure how those sums compare, Europe is pretty bad for accidents, and in any case if 50,000 people die every year from accidents out of a population of 300 million it’s not going to have much of an effect on life expectancy.
     
    Right now it looks like all the G7 countries get pretty much the same results, within a few percentage points of each other.  But if the US is paying significantly more to gain even a few percentage points better service, then its still pretty bad economics.
     
    And since Canada’s life expectancy in its least populated provinces is as  is as good as American life expectancy, I’d say its pretty likely that we can discount density as a major factor.  For that matter, is Alaska’s expectancy much different than New York’s?

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  46. tom p says:

    “On the other hand, Spain is broke.”
    JP, unsure exactly what your point is here, but are you trying to say that Spain is going broke because they spend between 1/10th and one half what we do????? What does that say for us???
    We are really screwed???
    All: I suggest you follow my link and look at the numbers. Then reach your own conclusions. For my money, the Spaniards are a hell of a lot smarter than we are (for that matter, so are the Chileans).
    What do you call someone who gets the same thing you do for half the price while you continue to argue that they are doing it all wrong?
    Never mind them, look in the mirror.

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  47. matt says:

    My mom is a long time nurse who has reached the highest point of education you can get without becoming a doctor. At her last job she spent most of the day arguing with insurance companies and filling out paper work. She was getting paid well above average pay due to her level of experience and education and yet she spent most of her work time not even directly helping people(experience = higher rate of success with insurance companies etc). I cannot help but see that as a giant waste of money and her experience is par for the course.
    Another interesting thing she noticed while working in emergency rooms (especially in the “bad” emergency rooms in Chicago) was the number of people showing up deathly sick with no insurance. Odds are these people would of been treatable early on for a minor amount of money but since they didn’t have insurance they would wait till they were deathly sick before hitting the emergency room and then treatment would end up costing thousands which the hospital was expected to pick up the tab for…

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  48. Drew says:

    steve –
     
    I suspect we are going to just have to respectfully disagree on this.  I have a passport.  I have travelled the world.  The notion tht we are restricted on price is bizarre.  That’s the whole point. The consumer is not exposed to price.  Health care is “free” because of the 3rd party payer system.  But foreign countries have rationally reacted to the natural byproduct of the demand for a supposed “free”‘ good, they ration it.
     
    Your passport may have more stamps than mine, but the laws of economics, like the laws of physics, do not stop at the border. 

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  49. MarkedMan says:

    Most of this argument is the same old argument.  It goes around and around about whether some more enlightened analysis will show that the US healthcare results are marginally better or marginally worse than some European country.  But the elephant in the room is that the US healthcare system is incredibly, pathetically inefficient.  It spends way more to deliver that healthcare than other systems, by an order of magnitude. Yet I rarely see this addressed in the debates.
    If the private industry had a 40% overhead, and had a significant percentage of their work force and time devoted to maintaing that overhead, they would never, ever tolerate it! We should let the free market work its magic! Oh.  Wait a minute.  The government run health care programs don’t have that horrible overhead.  It’s the private ones that do. Quick, so-called Conservatives! Deny reality! Change the subject!

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  50. john personna says:

    On Spain I guess I have this perceptions that all of their spending exploded in the recent past, in their bubble years.  If they held their medical costs down through that, then sure.
     
    I see in the news that Spain is cutting drug spending as part of austerity measures.

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  51. Steve Verdon says:

    George,
     
    I tend to agree with you on the overall closeness.  In some cases the differences are things like 0.5 years.  Is that statistically significant?  I don’t know, but given that we are usually talking 70+ years, maybe not.
     
    Aside from accidental deaths and violent deaths there is obesity.  While that is indeed a health issue, I wonder how effective cutting health care spending would be in dealing with that issue and its implications for life expectancy.  A rising rate of obesity might drive an increase in health care spending to deal with the secondary adverse health effects.
     
    It is a complicated dynamic here and looking at gross statistics is likely to give one misleading implications such as the notion that if we merely spend less on health care we’ll live longer…as if spending on health care is killing people including babies.  Spend more on infant health?  That is the implication?  Really?  Sounds very counter-intuitive to me.

     
    It is arguable. You are thinking of the NHS. Care in other OECD countries is not restricted nearly as much as is ours, which is restricted by price.

     
    I think the claim that price is a rationing mechanism of health care in the U.S. is greatly exaggerated.  It isn’t much of one for the elderly.  It isn’t for me and I have a job that pays for my health insurance….well okay, I pay for it, but its untaxed and I don’t see it coming out of my pocket directly and the $10 copay isn’t that big a deal.  The U.S. has a mixed system in terms of providing health care and a large bulk of it comes from the government.

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  52. george says:

    The U.S. has a mixed system in terms of providing health care and a large bulk of it comes from the government.
     

    Which is a good point.  From what I’ve read, all the G7 countries have mixed systems, with both private and public health providers.  The major difference seems to be in who pays (ie a doctor might own their own practice but be paid by a government), and even there its just a question of portions.  So why is the American system so much more expensive?  It just seems there has to be some real inefficiencies somewhere, and I don’t think its a question of private vs public, both of which seem to be run more efficiently in other countries.

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  53. André Kenji says:

    Since I´m a Brazilian, that has a mixed system, I can say that I think that the American Healthcare system is insane: anyone under 65 has a very fragile health coverage while people over that age gets the most generous public health care system in the world.

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  54. M1EK says:

    James, you’re arguing land; I’m arguing people. The experience of the average person in the USA is a suburban-style neighborhood in a metropolitan area (nothing like Mayberry); with urban residents being a close second; hardly anybody lives like Montana. The density of most suburban parts of metro areas is high enough to make the density argument re:healthcare a non-starter.

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