by jeffreyrogers on 10/17/24, 3:57 PM with 268 comments
by psd1 on 10/18/24, 3:23 PM
What I'm unclear on is whether "health spending", in this analysis, is defined as money paid to care providers such as hospitals and dentists, or money paid by citizens for healthcare. Because you've got insurers and PBMs taking profit.
The ratio of those two numbers is the efficiency of the American insurance model. How does it compare to the administration of a single-payer system such as the NHS?
Until I see some data indicating otherwise, I'm going to look at my £200pcm national insurance and my £9.90 prescriptions and my free ambulances, and Americans' $500pcm insurance and their unlimited prescription costs and their four-figure bills even when insured, and I'm going to continue to believe that Americans are punching themselves in the face.
by aDyslecticCrow on 10/18/24, 7:22 PM
Large wealth inequality makes GDP per capita and average household spending not representative of a real-world median household. If healthcare costs have outpaced median income but kept up with mean income, that is a MASSIVE societal issue.
Most of the plots and arguments in the article overlook this, so I don't trust the arguments much.
However, it is still interesting how strong the correlations are. It gives some interesting insights into what goes into the cost of running hospitals, I suppose.
by pessimist on 10/18/24, 5:45 PM
by gcanyon on 10/19/24, 11:33 AM
Here's a summary of the key points from the document in 11 bullet points:
• Health spending is primarily determined by income levels, with higher-income countries spending more on healthcare.
• The rising health share of GDP is driven by increasing quantities of healthcare consumed, not primarily by price inflation.
• Technological advancements and intensity of care are major drivers of increased health spending.
• The U.S. health system is not uniquely inefficient; its high spending is consistent with its high income levels.
• Commonly cited utilization indicators do not show that the U.S. uses less healthcare than expected given its spending.
• Physician incomes and hospital profits do not explain the high U.S. health spending.
• The U.S. healthcare workforce has grown significantly, reflecting increased intensity of care rather than just higher wages.
• America's mediocre health outcomes are explained by diminishing returns to healthcare spending and lifestyle factors like obesity.
• Rising healthcare spending does not mean reduced consumption in other areas due to productivity gains in other sectors.
• Price comparisons between countries are often methodologically flawed and do not accurately reflect true healthcare costs.
• The income elasticity of health spending is high, meaning people spend proportionally more on healthcare as they get richer.
by bluedino on 10/19/24, 2:50 PM
One prescription I get is $1.30, another is $85.
My son goes to a specialist and all $395 is paid by insurance, while my wife goes to a different one and we pay $86 out of pocket after a $14 "insurance discount", insurance pays nothing.
They're both in-network. I save my old antibiotics and such because it takes so long to get into urgent care, and it's expensive, and I can't go to my regular doctor for a sinus infection because it takes two weeks to get in.
Thankfully I pay $0 out of my check for Blue Cross since my employer pays for it. I just have co-pays, deductibles, etc
by efitz on 10/19/24, 4:49 PM
There are some hard to discover offerings in healthcare but overall very little differentiation.
Why don’t we have multiple chains of monthly subscription diabetes centers, for instance? If it weren’t for insurance and over-regulation of every aspect of healthcare, we would see market flourishing in the US as there is an over abundance of chronic illness.
I sympathize with the PoV that we want someone else to pay because it’s expensive, but another way to solve that would be to remove all the regulatory capture and industry collusion and predatory middlemen (PBMs I’m talking to you) and let new delivery mechanisms evolve. Let supply adapt to demand.
by throwme0827349 on 10/18/24, 4:58 PM
I think ordinary consumers care much less about whether their country spends a nominal share of GDP on the heath sector, than about whether they will be unexpectedly bankrupt by consuming health services, and this is why people are actually mad.
by neves on 10/18/24, 6:44 PM
Diminishing returns to spending and worse lifestyle factors explain America’s mediocre health outcomes
https://randomcriticalanalysis.com/why-conventional-wisdom-o...
by obastani on 10/19/24, 2:52 AM
by gcanyon on 10/19/24, 1:24 AM
In 2017 my wife and I were living in Portugal for several months. When we needed to refill her prescriptions, our short-term rental host said, "Go to the ER."
Backstory: we're well familiar with ERs in the U.S. Due to various conditions, we've been to at least a dozen ERs a total of perhaps twenty times. For anyone who doesn't know, unless you are actively dying, visiting the ER in the U.S. is sloooow. The average time to see a doctor, in our experience, is about an hour.
So we replied: "the ER? seriously?"
He assured us it would be fine, so we walked ten minutes to the ER and signed in. We had barely turned in the history paperwork when they called us to go back. No preliminary check-in with the nurse -- straight to the doctor.
She said, "Why did you come to the ER? We could have been busy and you would have had to wait."
We explained how our host had assured us this was the best way to go, and that the ER would take care of us.
The doctor nodded and said, "Sure, I'll sign for the prescriptions, but just remember it might take more time the next time."
We went back to the front desk. Remember, we had no travel insurance, this was full freight. "That will be twenty-eight euro." We happily paid, and walked out the door, prescriptions in hand, less than 30 minutes after we walked in.
Bonus: the cost to buy the prescriptions, again with no insurance, was less than the co-pay in the U.S. with employer-healthcare.
N=2: When my daughter was visiting me in Bangkok, she got a bit of a gastro issue. Same as in Portugal, we had no insurance for her. I took her to Bumrungrad, one of the best hospitals in Thailand. We were in and out in under an hour, including picking up the prescription, and the total cost was under $100.
I'm not trying to rebut the article, just throwing out some details.
by cryptonector on 10/18/24, 11:25 PM
Whoa. That's eye-opening. If country X spends less than country Y, rather than surmise that country X is more efficient with their healthcare spending we might want to look at whether country X has less per-capita income than country Y.
This makes sense, though it's very surprising. I've seen so much commentary here about how much better the Europeans are at dealing with healthcare than us Americans...
by nickpsecurity on 10/18/24, 7:04 PM
One told me the insurance companies incentivize him to treat patients like an assembly line where cash only lets him spend one on one time with customers. He also might treat people for several things on the same bill which he claimed he’d have to itemize and charge separately for with insurance.
So, do people here have specific examples (esp links) to support or refute those anecdotes? If they were true, it would mean insurance rules were driving much of the cost. Looking at their causes, my first guess would be how they respond to losses from both real malpractice and greed-driven lawsuits. I can’t imagine that costs aren’t impacted by this with all the lawyer ads I see for suing insurance companies. ;)
by Angostura on 10/19/24, 2:34 PM
by not2b on 10/18/24, 11:23 PM
by Peteragain on 10/19/24, 4:56 PM
by NHQ on 10/19/24, 3:47 PM
If U.S. Americans did not have an irrational verve for education as the supposed panacea of democracy, there would be no public education system. If they did not believe the intense pseudoscience of the medical industry, they would not care about health insurance.
But as they are under the sway of such false conscience, the system of gradual decline called inflation pays for unqualified people to keep a livelihood at the expense of a misled and deluded public. That expense is not only the costs of running these systems but their detriments to the health and education they pretend to treat.
The increased spending on healthcare is no different than spending more on education or the "homeless problem", it is simply a politics of shifting more funds into systems that are legally obligated to pay high sums for a lot of nothing. It only appears different than education because we pretend its not completely wrapped up in public spending and politics like education is. Obama made sure that healthcare would hold such a place as education in the system with the reforms to healthcare, and the people applauded this.
High incomes paying more for healthcare is simply those who can afford it using the system that ultimately pays for the health and education of the rich at the expense of the health and education of the poor. After all we know that nobody who is rich is paying any of their healthcare bills, they have excellent health insurance for that.