Elf Sternberg

These figures include no attempt to correct for the vastly greater demographic variations within the US population, the availability or cost of experimental care, the costs of developing new pharmaceuticals (generally recouped primarily from US patients), or many other factors that influence these figures. Many interesting nations simply aren't included-- South America, Africa. most of Asia, and most notably, some of the wealthiest oil-producing nations.

It's easy to see why the US spends so much on medical care; we can afford to. Many of us are hugely more wealthy than most of the nations on this chart. We've bought ourselves all kinds of expensive equipment, new expensive drugs, and lots of highly trained physicians.

Many of us are much more poor than most of the nations on this chart, too. We have large urban and rural populations that have little access to this state-of-the-art care, and worse, social traditions that interfere with utilization of the care that is available.

Rich or poor, many of us have issues with obesity and exercise and other health risks.

And it's easy to see why our life expectancy is within 1.5% of the world average anyway-- medical care is virtually unrelated to life expectancy. These numbers make that obvious. Life expectancy is, primarily, a function of social policies NOT related to medical care.

So why do I think you're trying to make the point that we should nationalize health care in order to "solve" this "problem"? Who's providing or paying for useless health care sure as heck isn't going to influence how effective it is.

This is just a big steaming pile of statistics. It's completely meaningless.

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damiana-swan.livejournal.com

Actually, things like life expectancy and infant mortality have been used by experts world-wide as a measure of the quality and availability of health care across a given population. Also, life expectancy, while certainly *affected* by social policies, is absolutely a factor of the availability and quality of health care--this CIA chart of life expectancies by nation clearly shows that first world countries tend to be around 75-80, while third world nations are far lower--the average life expectancies in Angola and Zambia are 38 years (38.2 and 38.63 respectively). Is some of that due to war? Of course. But not ALL of the low-ranking nations are currently at war; many of the lowest have national issues that are, yes, health-related. (A drought, a famine, HIV, etc.) Horrible things happen to *every* nation; how badly the population is hit by them and how quickly they recover has a LOT to do with what kind and how much health care they have available, and that is, in large part, a function of money and how well it's spent.

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"Life expectancy is, primarily, a function of social policies NOT related to medical care."

One factor that influences those social policies is putting the government on the hook for the cost of poor health. Canada and the US are fairly similar demographically, so life expectancies should be similar. However, federal and provincial governments in Canada have traditionally been far more enthusiastic about promoting seat belt usage, supporting prenatal nutrition, discouraging drunk driving, heavily taxing tobacco, and fighting obesity than their counterparts in the US.

If I were a smoker, I'd be fuming about having to pay twice as much per puff as someone in the US. In my case, my potentially-costly health concern was obesity. So, my provincial government paid for personal consultation with a registered dietitian. A year later, I'm 55 lbs lighter and my blood pressure is 30 mmHg lower, and the government is less worried about having to pay for future bypass surgery for me.

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Well you can't possibly be right, since the United States has the Best of All Possible Healthcare Systems in the World. Therefore, we should all ignore any evidence to the contrary as bad statistics.

Ahem.

Edited Date: 2010-01-27 01:39 am (UTC)

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"Fairly similar demographically"??

??

I'm speechless, so I'll just let Wikipedia do the talking.

http://en.wikipedia.org/wiki/Demographics_of_the_United_States
http://en.wikipedia.org/wiki/Demographics_of_Canada

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fjorlief.livejournal.com

"Life expectancy is, primarily, a function of social policies NOT related to medical care."

If that is the case, then why do adults without medical insurance die an average of at least ten years sooner than those with insurance...

If you think the system is working, try talking to someone without insurance. While some health care may be less than useful and too expensive, NO health care is not useful at all. And there are plenty of working people like myself who have no insurance at all, if that is what you call a "social tradition"

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gromm.livejournal.com

Many of us are hugely more wealthy than most of the nations on this chart.

In other words, the rich are willing to pay *much* more, and your doctors are getting rich off the rich. Meanwhile, anyone who *can't* pay for The Best Doctors Money Can Buy can piss up a rope.

I mean really, $60k for an emergency hospital visit? Where the hell is that going?

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Much of it pays for insurance. Some of it pays for unnecessary tests that are performed primarily to remove grounds for lawsuits. Sometimes it pays for legally required emergency-care facilities and staff that are underutilized. Sometimes it goes to pay for care other people received but didn't pay for.

All of these costs are driven by social and government policies that are more about liberal guilt than medical care per se.

Hospitals don't tend to be hugely profitable businesses. Most are officially non-profit, and most for-profit hospitals don't make much money. In particular, emergency rooms tend to hemorrhage money.

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From: (Anonymous)

I agree that we in the US are getting ripped off. (I agree with the other guy that overall life expectancy isn't a very important indicator of health care quality, though.)

I wish I saw some realistic possibility for improvement. The proposed HCR bill would have made things worse and I suspect any bill that can get through Congress will also make things worse.

We want more health care than we want to pay for. Since most of the direct costs of treatment are picked up by third parties rather than the consumer, we can kid ourselves that we are getting it in the short term. But premiums, and before long taxes, will keep on rising every year.

There is no way to take an average medical care spending of $8000 per person per year--working people, retired people, and children--and somehow shuffle that around in a way that gives us low insurance premiums and tax rates.

http://www.cbsnews.com/stories/2009/02/24/health/main4824163.shtml

There is no way to substantially reduce medical costs without also substantially reducing consumption of medical care. Politicians try to sell the idea that we can do it with computerized records or cutting out insurance advertising, but this is demagoguery.

I would like to see something like the Singapore system here, but I think the health care interests can guarantee it never happening.

In fact I do not think we will ever break the lock that Blue Cross and Aetna have as gatekeepers to health care services. The end game, I am guessing, is a few big insurance companies acting basically as national public utilities, with a universal health insurance mandate, high subsidies from the taxpayer, and some form of price regulation. Costs perhaps capped wherever they are at that point in time, but certainly not substantially reduced. A slow decline in service quality as consumers lose progressively more importance in the system.

Have a nice day.

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mundens.livejournal.com

We want more health care than we want to pay for

Actually, in the USA, you should be demanding far more more health care for what you're currently paying. It's pretty easy to spend an average of $8000 per person a year and get good health care if you're not crippled by insurance, drug company, and hospital, profiteers taking $6,000 of that $8,000, effectively leaving only $2,000 worth of actual health care per person.

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yarram.livejournal.com

Did you notice that the thickness of the lines indicates doctor-visits-per capita? The USA actually has one of the lowest rates, so we're paying a hefty chunk more per doctor visit, for much poorer outcomes. I'd say that's a pretty good indicator of pathetic return for value. Japan, OTOH, has outstanding value: lower-than-average overall cost covering more per-capita visits.

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The Japanese often go to the doctor for no significant reason, and get no significant care. It brings down the averages a lot.

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"We want more health care than we want to pay for. Since most of the direct costs of treatment are picked up by third parties rather than the consumer, we can kid ourselves that we are getting it in the short term. But premiums, and before long taxes, will keep on rising every year."

In Canada, 80% of health-care expenses are mandated by medical professionals. Parents going to their doctor when their baby has a case of the sniffles are a cost driver, but not enough to explain the weird difference in per-capita expenses between the US and Canada.

Of course, my provincial government runs a free 24/7 healthcare hotline - just call the 1-800 number to speak to a nurse, who will give you advice and tell you to stay home, go to the doctor, or get to the emergency room.

From: (Anonymous)

In Canada, you have one third party payor (per province), which operates within a fixed budget and has the power to transmit cost controls through the rest of the system.

In the U.S. third party payors act to insulate consumers from the immediate costs of care. They don't operate within a framework of cost containment. The incentive for medical providers and patients is to overtreat, using the best (newest and most expensive) options available.

My grandmother had an attack of dizziness a few years ago and ended up getting a battery of tests that lasted most of a day, including a body scan from one of those big expensive machines (probably a CT but maybe an MRI, not sure). The results were, unsurprisingly, inconclusive. We did rule out some things like brain tumors. I'm sure the costs ran to thousands of dollars. Typical for a hospital visit in the U.S.

The thing is, no one in the U.S. wants to give this up. We want every possible test to rule out all the scary and remote possibilities, and to be treated with the newest technology available, and to see an expensive specialist trained in whatever our specific ailment is. We don't want to pay for it, but we don't want to give it up either. Unfortunately, we have built a system that lets me have expensive care today, and everybody pay for it tomorrow, perpetually.

Like I said above, I think we'll eventually get government cost controls of some sort. But Americans who think we'll then get per capita costs like those of Canada are kidding themselves. The health care interests will trade cost controls for a guaranteed lock on the "their" share of the incomes of Americans. Reform will look a lot like the current system and cost about the same, with added government oversight to finally put a break on increasing costs (maybe, we hope). Sorry Elf.

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dornbeast.livejournal.com

We want every possible test to rule out all the scary and remote possibilities, and to be treated with the newest technology available, and to see an expensive specialist trained in whatever our specific ailment is.

Is this reality, or an episode of House, M.D.?!

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I've seen this same graph someplace before, Elf.

One thing that I've learned during the healthcare ~~orchestrated shouting match~~debate is that costs are so high because (A) providers have to charge the same price to everyone, no exceptions; and (B) the insurance companies and Medicare pay an exceedingly low fraction of what the providers charge. This is why, for example, an MRI costs $80,000; if they charged what it actually cost, the insurance companies wouldn't pay them enough to even buy the Liquid Helium to cool the electromagnets, much less run them. I asked my doctor what the insurance companies would pay her if she charged only what it actually cost her to operate her practice. It wouldn't even be enough to pay the rent on the office, it turns out.

One wonders if all of this is because insurance companies are in the business of extorting money out of people instead of, oh, I dunno, maybe insuring them?

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tagryn

I've seen this same graph someplace before, Elf.

Probably because Elf posted it already on Jan. 3rd. The problem with the apples-to-oranges homogeneity in the comparison he's making hasn't changed since he first posted it, either.

From: (Anonymous)

"This is why, for example, an MRI costs $80,000;"

That's a funny thing to say. I live in Australia. A couple of months ago I had a knee injury from falling off a ladder. Ambulance transfer to the next public hospital (in Queensland financed through a AU$0.29/day charge to all households collected through the energy bills), initial examination, x-rays of the knee, a brace, crutches, and weekly follow-up visits to the fracture clinic (all that is financed through http://www.medicare.gov.au/ via a 1.5% charge on income, collected through the same mechanisms as income tax) were all free.

Because I wanted a second opinion, I asked my GP for an MRI and he send me, on the same day, to a private company to get that done. Because of that I had to pay the full price of it myself (if I had gone to a public hospital it would have been free, but it might have taken 5-8 days before it gets done).

It cost me the grand total of AU$162. That is for a total of 250 slices on 10 films and a detailed 2 page report of all findings.

And let me be clear about this again, this was the full cost of the procedure, to a private company that definitely doesn't do anything under cost out of the kindness of their heart, and neither Medicare nor my private health insurance ( http://www.medibank.com.au/ they cover treatment in private hospitals ) paid a single cent for it.

AU$162 is a far cry from US$80000. You are getting ripped off. Badly.

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elfs.livejournal.com

But that's impossible. As we all know, Australia is one of those socialist hellholes.

From: (Anonymous)

Oh, and I forgot to mention in regards to Medicare. I'm not an Australian citizen. I'm only a permanent resident here, and still fully covered by Medicare.

Before I moved to Australia 7 years ago, I also had multiple job offers from the US. But the health care situation there alone is enough to put the US on my "never ever" list of countries to live.

And anyone who claims the comparison graph isn't valid because of the homogeneity of the other populations would do well to have a look here first: http://en.wikipedia.org/wiki/Demographics_of_Australia#Country_of_birth

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tagryn

The issue for homogeneity in the comparison isn't about makeup by country of origin, but rather the socioeconomic composition of the populations being compared to. A lot of the countries being compared to may not have comparable proportions re: distribution in higher/middle/lower SES classes; without controlling for that, there's an underlying assumption that the population compositions aren't that different, when that may well not be the case.

That's why I think the best part of the current health care plan, and the part that should be preserved going forward, are the pilot programs. They'll give us much better data on how alternatives would work out (or not) under the U.S.' setup than trying to estimate how other systems would work out if applied to the U.S.

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Oh yes, that's right! It's not a fair comparison because the US has systematically destroyed most of its middle class over the past 40 year.

I'd completely forgotten that. So, you're right, a comparison with Western Europe is completely unfair. We should be making a comparison against third-world countries.

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I've been out of work since mid-June, and my local public radio station devoted many, many weeks of its afternoon call-in show, Vox Pop to the state of healthcare here in the US.

That US$80,000? Came from a medical professional who'd called in. Now, I will admit that I may well be wrong, and that the person calling in said US$8000. But it's still very, very high.

I, too, had an MRI recently. The technician and I chatted for a bit, what with me having a background in physics and all. The comment, "the insurance companies wouldn't pay enough to even buy the liquid Helium to cool the electromagnets," came from that conversation.

So, the system is so horribly broken that there's no way to participate it unless you're dishonest.

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gromm.livejournal.com

A wealthy coworker of mine put it best:

"I shouldn't get the same care as some crack whore on the street."

This is precisely the attitude that America has. It's not about lifting the many out of the gutter, it's about keeping the few out of it. So when you talk about averages, you aren't speaking to the ones who hold power and make policy. In other words, the ones who would incite the masses with emotional statements about "death panels".

They're already getting the best health care that money can buy.

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elfs.livejournal.com

Or as was commonly heard earlier this year: "Glenn Beck and Rush Limbaugh are perfectly happy with their health care, so why would anyone want to tinker with a good thing?"

Nobody should have any illusions that crack whores get the same police protection, judicial consideration, or even fire coverage, as wealthy suburbanites.

From: (Anonymous)

Okay, but here in Canada, they do. In no small part because health care is funded by the provincial government, rather than the city government. I guess we like our equality here.

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In Canada, it's "I should get the same care as my Member of Parliament". And we do - it's illegal for my MP (and rock stars and business tycoons) to pay out-of-pocket to get any better treatment than I would get for free*. As a result, I'm quite pleased with the quality of care I get. If there were separate hospitals for rich people and everyone else, I suspect I'd be less happy with my care.

*Well, she COULD sneak off to India or the US and pay there, but if it got made public she'd probably lose the next election.

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gromm.livejournal.com

Seeing that we're Canadian, that should in fact have been his attitude. Except that it isn't.

Some people are just dicks, you know?

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littleone66.livejournal.com

This country does not have health care, we have sick care. If we had health care (and where I suspect Japan & others get their numbers) we would cover things like REGULAR stress reducing treatments (massage etc), weight management (dietitians, gym fee), smoking cession or other addiction management then we wouldn't have to be paying so much in medications or treatments that mask symptoms that don't fix the problem.

How many heart attacks could be prevented (by pass, transplant, ER costs, MRI's etc) with a gym membership and regular visits for massage to reduce stress and a dietitian? What about lung diseases, etc.

A little cost of prevention goes a VERY long way to lower over all health cost. The fact is, insurance companies don't want us healthy, they want us sick. They don't make their money if we're healthy.

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