7 ms·

Cost of Health Care By Country, as Compared to Life Expectancy

113 points by alexandros 17y ago

cwan 17y ago
A response to the graphic suggests that while "this was evidence of an insane and inefficient healthcare system", "if [they] really wanted a chart that captures what’s wrong with America’s healthcare system, [they] should have gone to the Centers for Medicare and Medicaid Services’ national health expenditures data website and downloaded the figures showing how rampant third-party payment has resulted in consumers directly paying for less than 12 percent of healthcare costs. And when people are purchasing something with (what is perceived to be) other people’s money, it’s understandable that they don’t pay much attention to cost." (http://biggovernment.com/2009/12/29/the-real-healthcare-chart-of-the-day/ http://biggovernment.com/2009/12/29/the-real-healthcare-char...) I'm sympathetic to this argument given that the American healthcare system is considerably different than many healthcare systems globally in that private insurers acting on behalf of employers (not the users of healthcare) pick up a significant portion of the pie (even if, on a per capita basis, Medicare spending is more than most countries like Canada - though this fact alone begs the question of why the US government wouldn't first seek to fix Medicare). As a Canadian, the one thing I don't quite understand is how many of my countrymen are so quick to condemn the American system despite all the obvious signs that the Canadian system is unsustainable and failing (http://network.nationalpost.com/np/blogs/fullcomment/archive/2009/08/18/national-post-editorial-board-canadian-healthcare-is-no-model.aspx http://network.nationalpost.com/np/blogs/fullcomment/archive...). Further, you read about Animal farm like anecdotes (to be fair, I've seen first hand some of this in Canada as well), and you wonder whether or not healthcare systems abroad can really be distinctly categorized between those that are "universal" and "non-universal" given how radically different implementation is - an example from Japan here: http://biglizards.net/blog/archives/2010/01/my_family_the_v.html http://biglizards.net/blog/archives/2010/01/my_family_the_v.... There are at least 2 other big problems with this graph if presumably it's being used to argue for changes in policy: (1) The measurement of life expectancy "at birth". The US spends a considerable amount of money aggressively attempting to treat what would otherwise be considered stillborns. (2) The lifestyles of Americans that may have nothing at all to do with healthcare implementation (http://www.usnews.com/health/family-health/articles/2008/04/22/obesitys-link-to-life-expectancy.html http://www.usnews.com/health/family-health/articles/2008/04/...) - ie this could very well mean that if the US miraculously grew an entirely public and universal healthcare system as modeled against XYZ country, US life expectancy might not necessarily get any cheaper or better - it is entirely possible that it would become more expensive and worse.
- SamAtt 17y ago
  The problem with the Health Care debate is that it's become so polarized that advocates of Single Payer won't admit its failures in other countries while those opposed to Single Payer won't admit we have a problem. Graphs like this are designed to create a visceral response but rationally they mean very little if not accompanied by an item by item breakdown of why the numbers are what they are. For example, the Canadian system puts price limits on patented medicines while the U.S. system does not. That has nothing to do with being a Single Payer system but is definitely a factor that contributes to higher costs in the U.S.
  - revorad 17y ago
    Indeed, politics is the mind killer. - http://lesswrong.com/lw/gw/politics_is_the_mindkiller/ http://lesswrong.com/lw/gw/politics_is_the_mindkiller/
  - sailormoon 17y ago
    Spot on. People absorb some opinion from somewhere - it's almost a cultural, tribal thing. They adopt that opinion. And then confirm it endlessly via Google University's excellent and popular Confirmation Bias program, as demonstrated by the GP's links. All systems fail, even if it's only rarely. But as soon as they do people seize upon the failure as if it's some kind of conclusive proof of the gut feeling they had all along. They are seemingly completely incapable of thinking in terms of statistics and average, large-scale outcomes. This is, of course, not at all confined to the health care "debate". The situation is so bad that I wonder if some kind of rational risk assessment/statistical thinking course should be introduced in schooling.
- chrischen 17y ago
  Also after a visit to a psychiatrist I found out they charge your insurance more, if you have it, than they would if you didn't. I'm not exactly sure what that was about, but if it was for sympathy, then it just shows that having a bureaucratic insurance company, private or government owned, would still have this problem of distancing the money from the patient. However I'm still a large proponent of not only life as a right, but healthcare too.
olefoo 17y ago
That's an awesome and persuasive infographic. In fact, it's main fault is that it's trying too hard to be persuasive. Putting the US above the legend detracts from the power of the raw data and strikes me as being unnecessarily editorial.
- walkon 17y ago
  It's not that awesome when you remember that correlation does not necessarily equal causation.
  - dhume 17y ago
    It's not about showing correlation. It's about showing that we're not getting what we're paying for.
    - dschobel 17y ago
      This graph basically proves that the bottom end of American society has fall off and says nothing about the quality of care that the majority are getting. As others have pointed out, life expectancy is only a single facet of the health of a nation and with many sociological factors such as the fact that americans eat too much which leads to heart disease which is not-incidentally the most common cause of death in the USA. Assuming you have coverage, what you're paying for is word-class care with minimal waiting times.
    - walkon 17y ago
      It fails to definitively show that we're not getting what we're paying for because a graph such as this only shows correlation.
      - onoj 17y ago
        You are correct. But, If Americans are paying (av. 7k) per year on health and have a lower life expectancy that other industrialized nations, the data alone suggest Something is going very wrong. Strange that it has some of the highest paid doctors and most profitable health care companies also. Surely there must be an explanation study somewhere? http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doc... http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103622972.html http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103622972.h...
chrischen 17y ago
Oh I must be stupid. I spent a good three minutes trying to find where the United States was because I scrolled down.
lionhearted 17y ago
Some reasons American medicine is very expensive: 1. Health insurance, but not treatment, is fully tax deductible. So if you buy your own penicillin, it's with after tax money, but if your insurance company buys it, it's pre-tax money. That's one of the reasons that health insurance is so widespred in America even for routine medicine like antibiotics and checkups. That's a major contributing factor in why the administrative costs are so high. 2. There's a shortage of doctors in America, and qualified doctors from other countries are not allowed to practice medicine in the United States. So there's good doctors from Canada, England, Japan, wherever that'd love to practice in the USA, but can't. This artificially inflates doctor's wages by restricting supply. 3. American doctors are typically required to get an undergraduate degree, medical degree, and do a below market, crazy hours residency in order to be able to practice medicine. That's 8-10 years of study and below market working to practice medicine. Now, medicine is very important and needs to be done right, but I don't believe for a second that a focused apprenceship couldn't teach a very specific kind of medicine - say arithscopic surgery - in just 2-4 years under a highly trained doctor, but this isn't an option. 4. The Food and Drug Administration requires new drugs to be proven not only for safety, but also efficacy. That's an incredibly high and expensive burden to meet - that means that drugs need to be proven to work to a certain standard, instead of just not harm. This adds years of development time and millions of dollars in cost to the new drug development cycle. Those are all legislated reasons that increase the cost of medical insurance, doctors, and drugs. They'd be fairly easy to remove - 1. All medical and health expenses can be written off taxes regardless of insurance. Employees can choose to convert som of their wages to a medical or health plan tax free to both the employer and employee. (Currently, under most circumstances, only employer-provided health insurance can is tax free) 2. Allow any doctor in a country with reasonably competent medical standards to practice in the United States. 3. Require that doctors be able to demonstrate that they can practice their area of medicine capably. Be flexible in how they demonstrate that. Note: This will incur high opposition from medical schools and current doctors who are currently enjoying the wage premium and had to go through the very long, difficult, and expensive system. 4. Change the drug standard from "safety and efficacy" to only safety. Drugs will come to market much faster and cheaper. There's plenty of people and organizations that will test proven safe drugs for efficacy for free or nominal cost once drugs hit market, and efficacy will get understood with time. Put this way - a proven safe but questionably effective treatment against heart disease being held off the market for five years and costing much more to get to market is not a good thing. If it's certainly safe, then let people make the decisions with their physicians, instead of having the FDA take such a strong gatekeeping stance. Technology has progressed such that we don't need government protection from ourselves as much any more. The current set of legislation has greatly increased the costs of doctors and medicine. Regardless of political position, and regardless of stance on other health issues, addressing these four points will make the medical system fairer, more effective, and and less expensive with relative ease. Admittedly, there's some powerful entrenched interests that are winning in the current arrangement, and will oppose these simple improvements.
nostrademons 17y ago
I wonder if this controls for various other lifestyle choices. I find it ironic that the government spends so much money subsidizing high fructose corn syrup, and then spends even more treating the health problems that result from it. If we didn't have an agricultural system that makes unhealthy food cheap and healthy food expensive, perhaps we wouldn't have quite so many obesity-related illnesses. Same thing with parking lots and interstates being subsidized while dense urban development (walkable/bikeable neighborhoods) is not. Cars kill a lot of people outright through accidents, and then indirectly through people becoming couch potatoes. Usually by the time people come under care of the health care, the battle's already been lost. Acute, lifesaving interventions on otherwise healthy people aren't all that expensive. Chronic conditions caused by 40 years of neglect are. I'm curious if we'd get both the cheaper health care and the longer life expectancy of European countries if our cities were laid out like theirs and our agricultural system didn't dump massive amounts of subsidies on the corn industry.
- terrellm 17y ago
  Good point...poor lifestyle drives healthcare costs up. It would be interesting to see fast food spending or avg calories/day on top of this chart.
  - pxlpshr 17y ago
    Couldn't agree more and it's a point a lot of people are hush-huse about because it's easier to point the finger at the system than poor personal habits. just a small sample... http://grab.by/1v6n http://grab.by/1v6n
    - potatolicious 17y ago
      Here's the thing, I'm a Canadian who's living in the USA. Canada has much lower health care costs - but our dietary patterns are much the same. In fact, I really have not changed my feeding habits at all since coming to the USA. Yes, unhealthy dietary choices weighs the system down - but it weighs all systems down, and to say it accounts for the majority of the discrepancy is IMHO missing the gorilla in the room, which is that the US health care system is unbelievably broken. Addendum: There is one thing where the US is very different from Canada. You guys eat the same stuff we do... but you eat much more of it. I'm pretty convinced that the average American can eat half, if not one quarter what they currently do and be just fine. Serving sizes in the US are so big that nowadays I often pack up lunch leftovers and have more than enough for dinner.
scott_s 17y ago
This is a terrible graph. It took me five minutes to figure out how everything is related. Data such as this is much more naturally plotted as an x-y scatter-plot. Thickness of the datapoints could indicate number of doctor visits. Instead, the graph eliminates the x-axis, but retains the space. Very strange choice.
- gabrielroth 17y ago
  I agree that it's unfamiliar, but once you've figured out how to read it, it strikingly demonstrates the degree to which the U.S. is an outlier.
  - scott_s 17y ago
    My claim wasn't that it's unfamiliar - which it is - but that's it's terrible. What's striking is the data, not the visualization applied to that data. I think the effect would be just as dramatic with an x-y scatter plot, and it would have the benefit of being easier to read. This graph also eliminates seeing if there is a correlation between money spent per individual and life expectancy. On a scatter plot, if there was a correlation, we would expect to see the data fall in some line. If a data point was outside of that line, then it would be obvious.
- hs 17y ago
  the graph gives an important ratio that's hard to capture in scatter plot age/cost (the slope) also, how do you identify your datapoints in scatter-plot neatly? to me this graph gives surprisingly rich information packed
  - scott_s 17y ago
    I don't understand your first point; the relationship between two variables is more clear to me from a scatter plot. And that's something else that bothers me about the graph: when I look at a graph with lines, I expect to see trends. But the lines in this graph are actually single data points. We're on the web, so it would be neat to be able to use the mouse to hover over data points to see labels.
borism 17y ago
it's a great graph to illustrate how f-up healthcare in US is. however, may I point out that life expectancy at birth is pretty poor measure of healthcare efficiency. japanese are living very long lives, but it is no secret that depression and suicide is the major problem there, especially in younger generations.
hs 17y ago
of the three countries that have highest (and surprisingly parallel) slope: japan, south kore, mexico ... it suggests that #visit correlates with LE ... and health coverage is unimportant but there are countries that have less #visit but more expensive (it suggests patients go to doctor not only for consultation) ... so #visit is an unreliable predictor so is cost to me it seems the most predictive is location (yes, the country names are data points too) ... if i want to live long, i'll settle in japan and do what the average japanese for their healthy lifestyle
- scott_s 17y ago
  The slope of the line is an artifact of the visualization choice.
  - DrJokepu 17y ago
    I think the slope is the whole point of the graph and it is supposed represent efficiency although in a very unfortunate way. The angle of the slope is defined by arcsin((life_expectancy - healthcare_costs) / constant). It's a bit like subtracting apples from oranges. If there's one thing I've learned at engineering school it's that mixing up units of measurement is not a good idea. If you subtract years from dollars the value you get will carry no meaning. And that's why this visualisation is completely meaningless. They should come up with a more clearly defined and sane approach.
- sailormoon 17y ago
  You could probably get 90% of the benefit of the Japanese lifestyle by moving to a walkable urban environment like NYC, selling the car, and eating the japanese diet. You'd probably have to visit there first to see what that actually is. Any other East Asian diet would be fine as well - hell, a pre-1970s American diet would probably be fine. I am curious if those life expectancy figures have been controlled for smoking, though. If not - wow.
chasingsparks 17y ago
Graphs are abused. Graphs are meant to present data clearly and concisely. The most clear and concise presentation method should be used. If it is not, there are reasons to be skeptical. This graph is not the best presentation imaginable; it's not even mediocre. It is meant to appeal visually to those who already have reached the conclusions it is meant to illicit; it is graph porn. Health care spending and quality is very complex. What about adjusting for relative wealth (not merely the health care spending share of GDP), lifestyles, racial composition (if I am correct, there are biological differences in addition to the obvious socio-economic ones), preferences (how much would you spend for an extra month), etc. Asking questions like why other countries spend less on drugs (does the U.S. subsidize medical research by spending more or is it merely the one that allows rent seeking or both?) After doing so, I believe you will still find evidence suggesting that the U.S. system spends more than it should and there can be clearly identified inefficiencies. That is the distilled information that is interesting -- not the merely manipulative.
- ams6110 17y ago
  The research question is one that occurred to me. Do these cost data include spending on medical and pharmaceutical research? I would imagine that the bulk of that spending occurs in those same countries that are "above" the average line in this graph, and could contribute to that skewing.
  - mtts 17y ago
    Doubtful. Medical and pharmaeutical research is done either by private companies or by universities and such.
  - chasingsparks 17y ago
    U.S. patients certainly subsidize drug research. There are frequent calls for re-importation of drugs from other countries because, often, they are identical to the U.S. drugs, but have been bought by foreign governments exercising monopoly purchasing power. It makes sense for the drug company to sell at the discount because the manufacturing cost is so low that it is still profitable. Consequently, U.S. patients, who do not get the monopoly proxy, pay the higher cost. This often leads to accusations of price gouging. However, looking at the returns on investment from publicly listed companies suggests that they are not charging extortionary fees. There financial figures are in line with that of the tech industry. Granted, drug costs only one element among many in the debate, but I am pretty confident in saying that if drug costs were uniform, other countries would be paying more and the U.S. would be paying less (relative to current spending.)
kadavy 17y ago
This is a great infographic with a high data-to-ink density.
- revorad 17y ago
  False. The data in this "infographic" is really best represented as a scatter plot, using much less ink, as shown in [1] and similar other blog posts. The lines are unnecessary and misleading. It's good that Tufte has made concepts like data-to-ink density popular. But I urge you to actually evaluate that value when you look at a graph and refrain from using it to merely signal your knowledge of the right buzzwords. [1]http://www.stat.columbia.edu/~cook/movabletype/archives/2009/12/healthcare_spen.html http://www.stat.columbia.edu/~cook/movabletype/archives/2009...
whyme 17y ago
Go Obama Go!
scythe 17y ago
Mexico is in red, which I suppose is "technically" accurate, but the Mexican Constitution guarantees health care to all citizens: http://en.wikipedia.org/wiki/Health_care_in_Mexico#Public_health_care_delivery http://en.wikipedia.org/wiki/Health_care_in_Mexico#Public_he...
elblanco 17y ago
The way the UK hits just at average (for cost and life expectancy) appears to almost make that look intentional.
Alex3917 17y ago
In addition to health insurance being broken, it seems like most doctors are really terrible in the U.S. I read the other day that it takes on average seven years to correctly diagnose a medical condition. Some diseases, like celiacs, have an average time until diagnosis of 10 years. If you haven't already read How Doctors Think, it's truly horrifying. Unless you have something like strept throat, you're generally pretty screwed even if you have great medical insurance. And I'm speaking from personal experience here; about three years ago I started having some medical issues, and I went into the doctor the day the symptoms started happening. A dozen doctors and specialists later and I still don't have a correct diagnosis. The fact that I'm probably going to have to wait another 5+ years until I can get the problem even diagnosed is complete bullshit. Now it could just be that I have something that is really hard to diagnose, but more likely the reason no one can figure it out is that medical schools have done their best to select doctors with zero intellectual curiosity who never voluntarily read anything about medicine other than pharma pamphlets. Just look at what happened to Shooter because the 'best' doctors couldn't even diagnose something as trivial as lyme disease: http://news.ycombinator.com/item?id=868325 http://news.ycombinator.com/item?id=868325 edit: Someone really needs to make a crowdsourced website where you can post all your symptoms and test results, and then offer up a bounty to anyone who can figure out the correct diagnosis.
- carbocation 17y ago
  Someone with even a remote familiarity with the practice of medicine would not refer to Lyme disease, one of the great imitators, as 'trivial'. The rest of your post, though forceful, similarly suffers from having no idea what you are talking about. Regarding the length of time from the onset of low-risk chronic diseases (unpleasant though they may be), you are right that this is a problem but dead wrong about the cause. The problem is overspecialization and undercoordination. An inherent idiocy in the practitioners would be an easy problem to remedy; the truth is much more pernicious.
  - Alex3917 17y ago
    "Someone with even a remote familiarity with the practice of medicine would not refer to Lyme disease, one of the great imitators, as 'trivial'." The fact that it is an imitator makes it easier to diagnose, because a competent doctor will test you for it whenever you have unexplained symptoms. While it's true that the blood tests aren't very accurate, most of the problem is that doctors just don't get people tested in the first place. And even for chronic lyme that is undetectable because it supposedly forms cysts within the cells, there is a new test up to 50x more accurate than the standard test being developed that you can have access to if you're willing to be part of the trial group.
shughes 17y ago
I think we should show a chart of each country's health care costs relative to how much their lawyers make on health care related malpractice cases. Because in America, it's out of control, and probably the largest reason health care costs so much. Honestly, a good first step in taming the health care and health insurance costs should be to cap how much lawyers make on malpractice cases. Why do people rarely talk about tort reform? I apologize if you did, but I just did a quick browser search for "tort" and "lawyer" and got no results.
- shughes 17y ago
  Really, why was I down voted? I'm not sure what was wrong with the comment. I think anyone would agree with the idea of tort reform, just like anyone would agree with the idea of health care reform. But even if you don't, I thought that with Hacker news, you only down vote people when they aren't insightful or off-topic. So, a differing opinion also accounts for down voting now? Like on Digg?
  - shughes 17y ago
    Sigh..
codexon 17y ago
Why is hacker news linking to blogspam instead of the original National Geographic website? The blog is copying Clusterflock which copied kottke which credited biancolo who presumably saw it directly from National Geographic. http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.h...
coffeemug 17y ago
I'd imagine that computing the cost of health care is an incredibly complex undertaking. Without being able to review the methodology used, this graph is next to useless. For example, here are just a few questions that come to mind (and I'm sure more would arise if the methodology was properly peer reviewed): 1. Are there no data points between the United States and Switzerland? Are there no data points above the United States and below Mexico? If there are, that would make the graph misleading and they have to specify this limitation if they're intellectually honest. If there aren't, they have to demonstrate that they've gone through the exhaustive list of countries and there are no other "interesting" data points. 2. Is the cost adjusted for cost of living at a given country? If not, that would make the graph extremely misleading. If yes, what adjustment strategy was used? Can we see the ratio between cost of health care and median yearly salary, for example? 3. What does "average life expectancy at birth mean"? Does it account for countries that have a significantly lower birth rate than the United States? I would guess not, which could significantly affect the perception of the numbers. How does one normalize for something like that? 4. How was the currency conversion rate computed? Currency prices fluctuate throughout the year, did they account for that? How much does that affect the numbers? Could be a lot, could be a little, but I need to know whether this was taken into account. 5. What does "universal health coverage" mean? Soviet Union had universal health coverage and no medication, surgery performed by under-qualified residents, and no post-surgery care, unless you know someone or bribe the doctor, of course. 6. Surely there are countries without universal health care other than the U.S. and Mexico - how do they stack up? 7. I'm willing to bet a country like Poland has a lot more homeless people that don't factor into the life expectancy numbers than the U.S. That begs a more general question of whether the same methodology was used for computing the cost or life expectancy for each country. If they simply took official numbers from each country, it's almost certain that they were computed differently. Was this accounted for? If not, I need to know. If yes, how were the numbers normalized? One could probably come up with dozens of questions like these. Of course any analysis of a problem that complex can be called into question, that doesn't mean every analysis is useless. But before we can seriously discuss this graph, or base any policy decisions on it, they at least have to provide the methodology. It doesn't look like this graph is intellectually honest to me, and the burden of proof is on the author.
axod 17y ago
This is just one of many reasons to not startup/move to the US. Don't buy the hype.
fauigerzigerk 17y ago
Apart from the utter brokenness of the US system, which needs no further proof I guess, this chart says that health care spending isn't very effective at increasing life expectancy. There are other factors, maybe food, that influence life expectancy much more than health care.
antirez 17y ago
Data for missing countries (from a comment written by the author of the original graph): HEALTH CARE SPENDING (per person in U.S. dollars) Norway: $4,763 Netherlands: 3,837 Belgium: 3,595 Germany: 3,588 Ireland: 3,424 Iceland: 3,319 -------------(OECD average: $2,986) Greece: 2,727 Italy: 2,686 Turkey: 618 LIFE EXPECTANCY Italy: 81.2 Iceland: 81.2 Norway: 80.6 Netherlands: 80.2 Germany: 79.8 Ireland: 79.7 Belgium: 79.5 Greece: 79.5 -------------(OECD average: 79.2) Turkey: 72.1 DOCTOR VISITS A YEAR Belgium: 7.6 Germany: 7.5 Iceland: 6.5 Netherlands: 5.7 Turkey: 5.6 Italy: no data Norway: no data Ireland: no data Greece: no data It's a shame the graph misses data form countries like Italy or German, both countries provides free universal health care.

113 points by alexandros 17y ago

cwan 17y ago

A response to the graphic suggests that while "this was evidence of an insane and inefficient healthcare system", "if [they] really wanted a chart that captures what’s wrong with America’s healthcare system, [they] should have gone to the Centers for Medicare and Medicaid Services’ national health expenditures data website and downloaded the figures showing how rampant third-party payment has resulted in consumers directly paying for less than 12 percent of healthcare costs. And when people are purchasing something with (what is perceived to be) other people’s money, it’s understandable that they don’t pay much attention to cost." (http://biggovernment.com/2009/12/29/the-real-healthcare-chart-of-the-day/ http://biggovernment.com/2009/12/29/the-real-healthcare-char...) I'm sympathetic to this argument given that the American healthcare system is considerably different than many healthcare systems globally in that private insurers acting on behalf of employers (not the users of healthcare) pick up a significant portion of the pie (even if, on a per capita basis, Medicare spending is more than most countries like Canada - though this fact alone begs the question of why the US government wouldn't first seek to fix Medicare). As a Canadian, the one thing I don't quite understand is how many of my countrymen are so quick to condemn the American system despite all the obvious signs that the Canadian system is unsustainable and failing (http://network.nationalpost.com/np/blogs/fullcomment/archive/2009/08/18/national-post-editorial-board-canadian-healthcare-is-no-model.aspx http://network.nationalpost.com/np/blogs/fullcomment/archive...). Further, you read about Animal farm like anecdotes (to be fair, I've seen first hand some of this in Canada as well), and you wonder whether or not healthcare systems abroad can really be distinctly categorized between those that are "universal" and "non-universal" given how radically different implementation is - an example from Japan here: http://biglizards.net/blog/archives/2010/01/my_family_the_v.html http://biglizards.net/blog/archives/2010/01/my_family_the_v.... There are at least 2 other big problems with this graph if presumably it's being used to argue for changes in policy: (1) The measurement of life expectancy "at birth". The US spends a considerable amount of money aggressively attempting to treat what would otherwise be considered stillborns. (2) The lifestyles of Americans that may have nothing at all to do with healthcare implementation (http://www.usnews.com/health/family-health/articles/2008/04/22/obesitys-link-to-life-expectancy.html http://www.usnews.com/health/family-health/articles/2008/04/...) - ie this could very well mean that if the US miraculously grew an entirely public and universal healthcare system as modeled against XYZ country, US life expectancy might not necessarily get any cheaper or better - it is entirely possible that it would become more expensive and worse.

SamAtt 17y ago
The problem with the Health Care debate is that it's become so polarized that advocates of Single Payer won't admit its failures in other countries while those opposed to Single Payer won't admit we have a problem. Graphs like this are designed to create a visceral response but rationally they mean very little if not accompanied by an item by item breakdown of why the numbers are what they are. For example, the Canadian system puts price limits on patented medicines while the U.S. system does not. That has nothing to do with being a Single Payer system but is definitely a factor that contributes to higher costs in the U.S.
- revorad 17y ago
  Indeed, politics is the mind killer. - http://lesswrong.com/lw/gw/politics_is_the_mindkiller/ http://lesswrong.com/lw/gw/politics_is_the_mindkiller/
- sailormoon 17y ago
  Spot on. People absorb some opinion from somewhere - it's almost a cultural, tribal thing. They adopt that opinion. And then confirm it endlessly via Google University's excellent and popular Confirmation Bias program, as demonstrated by the GP's links. All systems fail, even if it's only rarely. But as soon as they do people seize upon the failure as if it's some kind of conclusive proof of the gut feeling they had all along. They are seemingly completely incapable of thinking in terms of statistics and average, large-scale outcomes. This is, of course, not at all confined to the health care "debate". The situation is so bad that I wonder if some kind of rational risk assessment/statistical thinking course should be introduced in schooling.
chrischen 17y ago
Also after a visit to a psychiatrist I found out they charge your insurance more, if you have it, than they would if you didn't. I'm not exactly sure what that was about, but if it was for sympathy, then it just shows that having a bureaucratic insurance company, private or government owned, would still have this problem of distancing the money from the patient. However I'm still a large proponent of not only life as a right, but healthcare too.

olefoo 17y ago

That's an awesome and persuasive infographic. In fact, it's main fault is that it's trying too hard to be persuasive. Putting the US above the legend detracts from the power of the raw data and strikes me as being unnecessarily editorial.

walkon 17y ago
It's not that awesome when you remember that correlation does not necessarily equal causation.
- dhume 17y ago
  It's not about showing correlation. It's about showing that we're not getting what we're paying for.
  - dschobel 17y ago
    This graph basically proves that the bottom end of American society has fall off and says nothing about the quality of care that the majority are getting. As others have pointed out, life expectancy is only a single facet of the health of a nation and with many sociological factors such as the fact that americans eat too much which leads to heart disease which is not-incidentally the most common cause of death in the USA. Assuming you have coverage, what you're paying for is word-class care with minimal waiting times.
  - walkon 17y ago
    It fails to definitively show that we're not getting what we're paying for because a graph such as this only shows correlation.
    - onoj 17y ago
      You are correct. But, If Americans are paying (av. 7k) per year on health and have a lower life expectancy that other industrialized nations, the data alone suggest Something is going very wrong. Strange that it has some of the highest paid doctors and most profitable health care companies also. Surely there must be an explanation study somewhere? http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doc... http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103622972.html http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=103622972.h...

chrischen 17y ago

Oh I must be stupid. I spent a good three minutes trying to find where the United States was because I scrolled down.

lionhearted 17y ago

Some reasons American medicine is very expensive: 1. Health insurance, but not treatment, is fully tax deductible. So if you buy your own penicillin, it's with after tax money, but if your insurance company buys it, it's pre-tax money. That's one of the reasons that health insurance is so widespred in America even for routine medicine like antibiotics and checkups. That's a major contributing factor in why the administrative costs are so high. 2. There's a shortage of doctors in America, and qualified doctors from other countries are not allowed to practice medicine in the United States. So there's good doctors from Canada, England, Japan, wherever that'd love to practice in the USA, but can't. This artificially inflates doctor's wages by restricting supply. 3. American doctors are typically required to get an undergraduate degree, medical degree, and do a below market, crazy hours residency in order to be able to practice medicine. That's 8-10 years of study and below market working to practice medicine. Now, medicine is very important and needs to be done right, but I don't believe for a second that a focused apprenceship couldn't teach a very specific kind of medicine - say arithscopic surgery - in just 2-4 years under a highly trained doctor, but this isn't an option. 4. The Food and Drug Administration requires new drugs to be proven not only for safety, but also efficacy. That's an incredibly high and expensive burden to meet - that means that drugs need to be proven to work to a certain standard, instead of just not harm. This adds years of development time and millions of dollars in cost to the new drug development cycle. Those are all legislated reasons that increase the cost of medical insurance, doctors, and drugs. They'd be fairly easy to remove - 1. All medical and health expenses can be written off taxes regardless of insurance. Employees can choose to convert som of their wages to a medical or health plan tax free to both the employer and employee. (Currently, under most circumstances, only employer-provided health insurance can is tax free) 2. Allow any doctor in a country with reasonably competent medical standards to practice in the United States. 3. Require that doctors be able to demonstrate that they can practice their area of medicine capably. Be flexible in how they demonstrate that. Note: This will incur high opposition from medical schools and current doctors who are currently enjoying the wage premium and had to go through the very long, difficult, and expensive system. 4. Change the drug standard from "safety and efficacy" to only safety. Drugs will come to market much faster and cheaper. There's plenty of people and organizations that will test proven safe drugs for efficacy for free or nominal cost once drugs hit market, and efficacy will get understood with time. Put this way - a proven safe but questionably effective treatment against heart disease being held off the market for five years and costing much more to get to market is not a good thing. If it's certainly safe, then let people make the decisions with their physicians, instead of having the FDA take such a strong gatekeeping stance. Technology has progressed such that we don't need government protection from ourselves as much any more. The current set of legislation has greatly increased the costs of doctors and medicine. Regardless of political position, and regardless of stance on other health issues, addressing these four points will make the medical system fairer, more effective, and and less expensive with relative ease. Admittedly, there's some powerful entrenched interests that are winning in the current arrangement, and will oppose these simple improvements.

nostrademons 17y ago

I wonder if this controls for various other lifestyle choices. I find it ironic that the government spends so much money subsidizing high fructose corn syrup, and then spends even more treating the health problems that result from it. If we didn't have an agricultural system that makes unhealthy food cheap and healthy food expensive, perhaps we wouldn't have quite so many obesity-related illnesses. Same thing with parking lots and interstates being subsidized while dense urban development (walkable/bikeable neighborhoods) is not. Cars kill a lot of people outright through accidents, and then indirectly through people becoming couch potatoes. Usually by the time people come under care of the health care, the battle's already been lost. Acute, lifesaving interventions on otherwise healthy people aren't all that expensive. Chronic conditions caused by 40 years of neglect are. I'm curious if we'd get both the cheaper health care and the longer life expectancy of European countries if our cities were laid out like theirs and our agricultural system didn't dump massive amounts of subsidies on the corn industry.

terrellm 17y ago
Good point...poor lifestyle drives healthcare costs up. It would be interesting to see fast food spending or avg calories/day on top of this chart.
- pxlpshr 17y ago
  Couldn't agree more and it's a point a lot of people are hush-huse about because it's easier to point the finger at the system than poor personal habits. just a small sample... http://grab.by/1v6n http://grab.by/1v6n
  - potatolicious 17y ago
    Here's the thing, I'm a Canadian who's living in the USA. Canada has much lower health care costs - but our dietary patterns are much the same. In fact, I really have not changed my feeding habits at all since coming to the USA. Yes, unhealthy dietary choices weighs the system down - but it weighs all systems down, and to say it accounts for the majority of the discrepancy is IMHO missing the gorilla in the room, which is that the US health care system is unbelievably broken. Addendum: There is one thing where the US is very different from Canada. You guys eat the same stuff we do... but you eat much more of it. I'm pretty convinced that the average American can eat half, if not one quarter what they currently do and be just fine. Serving sizes in the US are so big that nowadays I often pack up lunch leftovers and have more than enough for dinner.

scott_s 17y ago

This is a terrible graph. It took me five minutes to figure out how everything is related. Data such as this is much more naturally plotted as an x-y scatter-plot. Thickness of the datapoints could indicate number of doctor visits. Instead, the graph eliminates the x-axis, but retains the space. Very strange choice.

gabrielroth 17y ago
I agree that it's unfamiliar, but once you've figured out how to read it, it strikingly demonstrates the degree to which the U.S. is an outlier.
- scott_s 17y ago
  My claim wasn't that it's unfamiliar - which it is - but that's it's terrible. What's striking is the data, not the visualization applied to that data. I think the effect would be just as dramatic with an x-y scatter plot, and it would have the benefit of being easier to read. This graph also eliminates seeing if there is a correlation between money spent per individual and life expectancy. On a scatter plot, if there was a correlation, we would expect to see the data fall in some line. If a data point was outside of that line, then it would be obvious.
hs 17y ago
the graph gives an important ratio that's hard to capture in scatter plot age/cost (the slope) also, how do you identify your datapoints in scatter-plot neatly? to me this graph gives surprisingly rich information packed
- scott_s 17y ago
  I don't understand your first point; the relationship between two variables is more clear to me from a scatter plot. And that's something else that bothers me about the graph: when I look at a graph with lines, I expect to see trends. But the lines in this graph are actually single data points. We're on the web, so it would be neat to be able to use the mouse to hover over data points to see labels.

borism 17y ago

it's a great graph to illustrate how f-up healthcare in US is. however, may I point out that life expectancy at birth is pretty poor measure of healthcare efficiency. japanese are living very long lives, but it is no secret that depression and suicide is the major problem there, especially in younger generations.

hs 17y ago

of the three countries that have highest (and surprisingly parallel) slope: japan, south kore, mexico ... it suggests that #visit correlates with LE ... and health coverage is unimportant but there are countries that have less #visit but more expensive (it suggests patients go to doctor not only for consultation) ... so #visit is an unreliable predictor so is cost to me it seems the most predictive is location (yes, the country names are data points too) ... if i want to live long, i'll settle in japan and do what the average japanese for their healthy lifestyle

scott_s 17y ago
The slope of the line is an artifact of the visualization choice.
- DrJokepu 17y ago
  I think the slope is the whole point of the graph and it is supposed represent efficiency although in a very unfortunate way. The angle of the slope is defined by arcsin((life_expectancy - healthcare_costs) / constant). It's a bit like subtracting apples from oranges. If there's one thing I've learned at engineering school it's that mixing up units of measurement is not a good idea. If you subtract years from dollars the value you get will carry no meaning. And that's why this visualisation is completely meaningless. They should come up with a more clearly defined and sane approach.
sailormoon 17y ago
You could probably get 90% of the benefit of the Japanese lifestyle by moving to a walkable urban environment like NYC, selling the car, and eating the japanese diet. You'd probably have to visit there first to see what that actually is. Any other East Asian diet would be fine as well - hell, a pre-1970s American diet would probably be fine. I am curious if those life expectancy figures have been controlled for smoking, though. If not - wow.

chasingsparks 17y ago

Graphs are abused. Graphs are meant to present data clearly and concisely. The most clear and concise presentation method should be used. If it is not, there are reasons to be skeptical. This graph is not the best presentation imaginable; it's not even mediocre. It is meant to appeal visually to those who already have reached the conclusions it is meant to illicit; it is graph porn. Health care spending and quality is very complex. What about adjusting for relative wealth (not merely the health care spending share of GDP), lifestyles, racial composition (if I am correct, there are biological differences in addition to the obvious socio-economic ones), preferences (how much would you spend for an extra month), etc. Asking questions like why other countries spend less on drugs (does the U.S. subsidize medical research by spending more or is it merely the one that allows rent seeking or both?) After doing so, I believe you will still find evidence suggesting that the U.S. system spends more than it should and there can be clearly identified inefficiencies. That is the distilled information that is interesting -- not the merely manipulative.

ams6110 17y ago
The research question is one that occurred to me. Do these cost data include spending on medical and pharmaceutical research? I would imagine that the bulk of that spending occurs in those same countries that are "above" the average line in this graph, and could contribute to that skewing.
- mtts 17y ago
  Doubtful. Medical and pharmaeutical research is done either by private companies or by universities and such.
- chasingsparks 17y ago
  U.S. patients certainly subsidize drug research. There are frequent calls for re-importation of drugs from other countries because, often, they are identical to the U.S. drugs, but have been bought by foreign governments exercising monopoly purchasing power. It makes sense for the drug company to sell at the discount because the manufacturing cost is so low that it is still profitable. Consequently, U.S. patients, who do not get the monopoly proxy, pay the higher cost. This often leads to accusations of price gouging. However, looking at the returns on investment from publicly listed companies suggests that they are not charging extortionary fees. There financial figures are in line with that of the tech industry. Granted, drug costs only one element among many in the debate, but I am pretty confident in saying that if drug costs were uniform, other countries would be paying more and the U.S. would be paying less (relative to current spending.)

kadavy 17y ago

This is a great infographic with a high data-to-ink density.

revorad 17y ago
False. The data in this "infographic" is really best represented as a scatter plot, using much less ink, as shown in [1] and similar other blog posts. The lines are unnecessary and misleading. It's good that Tufte has made concepts like data-to-ink density popular. But I urge you to actually evaluate that value when you look at a graph and refrain from using it to merely signal your knowledge of the right buzzwords. [1]http://www.stat.columbia.edu/~cook/movabletype/archives/2009/12/healthcare_spen.html http://www.stat.columbia.edu/~cook/movabletype/archives/2009...

whyme 17y ago

Go Obama Go!

scythe 17y ago

Mexico is in red, which I suppose is "technically" accurate, but the Mexican Constitution guarantees health care to all citizens: http://en.wikipedia.org/wiki/Health_care_in_Mexico#Public_health_care_delivery http://en.wikipedia.org/wiki/Health_care_in_Mexico#Public_he...

elblanco 17y ago

The way the UK hits just at average (for cost and life expectancy) appears to almost make that look intentional.

Alex3917 17y ago

In addition to health insurance being broken, it seems like most doctors are really terrible in the U.S. I read the other day that it takes on average seven years to correctly diagnose a medical condition. Some diseases, like celiacs, have an average time until diagnosis of 10 years. If you haven't already read How Doctors Think, it's truly horrifying. Unless you have something like strept throat, you're generally pretty screwed even if you have great medical insurance. And I'm speaking from personal experience here; about three years ago I started having some medical issues, and I went into the doctor the day the symptoms started happening. A dozen doctors and specialists later and I still don't have a correct diagnosis. The fact that I'm probably going to have to wait another 5+ years until I can get the problem even diagnosed is complete bullshit. Now it could just be that I have something that is really hard to diagnose, but more likely the reason no one can figure it out is that medical schools have done their best to select doctors with zero intellectual curiosity who never voluntarily read anything about medicine other than pharma pamphlets. Just look at what happened to Shooter because the 'best' doctors couldn't even diagnose something as trivial as lyme disease: http://news.ycombinator.com/item?id=868325 http://news.ycombinator.com/item?id=868325 edit: Someone really needs to make a crowdsourced website where you can post all your symptoms and test results, and then offer up a bounty to anyone who can figure out the correct diagnosis.

carbocation 17y ago
Someone with even a remote familiarity with the practice of medicine would not refer to Lyme disease, one of the great imitators, as 'trivial'. The rest of your post, though forceful, similarly suffers from having no idea what you are talking about. Regarding the length of time from the onset of low-risk chronic diseases (unpleasant though they may be), you are right that this is a problem but dead wrong about the cause. The problem is overspecialization and undercoordination. An inherent idiocy in the practitioners would be an easy problem to remedy; the truth is much more pernicious.
- Alex3917 17y ago
  "Someone with even a remote familiarity with the practice of medicine would not refer to Lyme disease, one of the great imitators, as 'trivial'." The fact that it is an imitator makes it easier to diagnose, because a competent doctor will test you for it whenever you have unexplained symptoms. While it's true that the blood tests aren't very accurate, most of the problem is that doctors just don't get people tested in the first place. And even for chronic lyme that is undetectable because it supposedly forms cysts within the cells, there is a new test up to 50x more accurate than the standard test being developed that you can have access to if you're willing to be part of the trial group.

shughes 17y ago

I think we should show a chart of each country's health care costs relative to how much their lawyers make on health care related malpractice cases. Because in America, it's out of control, and probably the largest reason health care costs so much. Honestly, a good first step in taming the health care and health insurance costs should be to cap how much lawyers make on malpractice cases. Why do people rarely talk about tort reform? I apologize if you did, but I just did a quick browser search for "tort" and "lawyer" and got no results.

shughes 17y ago
Really, why was I down voted? I'm not sure what was wrong with the comment. I think anyone would agree with the idea of tort reform, just like anyone would agree with the idea of health care reform. But even if you don't, I thought that with Hacker news, you only down vote people when they aren't insightful or off-topic. So, a differing opinion also accounts for down voting now? Like on Digg?
- shughes 17y ago
  Sigh..

codexon 17y ago

Why is hacker news linking to blogspam instead of the original National Geographic website? The blog is copying Clusterflock which copied kottke which credited biancolo who presumably saw it directly from National Geographic. http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.html http://blogs.ngm.com/blog_central/2009/12/the-cost-of-care.h...

coffeemug 17y ago

I'd imagine that computing the cost of health care is an incredibly complex undertaking. Without being able to review the methodology used, this graph is next to useless. For example, here are just a few questions that come to mind (and I'm sure more would arise if the methodology was properly peer reviewed): 1. Are there no data points between the United States and Switzerland? Are there no data points above the United States and below Mexico? If there are, that would make the graph misleading and they have to specify this limitation if they're intellectually honest. If there aren't, they have to demonstrate that they've gone through the exhaustive list of countries and there are no other "interesting" data points. 2. Is the cost adjusted for cost of living at a given country? If not, that would make the graph extremely misleading. If yes, what adjustment strategy was used? Can we see the ratio between cost of health care and median yearly salary, for example? 3. What does "average life expectancy at birth mean"? Does it account for countries that have a significantly lower birth rate than the United States? I would guess not, which could significantly affect the perception of the numbers. How does one normalize for something like that? 4. How was the currency conversion rate computed? Currency prices fluctuate throughout the year, did they account for that? How much does that affect the numbers? Could be a lot, could be a little, but I need to know whether this was taken into account. 5. What does "universal health coverage" mean? Soviet Union had universal health coverage and no medication, surgery performed by under-qualified residents, and no post-surgery care, unless you know someone or bribe the doctor, of course. 6. Surely there are countries without universal health care other than the U.S. and Mexico - how do they stack up? 7. I'm willing to bet a country like Poland has a lot more homeless people that don't factor into the life expectancy numbers than the U.S. That begs a more general question of whether the same methodology was used for computing the cost or life expectancy for each country. If they simply took official numbers from each country, it's almost certain that they were computed differently. Was this accounted for? If not, I need to know. If yes, how were the numbers normalized? One could probably come up with dozens of questions like these. Of course any analysis of a problem that complex can be called into question, that doesn't mean every analysis is useless. But before we can seriously discuss this graph, or base any policy decisions on it, they at least have to provide the methodology. It doesn't look like this graph is intellectually honest to me, and the burden of proof is on the author.

axod 17y ago

This is just one of many reasons to not startup/move to the US. Don't buy the hype.

fauigerzigerk 17y ago

Apart from the utter brokenness of the US system, which needs no further proof I guess, this chart says that health care spending isn't very effective at increasing life expectancy. There are other factors, maybe food, that influence life expectancy much more than health care.

antirez 17y ago

Data for missing countries (from a comment written by the author of the original graph): HEALTH CARE SPENDING (per person in U.S. dollars) Norway: $4,763 Netherlands: 3,837 Belgium: 3,595 Germany: 3,588 Ireland: 3,424 Iceland: 3,319 -------------(OECD average: $2,986) Greece: 2,727 Italy: 2,686 Turkey: 618 LIFE EXPECTANCY Italy: 81.2 Iceland: 81.2 Norway: 80.6 Netherlands: 80.2 Germany: 79.8 Ireland: 79.7 Belgium: 79.5 Greece: 79.5 -------------(OECD average: 79.2) Turkey: 72.1 DOCTOR VISITS A YEAR Belgium: 7.6 Germany: 7.5 Iceland: 6.5 Netherlands: 5.7 Turkey: 5.6 Italy: no data Norway: no data Ireland: no data Greece: no data It's a shame the graph misses data form countries like Italy or German, both countries provides free universal health care.