9 ms·

High US health care spending explained by its high material standard of living

30 points by elberto34 10y ago

scarface74 10y ago
Slightly off topic but is there is a such thing as universal affordable good healthcare? I've talked to a few U.S. citizens that worked abroad who said healthcare in European countries is universally available but the demand outstrips the supply causing longer wait times to get treated than in the U.S. and that they prefer the U.S. system. These are of course people who have good jobs in the U.S. with company provided coverage. Is that true? Is there any system that can both cover everyone without making healthcare worse for people who already have good coverage?
- deleted 10y ago
  [deleted]
- ramparrt 10y ago
  The Australian system is far from perfect but does come some way to solving this. It is effectively 2 tiered: 1) Public Medicare, the publicly funded system available to everybody. 2) Private insurance, paid for by the individual and tailored to their needs. To pay for the public system everybody pays a Medicare levy as part of their income tax. The levy is coarsely means tested. If you have private insurance then this levy is reduced somewhat. The real critical differentiation between the public (Medicare) and private offerings are that any services deemed as elective in nature (ie, non life threatening conditions such as surgeries to treat injuries, etc) can be completed by the public system but there is a wait list which can often be quite long. If you have private insurance then you can get in very quickly with the surgeon you want. Having private in no way restricts your usage of the public system so there is no downside to having private except that it costs more. There are also fee structures in place to encourage people to take up private when they're younger and the saving on the medicare levy. As I said, it's far from perfect, but the 2 tiers offer a high level of customized cover for people willing and able to afford it while offering an acceptable level of cover for those who can't.
  - ricardonunez 10y ago
    This sounds in some ways similar to Mark Cuban's solution. Here's the post: http://blogmaverick.com/2017/03/08/some-thoughts-on-fixing-obamacare-shoot-holes-in-this-please/ http://blogmaverick.com/2017/03/08/some-thoughts-on-fixing-o...
  - bigger_cheese 10y ago
    One thing I don't like about the Australian system is I think it is wasteful in someways. For example under my private cover I'm subsidized for ~$300 a year in optical expenses (split between lenses and frames). From anecdotal conversations I know there are many people who purchase a new pair of glasses every year just because the system is basically set up to encourage this which smells like very wasteful consumption to me. I don't need a pair of glasses every year. I have gone through 3 sets of glasses in 15 years. If I wanted to I could opt to exclude optical from my cover and save some money every month but then I'd worry about what happens if I lose my glasses or sit on them and I'd end up out of pocket so I keep paying for optical cover I don't use and feel like a sucker every year for not taking advantage of subsidized glasses. Same thing with trips to dentist I know people who insist on general dental (unnecessary cleaning etc) because they are subsidized so they "need to take advantage to get their money's worth".
    - robbiep 10y ago
      I suggest you stop thinking about it as a benefit and think about what it actually is, which is insurance. My travel insurance is cheaper if I don't cover any lost property, but what if I need it? Anecdotally many young travellers who head overseas 'lose' their $1500 DSLR or their 6 year old macbook when in South America in order to make use of their $300 travel insurance
      - bigger_cheese 10y ago
        Agreed exactly why I pay for it. The fact it is advertised as a benefit probably contributes to this. My insurer has gone as far as cold calling me last year "I notice you haven't been claiming any of these benefits, would you like to review your policy."
- leonroy 10y ago
  Well to begin with, the availability of free universal health care - like the NHS helps ensure a pretty competitive private healthcare market. For example, I know that if my wife becomes pregnant or if there are complications we won't be hit with thousands or tens of thousands in medical bills on leaving the hospital. However on the flip side, it's very difficult to find a decent NHS dentist where we live, so we'll pay about £300-600 in dental checkups or dental work per annum. Just by having the NHS provide dental or any medical care there is downward pricing pressure on private competitors so however flawed a system like the NHS is it certainly has a very important pricing function even if you choose to go completely private.
- Broken_Hippo 10y ago
  So far, I'm quite pleased with the Norwegian health care system - though to be honest, most of my experience has been through "working" as a CNA (it was actually part of language classes), classroom learning, a few doctor's visits, and the stories of other immigrants. Everyone is covered by the national health insurance. No more worries about getting hit with a huge health care bill. Children have a lot of free stuff - most health care and dental (braces are an exception). I can change my doctor a couple times a year if I want. Some things just make sense: For example, the government sends me a letter to remind me to get cancer screenings every 3 years (I'm female) - and this stuff isn't as possible with the fragmented system in the states. Now, the downsides are things like longer wait times. This does suck, for sure. Some of this is simply being cost-effective, I'm sure. But other cost effective things work out: For example, if you need a home nurse, you get one covered up to 6 times a day. Free, because it is cheaper than a nursing home. Dental can tend to be expensive and folks have some odd ways of going about this. For example, I've heard of a group of Norwegian dentists in... Poland?... that cater to Norwegians. The cost is often cheaper, even when factoring in the travel costs. There is a private health care system. The government still pays their normal rate to the private provider and the patient pays the difference. Some folks use this to go around the waiting times and I'm guessing this option would seem more similar to the American system for folks with insurance - though I'm not sure it is ever like the nearly on-demand medical care one comes to expect in the states. The system is vastly better for those with poor coverage or those that have good coverage but can't afford to use it. Hopefully, if the US does a single-payer system, they take a look at some of the downsides and try some things to lessen them.
- deleted 10y ago
  [deleted]
- pharrlax 10y ago
  >I've talked to a few U.S. citizens that worked abroad who said healthcare in European countries is universally available but the demand outstrips the supply causing longer wait times to get treated than in the U.S. and that they prefer the U.S. system. Whether we want to ration care by ability to pay or by another means, such as severity of illness, care will have to be rationed -- and the degree to which it must be rationed is inversely related to what percentage of people are covered by it. So of course well-off folks will perceive a system with a greater percentage of people covered and with care rationed in a way other than 'ability to pay' as being worse than a capitalist system -- they have to wait longer because they're standing in line alongside folks who, in the healthcare system they are used to, could not afford to be standing in line with them at all. The question is whether that drawback is worth providing access to care to folks who otherwise would not be able to access it.
- yulaow 10y ago
  Typically demand outstrips supply for very simple exams but the private sector covers it pretty well without making you pay a lot more. For example, here in Italy I can look for: public sector, private public-affiliated sector and full private sector. When I needed a full low abdomen echography I first contacted the public sector, they told me they had a wait list of 2.5months for that common exam, but I could call a private public-affiliated clinic and do it there (they also gave me suggestions on which clinics were available). Cost ~23euros (not all the exams have this waiting time, when I needed just physiotherapy or to see a psychologist I had <7 days wait time) Called three private public-affiliated clinics. These are clinics where all the staff is private and is managed like a normal company, but if they do an exam and you have the paper from your GP they can fill a form and get a part payed from the public sector (in a sort of exchange for helping reducing the wait time) In all of three they could visit me in 2-4 days, paying just ~30e. Lastly there was the full private clinic, those are not subsidized in any way but they have a very short list and if you want you can make a private insurance that cover basically whatever exams you will ever need from them. They could visit me in the next 2 hours for just ~80e. Note I was not in a emergency, if that was the case I could just run to the hospital and they would visit me instantly without making me pay anything (you can also run to the hospital without an ongoing emergency... they usually don't make you pay nothing anyway and do the exams but make you wait hours until they have no more urgent cases). Note also that if you have a serious condition (cancer like or anything with high risk of fatality) you will get ahead of any list and be visited asap, no money asked. And Italy is considered one of those "long list countries" in EUW.
- bjornsing 10y ago
  I'd say it depends on what you mean by "good". E.g. the Swedish system probably compares well to the US one in terms of (average) medical outcomes [1], but in terms of "customer satisfaction"... that's a different story. (Personally I feel "real" / objective health is more important than the subjective "customer satisfaction" aspect of health care, but yea, I guess that's politics.) 1. E.g. http://www.nationmaster.com/country-info/compare/Sweden/United-States/Health http://www.nationmaster.com/country-info/compare/Sweden/Unit...
- rbehrends 10y ago
  > I've talked to a few U.S. citizens that worked abroad who said healthcare in European countries is universally available but the demand outstrips the supply causing longer wait times to get treated than in the U.S. and that they prefer the U.S. system. These are of course people who have good jobs in the U.S. with company provided coverage. Is that true? This can be all over the place, depending on what you look at (GP appointments, specialist appointments, emergency and urgent care, elective surgeries, etc.) [1]. In general, the US outperforms some countries, but never all of them, and this is not taking into account that people without access to healthcare may suffer de facto infinite waiting times or that in many countries, people seek out their doctors far more frequently than in the US [2]. "Europe" is definitely not a homogeneous blob (just think of, say, France vs. Bulgaria) and there are great variations between even the affluent EU member states; it is pretty much impossible to generalize. What we do know is that the US has a fairly low physician density for a developed country [3], though that's not the only factor that goes into waiting times. [1] Google will show you a fairly large number of studies, but few that cover more than a handful or so of countries and/or more than a few metrics, so it's difficult to get a truly comprehensive overview. [2] https://www.statista.com/statistics/236589/number-of-doctor-visits-per-capita-by-country/ https://www.statista.com/statistics/236589/number-of-doctor-... [3] http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html http://gamapserver.who.int/gho/interactive_charts/health_wor...
hackuser 10y ago
(withdrawn)
- RUBwkVjwLsDKgPw 10y ago
  please read the article first. this criticism is addressed.
- yummyfajitas 10y ago
  The data in the article shows there is no country with the same standard of living. The article doesn't disagree that you could get similar health outcomes for less money. The claim of the article is that as people become richer, they spend more money on marginally beneficial health care. (Or sometimes just consumer goods masquerading as health care, e.g. Oxycontin and similar drugs, used by our leisure class use to mask their ennui. https://www.commentarymagazine.com/articles/our-miserable-21st-century/ https://www.commentarymagazine.com/articles/our-miserable-21... )
arcticbull 10y ago
Strange, this neglects that portion of health care spend that is accounted for by profits, by marketing expenses and administrative/billing bloat that ensues. It also neglects that for its massively higher spend 10% of Americans aren't covered and therefore don't receive preventative care yielding massively higher final costs, and it doesn't take into account the WHO ranks the US system as 31st in the world dramatically under all the socialized players. [Edit] as I suspected [1] indicates a full 20% of spend is wasted mostly on profits and administrative costs. That should be taken off the top. IMO this is a case of "figures don't lie, liars figure" but without the malicious intent. [1] https://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-report-02-15-2013.pdf https://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-repo...
- yummyfajitas 10y ago
  What do you mean "neglects"? Did the author somehow remove that from his numbers? The WHO ranks the US low because 62.5% of their score is a measure of inequality. Only 37.5% of their score is related to actual health care measures (health outcomes and patient satisfaction). The US scores #1 on patient satisfaction. http://www.who.int/whr/2000/en/whr00_en.pdf http://www.who.int/whr/2000/en/whr00_en.pdf
  - arcticbull 10y ago
    Neglects as in they don't consider that spend to be "waste" in the computation of whether Americans are paying more than a comparable country. IMO that should be subtracted off the top as none of that exists in a socialized system. They appear to be attributing those costs to the "higher standard of living".
  - huxley 10y ago
    Note: World Health Organization report is from 2000
    - yummyfajitas 10y ago
      Do you have something more current?
arcticbull 10y ago
Is it possible that healthcare in the US is a "superior good" (definition in article) because the lower quartiles can't afford proper care and as they become wealthier they progress from zero care, to basic plans that don't cover nearly what they should, to plans equivalent to the care people receive elsewhere in the world as a right of citizenship?
- yummyfajitas 10y ago
  No it's not. As it relates to this article, the relevant metric is whether healthcare is a superior good relative to GDP/capita. Those measurements are based on country data, including countries that have socialized medicine. Here's a link to the embedded image of text that explains this (which you can also find in the 3rd paragraph or so): https://randomcriticalanalysis.files.wordpress.com/2016/09/screenshot_890.png?w=1024 https://randomcriticalanalysis.files.wordpress.com/2016/09/s...
  - deleted 10y ago
    [deleted]
- photojosh 10y ago
  My immediate thought too.
- Spooky23 10y ago
  The bottom quartile didn't get zero care. The poorest of the poor are all eligible for Medicaid or get ad hoc acute care from emergency rooms. The people who get shafted are the middle-class or working class people who are stuck with contracting gigs or shitty employers who face financial ruin if they get sick. Your average truck driver, for example, is far more likely to die from preventable heart ailments due to the nature of the job and the inability to access medical care, even with insurance. That's a big reason why CVS Doc in the Box and Urgent care is a thing.
anonymousDan 10y ago
So his claim that the us has a higher standard of living is based on it having a higher AIC. But does this take into account that countries with higher taxation and hence public expenditure could reduce the need for households to spend money on public goods/services?
- yummyfajitas 10y ago
  Yes it does. This is explained in the fifth paragraph, pretty close to the top of the article. (Unfortunately that's an embedded image of text, so I can't quote it. But here's a link: https://randomcriticalanalysis.files.wordpress.com/2016/09/screenshot_893.png https://randomcriticalanalysis.files.wordpress.com/2016/09/s... )
- tcbawo 10y ago
  I find it odd to compare the nations of Europe individually, but taking the United States as a whole. Availability of subnational metrics probably makes this difficult, but averaging West Virginia and California is probably distortive.
  - Spooky23 10y ago
    It is odd and would be a damning set of metrics. People actually migrate away from the Deep South because their spin on Medicaid is garbage and there's no providers.
  - rcafdm 10y ago
    1) I was responding in large part to cross-country plots and regressions, e.g., https://randomcriticalanalysis.files.wordpress.com/2014/11/above-expected-500x406-1.jpg https://randomcriticalanalysis.files.wordpress.com/2014/11/a... 2) It's not sensible to run regressions when observations consist of US and EU-(14|28) alone. Small n and these all of these common EU aggregations would be MUCH poorer than the US. 3) US states have a fiscal, political, legal, social, and other union much beyond that of EU member states in the EU. I would very much anticipate larger spillover effects between US states than between EU member states for this reason (as in, MS's standard of care will be much more like MA's than Slovakia will be like Norway), not to mention gains from greater economic union, transfers, and the like. 3) Perfectly comparable data do not exist to make direct comparisons across different levels of analysis feasible. 4) I actually did run some regressions on US states and found: (i) states vary quite substantially in their expenditure levels and (ii) consumption (PCE) to be an exceptionally stronger predictor than GDP, personal income, and some other economic indicators. DC spends more than twice as much as Utah (and if you don't like DC as an observations, similar results are found for MA) https://randomcriticalanalysis.files.wordpress.com/2016/09/rcafdm_39_hce_by_pce_by_state.png https://randomcriticalanalysis.files.wordpress.com/2016/09/r... Even so, even if I were to try to equate these measures, I would not except the slope within countries like this to match the cross country slope due to some of the aforementioned spillovers. 5) I actually did analyze outcomes between states and even counties. https://randomcriticalanalysis.wordpress.com/2016/11/06/us-life-expectancy-is-below-naive-expectations-mostly-because-it-economically-outperforms/ https://randomcriticalanalysis.wordpress.com/2016/11/06/us-l... 6) Tho the US has greater geographic heterogeneity in outcomes than most of individual EU countries due to its size, greater historic diversity, and more, it's worth pointing out that health systems do not produce equal outcomes within countries. As I pointed out in the above link, the northern areas of England and southern parts of Scotland perform quite terribly. https://randomcriticalanalysis.files.wordpress.com/2016/11/screenshot_1170.png https://randomcriticalanalysis.files.wordpress.com/2016/11/s... These regions, btw, are where a large fraction of people in the US came from (especially those that settled in and around Appalachia). There is a whole literature indicating that "deep history" predicts economic and social outcomes many centuries later.....
ddingus 10y ago
Lmao, bullshit. I have had quite enough of these constant talks down to ordinary people. When we do not value our people well enough to find a reasonable standard of living, nearly all of us lose.
WalterBright 10y ago
Sam Peltzman in "Regulation of Pharmaceutical Innovation" shows how the 1962 FDA regulations have slowed down progress in pharmaceutical development to more than outweigh the improved safety. I.e. it's a net negative.
arkis22 10y ago
This strikes me as circular logic. "The reason healthcare is expensive is because the US is expensive." I have no problem with the idea of healthcare expenditures increasing proportionally to GDP because it's a luxury good. This is logical. I'll pay more to protect my life than widgets. But I don't see the connection between this and the thesis: >Now, to be clear, my position is not that we ought to be spending as much as we spend. My position is that the issues we face are very similar to the issues faced in Europe and other prosperous countries (and are generally similar to patterns many decades earlier). They are largely differences in degree, not kind. Our large apparent cost differences mostly originate from our significantly higher material standard of living. The long term increases found in the United States and other developed countries are generally a product of ever increasing material living conditions and varying levels of productivity in different economic sectors (healthcare being labor intensive and relatively high skilled at that). Despite the fact that all developed countries allocate a large and increasing share of their consumption expenditures on health care these these richer countries, including the United States, still spend more on other forms of consumption. That sounds to me like the cost of our healthcare is ultimately up to the market, but that's not a thesis to fight for, as it's always a fact. By using end result economic data like GPD or AIC to compare healthcare costs the analysis ignores the changing cost of inputs. Those rising costs should be linked to changes in business conditions. Healthcare costs have been rising faster than inflation. And they have been rising faster than the material standard of living in the US. There are structural problems.
- yummyfajitas 10y ago
  No, what he's saying is the reason (health care consumption / GDP per capita) is abnormally high in the US is the probably same as the reason that (all consumption / gdp per capita) is abnormally high in the US. That's not circular. It's merely pointing to an underlying cause that is probably not specific to the health care system.
  - arkis22 10y ago
    If it's not specific to the healthcare system, price increases should mirror inflation. The underlying cause being high material standard of living? Because that is why it's circular logic to me. I still have a problem with using the end economic result data. It _automatically_ assumes that price increases are called for based on the market. If all firms in an industry can raise prices at the micro level, then no firm stands out at the macro level, which means macro analysis is kind of useless. An analysis of healthcare companies COGS and profit margins would be more illuminating.
transfire 10y ago
I have a severe migraine attack, I need narcotic strength pain meds. Only place to get them on short notice is the Emergency room. Takes four hours and I get a bill for $3,000. This has nothing to do with US being expensive. It's a broken system.

30 points by elberto34 10y ago

Slightly off topic but is there is a such thing as universal affordable good healthcare? I've talked to a few U.S. citizens that worked abroad who said healthcare in European countries is universally available but the demand outstrips the supply causing longer wait times to get treated than in the U.S. and that they prefer the U.S. system. These are of course people who have good jobs in the U.S. with company provided coverage. Is that true? Is there any system that can both cover everyone without making healthcare worse for people who already have good coverage?

deleted 10y ago
[deleted]
ramparrt 10y ago
The Australian system is far from perfect but does come some way to solving this. It is effectively 2 tiered: 1) Public Medicare, the publicly funded system available to everybody. 2) Private insurance, paid for by the individual and tailored to their needs. To pay for the public system everybody pays a Medicare levy as part of their income tax. The levy is coarsely means tested. If you have private insurance then this levy is reduced somewhat. The real critical differentiation between the public (Medicare) and private offerings are that any services deemed as elective in nature (ie, non life threatening conditions such as surgeries to treat injuries, etc) can be completed by the public system but there is a wait list which can often be quite long. If you have private insurance then you can get in very quickly with the surgeon you want. Having private in no way restricts your usage of the public system so there is no downside to having private except that it costs more. There are also fee structures in place to encourage people to take up private when they're younger and the saving on the medicare levy. As I said, it's far from perfect, but the 2 tiers offer a high level of customized cover for people willing and able to afford it while offering an acceptable level of cover for those who can't.
- ricardonunez 10y ago
  This sounds in some ways similar to Mark Cuban's solution. Here's the post: http://blogmaverick.com/2017/03/08/some-thoughts-on-fixing-obamacare-shoot-holes-in-this-please/ http://blogmaverick.com/2017/03/08/some-thoughts-on-fixing-o...
- bigger_cheese 10y ago
  One thing I don't like about the Australian system is I think it is wasteful in someways. For example under my private cover I'm subsidized for ~$300 a year in optical expenses (split between lenses and frames). From anecdotal conversations I know there are many people who purchase a new pair of glasses every year just because the system is basically set up to encourage this which smells like very wasteful consumption to me. I don't need a pair of glasses every year. I have gone through 3 sets of glasses in 15 years. If I wanted to I could opt to exclude optical from my cover and save some money every month but then I'd worry about what happens if I lose my glasses or sit on them and I'd end up out of pocket so I keep paying for optical cover I don't use and feel like a sucker every year for not taking advantage of subsidized glasses. Same thing with trips to dentist I know people who insist on general dental (unnecessary cleaning etc) because they are subsidized so they "need to take advantage to get their money's worth".
  - robbiep 10y ago
    I suggest you stop thinking about it as a benefit and think about what it actually is, which is insurance. My travel insurance is cheaper if I don't cover any lost property, but what if I need it? Anecdotally many young travellers who head overseas 'lose' their $1500 DSLR or their 6 year old macbook when in South America in order to make use of their $300 travel insurance
    - bigger_cheese 10y ago
      Agreed exactly why I pay for it. The fact it is advertised as a benefit probably contributes to this. My insurer has gone as far as cold calling me last year "I notice you haven't been claiming any of these benefits, would you like to review your policy."
leonroy 10y ago
Well to begin with, the availability of free universal health care - like the NHS helps ensure a pretty competitive private healthcare market. For example, I know that if my wife becomes pregnant or if there are complications we won't be hit with thousands or tens of thousands in medical bills on leaving the hospital. However on the flip side, it's very difficult to find a decent NHS dentist where we live, so we'll pay about £300-600 in dental checkups or dental work per annum. Just by having the NHS provide dental or any medical care there is downward pricing pressure on private competitors so however flawed a system like the NHS is it certainly has a very important pricing function even if you choose to go completely private.
Broken_Hippo 10y ago
So far, I'm quite pleased with the Norwegian health care system - though to be honest, most of my experience has been through "working" as a CNA (it was actually part of language classes), classroom learning, a few doctor's visits, and the stories of other immigrants. Everyone is covered by the national health insurance. No more worries about getting hit with a huge health care bill. Children have a lot of free stuff - most health care and dental (braces are an exception). I can change my doctor a couple times a year if I want. Some things just make sense: For example, the government sends me a letter to remind me to get cancer screenings every 3 years (I'm female) - and this stuff isn't as possible with the fragmented system in the states. Now, the downsides are things like longer wait times. This does suck, for sure. Some of this is simply being cost-effective, I'm sure. But other cost effective things work out: For example, if you need a home nurse, you get one covered up to 6 times a day. Free, because it is cheaper than a nursing home. Dental can tend to be expensive and folks have some odd ways of going about this. For example, I've heard of a group of Norwegian dentists in... Poland?... that cater to Norwegians. The cost is often cheaper, even when factoring in the travel costs. There is a private health care system. The government still pays their normal rate to the private provider and the patient pays the difference. Some folks use this to go around the waiting times and I'm guessing this option would seem more similar to the American system for folks with insurance - though I'm not sure it is ever like the nearly on-demand medical care one comes to expect in the states. The system is vastly better for those with poor coverage or those that have good coverage but can't afford to use it. Hopefully, if the US does a single-payer system, they take a look at some of the downsides and try some things to lessen them.
deleted 10y ago
[deleted]
pharrlax 10y ago
>I've talked to a few U.S. citizens that worked abroad who said healthcare in European countries is universally available but the demand outstrips the supply causing longer wait times to get treated than in the U.S. and that they prefer the U.S. system. Whether we want to ration care by ability to pay or by another means, such as severity of illness, care will have to be rationed -- and the degree to which it must be rationed is inversely related to what percentage of people are covered by it. So of course well-off folks will perceive a system with a greater percentage of people covered and with care rationed in a way other than 'ability to pay' as being worse than a capitalist system -- they have to wait longer because they're standing in line alongside folks who, in the healthcare system they are used to, could not afford to be standing in line with them at all. The question is whether that drawback is worth providing access to care to folks who otherwise would not be able to access it.
yulaow 10y ago
Typically demand outstrips supply for very simple exams but the private sector covers it pretty well without making you pay a lot more. For example, here in Italy I can look for: public sector, private public-affiliated sector and full private sector. When I needed a full low abdomen echography I first contacted the public sector, they told me they had a wait list of 2.5months for that common exam, but I could call a private public-affiliated clinic and do it there (they also gave me suggestions on which clinics were available). Cost ~23euros (not all the exams have this waiting time, when I needed just physiotherapy or to see a psychologist I had <7 days wait time) Called three private public-affiliated clinics. These are clinics where all the staff is private and is managed like a normal company, but if they do an exam and you have the paper from your GP they can fill a form and get a part payed from the public sector (in a sort of exchange for helping reducing the wait time) In all of three they could visit me in 2-4 days, paying just ~30e. Lastly there was the full private clinic, those are not subsidized in any way but they have a very short list and if you want you can make a private insurance that cover basically whatever exams you will ever need from them. They could visit me in the next 2 hours for just ~80e. Note I was not in a emergency, if that was the case I could just run to the hospital and they would visit me instantly without making me pay anything (you can also run to the hospital without an ongoing emergency... they usually don't make you pay nothing anyway and do the exams but make you wait hours until they have no more urgent cases). Note also that if you have a serious condition (cancer like or anything with high risk of fatality) you will get ahead of any list and be visited asap, no money asked. And Italy is considered one of those "long list countries" in EUW.
bjornsing 10y ago
I'd say it depends on what you mean by "good". E.g. the Swedish system probably compares well to the US one in terms of (average) medical outcomes [1], but in terms of "customer satisfaction"... that's a different story. (Personally I feel "real" / objective health is more important than the subjective "customer satisfaction" aspect of health care, but yea, I guess that's politics.) 1. E.g. http://www.nationmaster.com/country-info/compare/Sweden/United-States/Health http://www.nationmaster.com/country-info/compare/Sweden/Unit...
rbehrends 10y ago
> I've talked to a few U.S. citizens that worked abroad who said healthcare in European countries is universally available but the demand outstrips the supply causing longer wait times to get treated than in the U.S. and that they prefer the U.S. system. These are of course people who have good jobs in the U.S. with company provided coverage. Is that true? This can be all over the place, depending on what you look at (GP appointments, specialist appointments, emergency and urgent care, elective surgeries, etc.) [1]. In general, the US outperforms some countries, but never all of them, and this is not taking into account that people without access to healthcare may suffer de facto infinite waiting times or that in many countries, people seek out their doctors far more frequently than in the US [2]. "Europe" is definitely not a homogeneous blob (just think of, say, France vs. Bulgaria) and there are great variations between even the affluent EU member states; it is pretty much impossible to generalize. What we do know is that the US has a fairly low physician density for a developed country [3], though that's not the only factor that goes into waiting times. [1] Google will show you a fairly large number of studies, but few that cover more than a handful or so of countries and/or more than a few metrics, so it's difficult to get a truly comprehensive overview. [2] https://www.statista.com/statistics/236589/number-of-doctor-visits-per-capita-by-country/ https://www.statista.com/statistics/236589/number-of-doctor-... [3] http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_Total/atlas.html http://gamapserver.who.int/gho/interactive_charts/health_wor...

hackuser 10y ago

(withdrawn)

RUBwkVjwLsDKgPw 10y ago
please read the article first. this criticism is addressed.
yummyfajitas 10y ago
The data in the article shows there is no country with the same standard of living. The article doesn't disagree that you could get similar health outcomes for less money. The claim of the article is that as people become richer, they spend more money on marginally beneficial health care. (Or sometimes just consumer goods masquerading as health care, e.g. Oxycontin and similar drugs, used by our leisure class use to mask their ennui. https://www.commentarymagazine.com/articles/our-miserable-21st-century/ https://www.commentarymagazine.com/articles/our-miserable-21... )

arcticbull 10y ago

Strange, this neglects that portion of health care spend that is accounted for by profits, by marketing expenses and administrative/billing bloat that ensues. It also neglects that for its massively higher spend 10% of Americans aren't covered and therefore don't receive preventative care yielding massively higher final costs, and it doesn't take into account the WHO ranks the US system as 31st in the world dramatically under all the socialized players. [Edit] as I suspected [1] indicates a full 20% of spend is wasted mostly on profits and administrative costs. That should be taken off the top. IMO this is a case of "figures don't lie, liars figure" but without the malicious intent. [1] https://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-report-02-15-2013.pdf https://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-repo...

yummyfajitas 10y ago
What do you mean "neglects"? Did the author somehow remove that from his numbers? The WHO ranks the US low because 62.5% of their score is a measure of inequality. Only 37.5% of their score is related to actual health care measures (health outcomes and patient satisfaction). The US scores #1 on patient satisfaction. http://www.who.int/whr/2000/en/whr00_en.pdf http://www.who.int/whr/2000/en/whr00_en.pdf
- arcticbull 10y ago
  Neglects as in they don't consider that spend to be "waste" in the computation of whether Americans are paying more than a comparable country. IMO that should be subtracted off the top as none of that exists in a socialized system. They appear to be attributing those costs to the "higher standard of living".
- huxley 10y ago
  Note: World Health Organization report is from 2000
  - yummyfajitas 10y ago
    Do you have something more current?

arcticbull 10y ago

Is it possible that healthcare in the US is a "superior good" (definition in article) because the lower quartiles can't afford proper care and as they become wealthier they progress from zero care, to basic plans that don't cover nearly what they should, to plans equivalent to the care people receive elsewhere in the world as a right of citizenship?

yummyfajitas 10y ago
No it's not. As it relates to this article, the relevant metric is whether healthcare is a superior good relative to GDP/capita. Those measurements are based on country data, including countries that have socialized medicine. Here's a link to the embedded image of text that explains this (which you can also find in the 3rd paragraph or so): https://randomcriticalanalysis.files.wordpress.com/2016/09/screenshot_890.png?w=1024 https://randomcriticalanalysis.files.wordpress.com/2016/09/s...
- deleted 10y ago
  [deleted]
photojosh 10y ago
My immediate thought too.
Spooky23 10y ago
The bottom quartile didn't get zero care. The poorest of the poor are all eligible for Medicaid or get ad hoc acute care from emergency rooms. The people who get shafted are the middle-class or working class people who are stuck with contracting gigs or shitty employers who face financial ruin if they get sick. Your average truck driver, for example, is far more likely to die from preventable heart ailments due to the nature of the job and the inability to access medical care, even with insurance. That's a big reason why CVS Doc in the Box and Urgent care is a thing.

anonymousDan 10y ago

So his claim that the us has a higher standard of living is based on it having a higher AIC. But does this take into account that countries with higher taxation and hence public expenditure could reduce the need for households to spend money on public goods/services?

yummyfajitas 10y ago
Yes it does. This is explained in the fifth paragraph, pretty close to the top of the article. (Unfortunately that's an embedded image of text, so I can't quote it. But here's a link: https://randomcriticalanalysis.files.wordpress.com/2016/09/screenshot_893.png https://randomcriticalanalysis.files.wordpress.com/2016/09/s... )
tcbawo 10y ago
I find it odd to compare the nations of Europe individually, but taking the United States as a whole. Availability of subnational metrics probably makes this difficult, but averaging West Virginia and California is probably distortive.
- Spooky23 10y ago
  It is odd and would be a damning set of metrics. People actually migrate away from the Deep South because their spin on Medicaid is garbage and there's no providers.
- rcafdm 10y ago
  1) I was responding in large part to cross-country plots and regressions, e.g., https://randomcriticalanalysis.files.wordpress.com/2014/11/above-expected-500x406-1.jpg https://randomcriticalanalysis.files.wordpress.com/2014/11/a... 2) It's not sensible to run regressions when observations consist of US and EU-(14|28) alone. Small n and these all of these common EU aggregations would be MUCH poorer than the US. 3) US states have a fiscal, political, legal, social, and other union much beyond that of EU member states in the EU. I would very much anticipate larger spillover effects between US states than between EU member states for this reason (as in, MS's standard of care will be much more like MA's than Slovakia will be like Norway), not to mention gains from greater economic union, transfers, and the like. 3) Perfectly comparable data do not exist to make direct comparisons across different levels of analysis feasible. 4) I actually did run some regressions on US states and found: (i) states vary quite substantially in their expenditure levels and (ii) consumption (PCE) to be an exceptionally stronger predictor than GDP, personal income, and some other economic indicators. DC spends more than twice as much as Utah (and if you don't like DC as an observations, similar results are found for MA) https://randomcriticalanalysis.files.wordpress.com/2016/09/rcafdm_39_hce_by_pce_by_state.png https://randomcriticalanalysis.files.wordpress.com/2016/09/r... Even so, even if I were to try to equate these measures, I would not except the slope within countries like this to match the cross country slope due to some of the aforementioned spillovers. 5) I actually did analyze outcomes between states and even counties. https://randomcriticalanalysis.wordpress.com/2016/11/06/us-life-expectancy-is-below-naive-expectations-mostly-because-it-economically-outperforms/ https://randomcriticalanalysis.wordpress.com/2016/11/06/us-l... 6) Tho the US has greater geographic heterogeneity in outcomes than most of individual EU countries due to its size, greater historic diversity, and more, it's worth pointing out that health systems do not produce equal outcomes within countries. As I pointed out in the above link, the northern areas of England and southern parts of Scotland perform quite terribly. https://randomcriticalanalysis.files.wordpress.com/2016/11/screenshot_1170.png https://randomcriticalanalysis.files.wordpress.com/2016/11/s... These regions, btw, are where a large fraction of people in the US came from (especially those that settled in and around Appalachia). There is a whole literature indicating that "deep history" predicts economic and social outcomes many centuries later.....

ddingus 10y ago

Lmao, bullshit. I have had quite enough of these constant talks down to ordinary people. When we do not value our people well enough to find a reasonable standard of living, nearly all of us lose.

WalterBright 10y ago

Sam Peltzman in "Regulation of Pharmaceutical Innovation" shows how the 1962 FDA regulations have slowed down progress in pharmaceutical development to more than outweigh the improved safety. I.e. it's a net negative.

arkis22 10y ago

This strikes me as circular logic. "The reason healthcare is expensive is because the US is expensive." I have no problem with the idea of healthcare expenditures increasing proportionally to GDP because it's a luxury good. This is logical. I'll pay more to protect my life than widgets. But I don't see the connection between this and the thesis: >Now, to be clear, my position is not that we ought to be spending as much as we spend. My position is that the issues we face are very similar to the issues faced in Europe and other prosperous countries (and are generally similar to patterns many decades earlier). They are largely differences in degree, not kind. Our large apparent cost differences mostly originate from our significantly higher material standard of living. The long term increases found in the United States and other developed countries are generally a product of ever increasing material living conditions and varying levels of productivity in different economic sectors (healthcare being labor intensive and relatively high skilled at that). Despite the fact that all developed countries allocate a large and increasing share of their consumption expenditures on health care these these richer countries, including the United States, still spend more on other forms of consumption. That sounds to me like the cost of our healthcare is ultimately up to the market, but that's not a thesis to fight for, as it's always a fact. By using end result economic data like GPD or AIC to compare healthcare costs the analysis ignores the changing cost of inputs. Those rising costs should be linked to changes in business conditions. Healthcare costs have been rising faster than inflation. And they have been rising faster than the material standard of living in the US. There are structural problems.

yummyfajitas 10y ago
No, what he's saying is the reason (health care consumption / GDP per capita) is abnormally high in the US is the probably same as the reason that (all consumption / gdp per capita) is abnormally high in the US. That's not circular. It's merely pointing to an underlying cause that is probably not specific to the health care system.
- arkis22 10y ago
  If it's not specific to the healthcare system, price increases should mirror inflation. The underlying cause being high material standard of living? Because that is why it's circular logic to me. I still have a problem with using the end economic result data. It _automatically_ assumes that price increases are called for based on the market. If all firms in an industry can raise prices at the micro level, then no firm stands out at the macro level, which means macro analysis is kind of useless. An analysis of healthcare companies COGS and profit margins would be more illuminating.

transfire 10y ago

I have a severe migraine attack, I need narcotic strength pain meds. Only place to get them on short notice is the Emergency room. Takes four hours and I get a bill for $3,000. This has nothing to do with US being expensive. It's a broken system.