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The math in the article is not quite right. Growth from 1.2 trillion to 2.1 trillion in 17 years (1996-2013) only amounts to 3.3% annual growth, which is not th

The math in the article is not quite right. Growth from 1.2 trillion to 2.1 trillion in 17 years (1996-2013) only amounts to 3.3% annual growth, which is not that far away from the 2.4% of the overall economic growth. The U.S. does spend more per capita than any other country, with Switzerland, Luxembourg and Norway being the runners up. https://www.npr.org/sections/goatsandsoda/2017/04/20/524774195/what-country-spends-the-most-and-least-on-health-care-per-person https://www.npr.org/sections/goatsandsoda/2017/04/20/5247741... I think that statistics gives a hint: the richer the country, the more it can afford to spend. Also the mostly private health care sector in the U.S. doesn't have similar incentives to cap their spending at a certain point as their publicly funded counterparts in Europe. There must be a lot of cases where a rich person buys expensive treatments for a terminal illness that would be deemed hopeless and left untreated elsewhere, and that has to show in the statistics somehow. I don't consider this a big flaw in the U.S. system.

Broken_Hippo 9y ago
There must be a lot of cases where a rich person buys expensive treatments for a terminal illness that would be deemed hopeless and left untreated elsewhere, and that has to show in the statistics somehow. I don't consider this a big flaw in the U.S. system. Probably not a lot, since most people aren't rich. But more to the point: That stuff happens other places as well. I'm in Norway, and there is a private healthcare system. Most of the time, I hear it being used for shortened waiting times or more luxury in the hospital, but I'm pretty sure rich folks can go to other lengths - on their own dime. This doesn't affect the state much because it isn't their freaking money. Also the mostly private health care sector in the U.S. doesn't have similar incentives to cap their spending at a certain point as their publicly funded counterparts in Europe. I think this is correct, but I think the fragmentation is what causes it. The fragmentation means there is no incentive to combine resources to make things cheaper and easier. Where I live in Norway, people can have - free - up to 6 nurse visits a day. Even if you live on an island or are spending your summer in a remote cabin. All because overall, the outcomes are good. People live longer, happier lives the longer they can be at home and it is cheaper than sending the same people to a nursing home.
- vidarh 9y ago
  Actually in Norway there is relatively little you can do in Norway, as private providers are highly restricted in what services they can legally provide in areas that are covered by public healthcare, in part because it's long been seen as immoral to let people buy preference to what is effectively a limited resource as long as the number of doctors available is limited (and the answer is not to drastically increase the pool of doctors either, as the problem there is training - you don't have enough heart transplant cases, say, to train a much larger pool of transplant surgeons). I believe the restrictions are lighter than they were, but it's still far more regulated than most places. But of course rich people can easily fly to get private treatment abroad. Healthcare in Norway is close to US costs mostly for other reasons: A much flatter salary curve means the services that are typically cheap elsewhere, like e.g. cleaning staff, is much closer to the cost of higher level staff, driving up overall staff costs significantly; this also drives up costs of goods and services bought externally by the healthcare system. The population density is also extremely low - less than half the US, and the US is extremely low too - and that affects cost to e.g have good hospital coverage and emergency services. Providing service at all in some places is an ongoing challenge, with the Northern regions finding it hard to hire and retain staff despite the tax breaks (for the non-Norwegians: people in the Northernmost regions gets various tax breaks and other benefits such as student debt write-downs to get people to stay/move there)
  - Broken_Hippo 9y ago
    Thanks for the information. Most of what I know about the private system here (Norway) is from language & civics classes - though I hear rumors of tourism as you've mentioned.
- juhanima 9y ago
  Most people are not rich, but if the richest 1/10 spend ten times the amount of what the rest in average, that alone almost doubles the total average. Averages are funny that way. I don't think this is even far fetched, because if you have the money and you are going to die, why would you not clutch to any straws you are being offered? Certainly the same takes place in other rich countries as well, but maybe in not quite the same extent. Anyway, it would be very interesting to see how the healthcare spending would look like when grouped in percentiles by the total spending of each patient. I wouldn't be surprised if there was quite a bulge on the far right with the U.S. and not so much elsewhere. Another reason why I don't consider this a big flaw is that expensive treatments are also often experimental and drive the general medicine forward, which may make them more affordable and more generally accessible in the future. Not saying the system is perfect. Just that maybe it's not such an outrageous rip-off as the article makes it look like.
cma 9y ago
Rich people can still buy supplemental insurance in most other places.
- vidarh 9y ago
  E.g. in the UK 10% have private insurance (though very often as a employee benefit that they don't pay much for and so the takeup is artificially inflated that way). But presumably the fact that they have to convince people it's worth paying extra on top of their taxes provides massive additional competitive pressure and is part of what helps keeping the prices low relative to the service provided. E.g. I've seen cases where it'd pay for Americans to fly to London and stay in a luxury hotel and get treated at top private clinics in London vs. getting relatively basic private treatment in the US.
  - vertex-four 9y ago
    Note that private insurance in the UK does not cover chronic conditions - they shunt you off to the NHS for anything that isn't easily curable. That's a large reason why it's cheap.
hackeraccount 9y ago
Everything I've read says that especially post 80's health care inflation in the US is somewhere in the middle of the pack of OECD countries. That should give everyone on a high horse convinced that they have a solution in their pocket a real cause for concern. It doesn't of course. But it should.

Broken_Hippo 9y ago

There must be a lot of cases where a rich person buys expensive treatments for a terminal illness that would be deemed hopeless and left untreated elsewhere, and that has to show in the statistics somehow. I don't consider this a big flaw in the U.S. system. Probably not a lot, since most people aren't rich. But more to the point: That stuff happens other places as well. I'm in Norway, and there is a private healthcare system. Most of the time, I hear it being used for shortened waiting times or more luxury in the hospital, but I'm pretty sure rich folks can go to other lengths - on their own dime. This doesn't affect the state much because it isn't their freaking money. Also the mostly private health care sector in the U.S. doesn't have similar incentives to cap their spending at a certain point as their publicly funded counterparts in Europe. I think this is correct, but I think the fragmentation is what causes it. The fragmentation means there is no incentive to combine resources to make things cheaper and easier. Where I live in Norway, people can have - free - up to 6 nurse visits a day. Even if you live on an island or are spending your summer in a remote cabin. All because overall, the outcomes are good. People live longer, happier lives the longer they can be at home and it is cheaper than sending the same people to a nursing home.

vidarh 9y ago
Actually in Norway there is relatively little you can do in Norway, as private providers are highly restricted in what services they can legally provide in areas that are covered by public healthcare, in part because it's long been seen as immoral to let people buy preference to what is effectively a limited resource as long as the number of doctors available is limited (and the answer is not to drastically increase the pool of doctors either, as the problem there is training - you don't have enough heart transplant cases, say, to train a much larger pool of transplant surgeons). I believe the restrictions are lighter than they were, but it's still far more regulated than most places. But of course rich people can easily fly to get private treatment abroad. Healthcare in Norway is close to US costs mostly for other reasons: A much flatter salary curve means the services that are typically cheap elsewhere, like e.g. cleaning staff, is much closer to the cost of higher level staff, driving up overall staff costs significantly; this also drives up costs of goods and services bought externally by the healthcare system. The population density is also extremely low - less than half the US, and the US is extremely low too - and that affects cost to e.g have good hospital coverage and emergency services. Providing service at all in some places is an ongoing challenge, with the Northern regions finding it hard to hire and retain staff despite the tax breaks (for the non-Norwegians: people in the Northernmost regions gets various tax breaks and other benefits such as student debt write-downs to get people to stay/move there)
- Broken_Hippo 9y ago
  Thanks for the information. Most of what I know about the private system here (Norway) is from language & civics classes - though I hear rumors of tourism as you've mentioned.
juhanima 9y ago
Most people are not rich, but if the richest 1/10 spend ten times the amount of what the rest in average, that alone almost doubles the total average. Averages are funny that way. I don't think this is even far fetched, because if you have the money and you are going to die, why would you not clutch to any straws you are being offered? Certainly the same takes place in other rich countries as well, but maybe in not quite the same extent. Anyway, it would be very interesting to see how the healthcare spending would look like when grouped in percentiles by the total spending of each patient. I wouldn't be surprised if there was quite a bulge on the far right with the U.S. and not so much elsewhere. Another reason why I don't consider this a big flaw is that expensive treatments are also often experimental and drive the general medicine forward, which may make them more affordable and more generally accessible in the future. Not saying the system is perfect. Just that maybe it's not such an outrageous rip-off as the article makes it look like.

cma 9y ago

Rich people can still buy supplemental insurance in most other places.

vidarh 9y ago
E.g. in the UK 10% have private insurance (though very often as a employee benefit that they don't pay much for and so the takeup is artificially inflated that way). But presumably the fact that they have to convince people it's worth paying extra on top of their taxes provides massive additional competitive pressure and is part of what helps keeping the prices low relative to the service provided. E.g. I've seen cases where it'd pay for Americans to fly to London and stay in a luxury hotel and get treated at top private clinics in London vs. getting relatively basic private treatment in the US.
- vertex-four 9y ago
  Note that private insurance in the UK does not cover chronic conditions - they shunt you off to the NHS for anything that isn't easily curable. That's a large reason why it's cheap.

hackeraccount 9y ago

Everything I've read says that especially post 80's health care inflation in the US is somewhere in the middle of the pack of OECD countries. That should give everyone on a high horse convinced that they have a solution in their pocket a real cause for concern. It doesn't of course. But it should.