10 ms·

Blame Emergency Rooms for the Out-Of-Control Cost of Health Care

34 points by tysone 8y ago

refurb 8y ago
If people really want to understand why US healthcare is more expensive, I'd suggest this detailed, if somewhat dated (2008) analysis by McKinsey which breaks down US healthcare spending by category and compares it to other countries, accounting for differences in GDP - in particular page4 [1]. Findings: - most of the extra spending, ~70%, is occurring in the outpatient setting (which includes the ER) - in-patient care is only marginally higher than expected compared to other countries (~10%) - the US spends less than most developed countries on long-term care and home care [1]https://healthcare.mckinsey.com/sites/default/files/752233%20Why%20Americans%20pay%20more%20for%20health%20care.pdf https://healthcare.mckinsey.com/sites/default/files/752233%2...
- zeroego 8y ago
  That was an interesting read, thanks for sharing. My own understanding, from personal experience working in an ER, was that they charge more there to offset the cost of the (often impoverished) people who use it for everything from the sniffles to gun shot wounds. These people, who don't have health insurance, typically don't pay their bills. Also, I saw many homeless people come in simply for a bed to sleep in and a hot meal. They take up a bed and nurses/doctor's time. ER's aren't mean't to be non-emergent PCP's or soup kitchens, yet they often end up serving that purpose. The end result as I see it is a bunch of expensive and poorly delegated resources.
  - lighthazard 8y ago
    Any statistics on patient usage, non-payment, and free clinics?
    - zeroego 8y ago
      Unfortunately I do not have any. This was just my experience/what I was told working in a busy ER in a major metro area.
  - village-idiot 8y ago
    It’s estimated that keeping a homeless person on the streets can cost the local government up to $1m/year in terms of police, jail, and hospital resource usages.
    - Judgmentality 8y ago
      I'd love to read more about that. Do you have a source?
      - village-idiot 8y ago
        Can’t find my old source, and it looks like $1m is pretty off the mark. It looks like this number is wildly variable. Places like Texas spend a low of $9-40k to jail and treat homelessness in ERs. Places like the Puget Sound spend about $1 billion[0] a year to deal with their ~5,500 homeless people. While that’s far from $1m, it is pretty high at $181,000 a person year. 0. https://www.bizjournals.com/seattle/news/2017/11/16/price-of-homelessness-seattle-king-county-costs.html https://www.bizjournals.com/seattle/news/2017/11/16/price-of...
    - Johnny555 8y ago
      I'd like to see a reference for that number, $1M sounds awfully high.
      - village-idiot 8y ago
        I can’t find my old sources, and t seems like $1m is indeed quite off the mark. It looks like this number is wildly variable. Places like Texas spend a low of $9-40k to jail and treat homelessness in ERs. Places like the Puget Sound spend about $1 billion[0] a year to deal with their ~5,500 homeless people. While that’s far from $1m, it is pretty high at $181,000 a person year. 0. https://www.bizjournals.com/seattle/news/2017/11/16/price-of-homelessness-seattle-king-county-costs.html https://www.bizjournals.com/seattle/news/2017/11/16/price-of...
        ardy42 8y ago
- candiodari 8y ago
  2008 was before Obamacare wasn't it ? That seem likely to have changed things.
- wrp 8y ago
  A more recent (2015) and I think clearer analysis is given in "Healthcare Cost Drivers White Paper"[1] from the National Association of Health Underwriters. The NAHU seems in general to be a good non-partisan source of information on the health care industry. [1] https://nahu.org/media/1147/healthcarecost-driverswhitepaper.pdf https://nahu.org/media/1147/healthcarecost-driverswhitepaper... (PDF)
me123456789 8y ago
Most plans are not paying the inflated rates. Federal law requires plans to cover emergency care by out-of-network providers, but the plan can limit the payment to the usual and customary rate for the services. This leaves the patient susceptible to balance billing for the inflated rates. Self-insured employer group plans, which is what most people have, are federally regulated. State law does not apply to them. State-regulated plans often are required to cover the full costs depending on state law, so the author's point is valid there.
village-idiot 8y ago
It’s almost as if, and stay with me here, preventative care is cheaper than reactive care. Well, that and hospital billing is bullshit. Got charged $500 because the doctor at the ER we went to for a sudden emergency was out of network, even though the ER wasn’t. How the heck I’m supposed to do something about that is beyond me.
- nonbel 8y ago
  Hospital "billing" is mostly BS opaque negotiations between them and insurance companies. Those numbers mean nothing for individual patients. http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ http://selfpaypatient.com/2014/01/03/insured-patients-can-sa...
  - village-idiot 8y ago
    Yup. This is why I rage against the “free market” solutions being proposed that do nothing about opaque billing. You can’t have a free market when you need to buy the product and can’t tell how much it will cost before hand.
    - refurb 8y ago
      Don’t forget that government regulations actually contributed to the opaque billing issue. Laws state that hospitals must maintain a chargemaster with prices for all procedures. When hospitals realized that the chargemaster would become a starting point for negotiations with insurance companies, they inflated the numbers wildly. In the end the uninsured bear the brunt of it.
      - maxxxxx 8y ago
        Blaming this on government regulations seems a stretch.
        village-idiot 8y ago
jfoutz 8y ago
That sounds like an option. But after some reflection, nah. It’s more complicated than “blame emergency rooms”. Thanks for the suggestion though.
scottlocklin 8y ago
Article brought to you by Blue Cross and the American Medical Association. Pay no attention to the cartels behind the author. "Glenn A. Melnick, PhD Title Blue Cross of California Chair in Healthcare Finance, and Professor of Public Policy"
- tzs 8y ago
  I think you may be confused a bit here. Did you by any chance think that "Blue Cross of California Chair in Healthcare Finance" means that he holds a position at Blue Cross? It doesn't. In 1994 Blue Cross gave $2.5 million to the University of Southern California to endow a chair. The way an endowed chair works is that donation is logically kept separate from the rest of the university's endowment, and the earnings from that separate endowment go toward the salary of whatever professor holds the chair. Other than having part (or all, depending on how much the endowment earns) of their pay come from that instead of from the general university budget there is little or no difference between a professor holding an endowed chair and one who does not. (Sometimes a donor might specify that there will be some extras, like funding for an assistant). The donor has no involvement after the initial donation, other than their name is on the chair (well, not always their name...someone can endow a chair and name it after someone else) and the title of whoever holds it. In particular, the donor gets no financial leverage over the holder of the chair. I have no idea where you got the American Medical Association connection from.
nonbel 8y ago
When I looked into healthcare spending in the US about 5 years ago, it was almost all (~75%) chronic treatments for people over 70 years old. Does anyone have a current reference regarding this type of data?
TangoTrotFox 8y ago
This is a critical statement from the article, "Data from California illustrate how hospitals have exploited this situation. From 2002 to 2016, total billed charges by hospitals rose by a staggering $263 billion, to $386 billion, even though the number of patients admitted did not increase.". That feels like statistical butchery. Two immediate things come to mind. Obesity has skyrocketed in the US between those time periods and thus more people are going to be facing more severe and more expensive health issues. How much of the cost is due to increased severity of issues? And second, does that account for inflation? Inflation alone, which increased 33% between 2002 and 2016, would explain the cost differences if that was not adjusted. Though also why in the world would the number of people admitted not increase even though the population grew substantially in that time period? I tried to answer these questions myself, but the link provided in the article just leads to dozens of links to other PDFs, which also inspires some skepticism. It would be nice if they specified exactly where they information came from. There's also a third possible issue. In the US all public emergency rooms are required to treat and care for individuals regardless of whether or not they can pay. I have no idea how the billing for this works behind the scenes, but it's likely hospitals are recouped for most/all of these costs from the government. However, that would indeed create a huge incentive to charge as much as they could while also providing as expensive of care as possible. Not dissimilar to how government guaranteed student loans have created an incentive for universities to charge as much as they possibly can. In any case if the number of people utilizing this 'benefit' increased, we'd also expect to see a change in costs. Articles like this just make me think of that old quote, "There are three kinds of lies: lies, damned lies, and statistics."
- tzs 8y ago
  > Obesity has skyrocketed in the US between those time periods and thus more people are going to be facing more severe and more expensive health issues. US obesity skyrocketed in that time. It went from 30.5% to 39.6% for adults (15.4% to 18.5%) for youth. But California obesity rates did not. I don't have 2002 numbers, but in 2003 it was 23.2% for adults, which only grew to 25% by 2016. Youth obesity rates in California were in the 16.4-16.6% percent range that whole period. (California did have skyrocketing rates...but that was from 1990 to 2003, when they went from 9.9% to 23.2%. Then they pretty much leveled off).
mirimir 8y ago
It's crucial, in the US, to research general practitioners, relevant specialists, and hospitals in ones area that accept ones insurance plan. And if possible, to do that before selecting an insurance plan. In most states, in-network providers can't collect uncovered charges from patients. But it's good to check on that too. Many providers will bill anyway, even if they can't collect. Also, if at all possible, in situations that aren't life threatening, it's prudent to confirm network status and coverage, before accepting care.
- ceph_ 8y ago
  How is it legal to bill on something they can't collect on? So you're just supposed to ignore a bill and let it go to collections. The US healthcare system is beyond fucked.
  - mirimir 8y ago
    Well, it's not exactly legal to bill for it ;) But what you do is call their billing office, and point out their error. And then the charge disappears. I'm not sure what'd happen if you let it just go for collection. It'd probably hurt credit rating, even if it wasn't legally collectable. And yes, I agree. It's beyond fucked. The health insurance industry has bought off the government.
JarlUlvi 8y ago
There are a number of problems with TFA such as below: 1. No mention of EMTALA & No mention of the uninsured exploiting ERs. 2. No caps on Doctors and other providers charging out-of-network rates 20x in-network (not hospitals) 3. No discussion of emergent in-network vs out-of-network, whether through the ER, or not. 4. Legal Liability, defensive medicine, and malpractice at 20k to 100k+ a year, depending on specialty 5. Doctors spending 20% of their time doing billing & coding or more, depending on specialty 6. The Profit-Center certification bandwagon (Maintenance of Certification scams) 7. The reboarding scam (7-10 year reboarding) 8. The growth of non-clinical "hospital administrators & middle management" 9. The bureaucracy of Medicine ever-increasing ICD 9/10/11 10. Overpaid "Nonprofit" Hospital Executives making 10x any doctor for smaller hospital groups 11. Duplicate State Medical Licenses, Duplicate State DEA licenses, and Hospital Credentialing, just to name a few 12. The US subsidizing all medical research for the entire planet Fixing the problems with out-of-control health care costs is more complex than many realize
caseysoftware 8y ago
> "From 2002 to 2016, total billed charges by hospitals rose by a staggering $263 billion, to $386 billion.." The Affordable Care Act (aka Obamacare) went into effect for the final third of that which was a major upheaval in the health insurance system. I'd love to see this broken down by 2002-2010 and 2010-2016 compared. Glossing over that period without any distinction seems like playing fast and loose with the facts when it could be important.
- ddebernardy 8y ago
  Some data points here: https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/ https://www.healthsystemtracker.org/chart-collection/u-s-spe... The salient bit is this: the health spending growth rate has slowed since 2010, to slightly above the economy's growth rate. During the 2000s, by contrast, health spending grew a bit over twice as fast as the economy as a whole.
  - caseysoftware 8y ago
    While interesting, it's unrelated - "total billed charges" as used in the article is not the same as the health spending.
pimmen 8y ago
I don't think we we should blame the ER, we should blame the system that allows hospitals to exploit them.
tzs 8y ago
Note that there are two cost problems with US health care. 1. It is way more expensive (both in dollars/capita and as percent of GDP) here than it is in most or all countries it is reasonable to compare against (e.g., those in the EU, the OECD, or G20). 2. The costs are going up too rapidly. There is a tendency to conflate these two issues, which I think is a mistake because issue #2 is not just a problem in the US. The rapid increase in costs is happening in those other countries, too. Emergency room shenanigans like we have in the US can partly explain #1, but I don't think the other civilized countries have similar shenanigans, so what the hell is going on with #2? For example, from 1970 to 2017 US went from $327/capita to $10209/capita. That's 31.2x more expensive. Japan over the same time went from $141/capita to $4717/capita, and Germany went from $264/capita to $5728/capita. That's growth of 33.5x and 21.7x, respectively. That's not using constant dollars. Constant dollars for each country would change the growth to 4.9x for US, 10.1x for Japan, 6.5x for Germany. (Calculated using online inflation calculators for each country to convert the 1970 values to 2017 values, and dividing into the 2017 cost/capita). None of those are sustainable. Data and visualizations available here: https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm (Uncheck "latest data available" to enable charts showing growth).
jeffbax 8y ago
Instead of price controls we should stop giving hospitals veto power over competitors opening up. Our regulations have been encouraging consolidation, but incumbent hospitals generally have the right to say "no, you don't need another hospital in this municipality" and block competitors. Additionally we should let in far more trained immigrants who are perfectly good at medicine and lower the credentials required to be a GP. The typical doctor in the USA has to go through 3 more years of school than those elsewhere to little gain in outcomes. Medicines problem is a lack of markets, legislating what places can charge won't fix the underlying issues as much as breaking the hospital and labor monopoly will in the long run.

34 points by tysone 8y ago

If people really want to understand why US healthcare is more expensive, I'd suggest this detailed, if somewhat dated (2008) analysis by McKinsey which breaks down US healthcare spending by category and compares it to other countries, accounting for differences in GDP - in particular page4 [1]. Findings: - most of the extra spending, ~70%, is occurring in the outpatient setting (which includes the ER) - in-patient care is only marginally higher than expected compared to other countries (~10%) - the US spends less than most developed countries on long-term care and home care [1]https://healthcare.mckinsey.com/sites/default/files/752233%20Why%20Americans%20pay%20more%20for%20health%20care.pdf https://healthcare.mckinsey.com/sites/default/files/752233%2...

zeroego 8y ago
That was an interesting read, thanks for sharing. My own understanding, from personal experience working in an ER, was that they charge more there to offset the cost of the (often impoverished) people who use it for everything from the sniffles to gun shot wounds. These people, who don't have health insurance, typically don't pay their bills. Also, I saw many homeless people come in simply for a bed to sleep in and a hot meal. They take up a bed and nurses/doctor's time. ER's aren't mean't to be non-emergent PCP's or soup kitchens, yet they often end up serving that purpose. The end result as I see it is a bunch of expensive and poorly delegated resources.
- lighthazard 8y ago
  Any statistics on patient usage, non-payment, and free clinics?
  - zeroego 8y ago
    Unfortunately I do not have any. This was just my experience/what I was told working in a busy ER in a major metro area.
- village-idiot 8y ago
  It’s estimated that keeping a homeless person on the streets can cost the local government up to $1m/year in terms of police, jail, and hospital resource usages.
  - Judgmentality 8y ago
    I'd love to read more about that. Do you have a source?
    - village-idiot 8y ago
      Can’t find my old source, and it looks like $1m is pretty off the mark. It looks like this number is wildly variable. Places like Texas spend a low of $9-40k to jail and treat homelessness in ERs. Places like the Puget Sound spend about $1 billion[0] a year to deal with their ~5,500 homeless people. While that’s far from $1m, it is pretty high at $181,000 a person year. 0. https://www.bizjournals.com/seattle/news/2017/11/16/price-of-homelessness-seattle-king-county-costs.html https://www.bizjournals.com/seattle/news/2017/11/16/price-of...
  - Johnny555 8y ago
    I'd like to see a reference for that number, $1M sounds awfully high.
    - village-idiot 8y ago
      I can’t find my old sources, and t seems like $1m is indeed quite off the mark. It looks like this number is wildly variable. Places like Texas spend a low of $9-40k to jail and treat homelessness in ERs. Places like the Puget Sound spend about $1 billion[0] a year to deal with their ~5,500 homeless people. While that’s far from $1m, it is pretty high at $181,000 a person year. 0. https://www.bizjournals.com/seattle/news/2017/11/16/price-of-homelessness-seattle-king-county-costs.html https://www.bizjournals.com/seattle/news/2017/11/16/price-of...
      - ardy42 8y ago
candiodari 8y ago
2008 was before Obamacare wasn't it ? That seem likely to have changed things.
wrp 8y ago
A more recent (2015) and I think clearer analysis is given in "Healthcare Cost Drivers White Paper"[1] from the National Association of Health Underwriters. The NAHU seems in general to be a good non-partisan source of information on the health care industry. [1] https://nahu.org/media/1147/healthcarecost-driverswhitepaper.pdf https://nahu.org/media/1147/healthcarecost-driverswhitepaper... (PDF)

me123456789 8y ago

Most plans are not paying the inflated rates. Federal law requires plans to cover emergency care by out-of-network providers, but the plan can limit the payment to the usual and customary rate for the services. This leaves the patient susceptible to balance billing for the inflated rates. Self-insured employer group plans, which is what most people have, are federally regulated. State law does not apply to them. State-regulated plans often are required to cover the full costs depending on state law, so the author's point is valid there.

village-idiot 8y ago

It’s almost as if, and stay with me here, preventative care is cheaper than reactive care. Well, that and hospital billing is bullshit. Got charged $500 because the doctor at the ER we went to for a sudden emergency was out of network, even though the ER wasn’t. How the heck I’m supposed to do something about that is beyond me.

nonbel 8y ago
Hospital "billing" is mostly BS opaque negotiations between them and insurance companies. Those numbers mean nothing for individual patients. http://selfpaypatient.com/2014/01/03/insured-patients-can-save-money-by-pretending-to-be-uninsured/ http://selfpaypatient.com/2014/01/03/insured-patients-can-sa...
- village-idiot 8y ago
  Yup. This is why I rage against the “free market” solutions being proposed that do nothing about opaque billing. You can’t have a free market when you need to buy the product and can’t tell how much it will cost before hand.
  - refurb 8y ago
    Don’t forget that government regulations actually contributed to the opaque billing issue. Laws state that hospitals must maintain a chargemaster with prices for all procedures. When hospitals realized that the chargemaster would become a starting point for negotiations with insurance companies, they inflated the numbers wildly. In the end the uninsured bear the brunt of it.
    - maxxxxx 8y ago
      Blaming this on government regulations seems a stretch.
      - village-idiot 8y ago

jfoutz 8y ago

That sounds like an option. But after some reflection, nah. It’s more complicated than “blame emergency rooms”. Thanks for the suggestion though.

scottlocklin 8y ago

Article brought to you by Blue Cross and the American Medical Association. Pay no attention to the cartels behind the author. "Glenn A. Melnick, PhD Title Blue Cross of California Chair in Healthcare Finance, and Professor of Public Policy"

tzs 8y ago
I think you may be confused a bit here. Did you by any chance think that "Blue Cross of California Chair in Healthcare Finance" means that he holds a position at Blue Cross? It doesn't. In 1994 Blue Cross gave $2.5 million to the University of Southern California to endow a chair. The way an endowed chair works is that donation is logically kept separate from the rest of the university's endowment, and the earnings from that separate endowment go toward the salary of whatever professor holds the chair. Other than having part (or all, depending on how much the endowment earns) of their pay come from that instead of from the general university budget there is little or no difference between a professor holding an endowed chair and one who does not. (Sometimes a donor might specify that there will be some extras, like funding for an assistant). The donor has no involvement after the initial donation, other than their name is on the chair (well, not always their name...someone can endow a chair and name it after someone else) and the title of whoever holds it. In particular, the donor gets no financial leverage over the holder of the chair. I have no idea where you got the American Medical Association connection from.

nonbel 8y ago

When I looked into healthcare spending in the US about 5 years ago, it was almost all (~75%) chronic treatments for people over 70 years old. Does anyone have a current reference regarding this type of data?

TangoTrotFox 8y ago

This is a critical statement from the article, "Data from California illustrate how hospitals have exploited this situation. From 2002 to 2016, total billed charges by hospitals rose by a staggering $263 billion, to $386 billion, even though the number of patients admitted did not increase.". That feels like statistical butchery. Two immediate things come to mind. Obesity has skyrocketed in the US between those time periods and thus more people are going to be facing more severe and more expensive health issues. How much of the cost is due to increased severity of issues? And second, does that account for inflation? Inflation alone, which increased 33% between 2002 and 2016, would explain the cost differences if that was not adjusted. Though also why in the world would the number of people admitted not increase even though the population grew substantially in that time period? I tried to answer these questions myself, but the link provided in the article just leads to dozens of links to other PDFs, which also inspires some skepticism. It would be nice if they specified exactly where they information came from. There's also a third possible issue. In the US all public emergency rooms are required to treat and care for individuals regardless of whether or not they can pay. I have no idea how the billing for this works behind the scenes, but it's likely hospitals are recouped for most/all of these costs from the government. However, that would indeed create a huge incentive to charge as much as they could while also providing as expensive of care as possible. Not dissimilar to how government guaranteed student loans have created an incentive for universities to charge as much as they possibly can. In any case if the number of people utilizing this 'benefit' increased, we'd also expect to see a change in costs. Articles like this just make me think of that old quote, "There are three kinds of lies: lies, damned lies, and statistics."

tzs 8y ago
> Obesity has skyrocketed in the US between those time periods and thus more people are going to be facing more severe and more expensive health issues. US obesity skyrocketed in that time. It went from 30.5% to 39.6% for adults (15.4% to 18.5%) for youth. But California obesity rates did not. I don't have 2002 numbers, but in 2003 it was 23.2% for adults, which only grew to 25% by 2016. Youth obesity rates in California were in the 16.4-16.6% percent range that whole period. (California did have skyrocketing rates...but that was from 1990 to 2003, when they went from 9.9% to 23.2%. Then they pretty much leveled off).

mirimir 8y ago

It's crucial, in the US, to research general practitioners, relevant specialists, and hospitals in ones area that accept ones insurance plan. And if possible, to do that before selecting an insurance plan. In most states, in-network providers can't collect uncovered charges from patients. But it's good to check on that too. Many providers will bill anyway, even if they can't collect. Also, if at all possible, in situations that aren't life threatening, it's prudent to confirm network status and coverage, before accepting care.

ceph_ 8y ago
How is it legal to bill on something they can't collect on? So you're just supposed to ignore a bill and let it go to collections. The US healthcare system is beyond fucked.
- mirimir 8y ago
  Well, it's not exactly legal to bill for it ;) But what you do is call their billing office, and point out their error. And then the charge disappears. I'm not sure what'd happen if you let it just go for collection. It'd probably hurt credit rating, even if it wasn't legally collectable. And yes, I agree. It's beyond fucked. The health insurance industry has bought off the government.

JarlUlvi 8y ago

There are a number of problems with TFA such as below: 1. No mention of EMTALA & No mention of the uninsured exploiting ERs. 2. No caps on Doctors and other providers charging out-of-network rates 20x in-network (not hospitals) 3. No discussion of emergent in-network vs out-of-network, whether through the ER, or not. 4. Legal Liability, defensive medicine, and malpractice at 20k to 100k+ a year, depending on specialty 5. Doctors spending 20% of their time doing billing & coding or more, depending on specialty 6. The Profit-Center certification bandwagon (Maintenance of Certification scams) 7. The reboarding scam (7-10 year reboarding) 8. The growth of non-clinical "hospital administrators & middle management" 9. The bureaucracy of Medicine ever-increasing ICD 9/10/11 10. Overpaid "Nonprofit" Hospital Executives making 10x any doctor for smaller hospital groups 11. Duplicate State Medical Licenses, Duplicate State DEA licenses, and Hospital Credentialing, just to name a few 12. The US subsidizing all medical research for the entire planet Fixing the problems with out-of-control health care costs is more complex than many realize

caseysoftware 8y ago

> "From 2002 to 2016, total billed charges by hospitals rose by a staggering $263 billion, to $386 billion.." The Affordable Care Act (aka Obamacare) went into effect for the final third of that which was a major upheaval in the health insurance system. I'd love to see this broken down by 2002-2010 and 2010-2016 compared. Glossing over that period without any distinction seems like playing fast and loose with the facts when it could be important.

ddebernardy 8y ago
Some data points here: https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/ https://www.healthsystemtracker.org/chart-collection/u-s-spe... The salient bit is this: the health spending growth rate has slowed since 2010, to slightly above the economy's growth rate. During the 2000s, by contrast, health spending grew a bit over twice as fast as the economy as a whole.
- caseysoftware 8y ago
  While interesting, it's unrelated - "total billed charges" as used in the article is not the same as the health spending.

pimmen 8y ago

I don't think we we should blame the ER, we should blame the system that allows hospitals to exploit them.

tzs 8y ago

Note that there are two cost problems with US health care. 1. It is way more expensive (both in dollars/capita and as percent of GDP) here than it is in most or all countries it is reasonable to compare against (e.g., those in the EU, the OECD, or G20). 2. The costs are going up too rapidly. There is a tendency to conflate these two issues, which I think is a mistake because issue #2 is not just a problem in the US. The rapid increase in costs is happening in those other countries, too. Emergency room shenanigans like we have in the US can partly explain #1, but I don't think the other civilized countries have similar shenanigans, so what the hell is going on with #2? For example, from 1970 to 2017 US went from $327/capita to $10209/capita. That's 31.2x more expensive. Japan over the same time went from $141/capita to $4717/capita, and Germany went from $264/capita to $5728/capita. That's growth of 33.5x and 21.7x, respectively. That's not using constant dollars. Constant dollars for each country would change the growth to 4.9x for US, 10.1x for Japan, 6.5x for Germany. (Calculated using online inflation calculators for each country to convert the 1970 values to 2017 values, and dividing into the 2017 cost/capita). None of those are sustainable. Data and visualizations available here: https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm (Uncheck "latest data available" to enable charts showing growth).

jeffbax 8y ago

Instead of price controls we should stop giving hospitals veto power over competitors opening up. Our regulations have been encouraging consolidation, but incumbent hospitals generally have the right to say "no, you don't need another hospital in this municipality" and block competitors. Additionally we should let in far more trained immigrants who are perfectly good at medicine and lower the credentials required to be a GP. The typical doctor in the USA has to go through 3 more years of school than those elsewhere to little gain in outcomes. Medicines problem is a lack of markets, legislating what places can charge won't fix the underlying issues as much as breaking the hospital and labor monopoly will in the long run.