9 ms·

> Every year America spends about $5,000 more per person on health care than other rich countries do. Yet its people are not any healthier. I think part of the

by knubie 6y ago

> Every year America spends about $5,000 more per person on health care than other rich countries do. Yet its people are not any healthier. I think part of the reason Americans spend more on healthcare is precisely because they're unhealthy. According to the American CDC the obesity rate has reached a staggering 42.4% of adults[0], which brings with it a slew of health problems. This accounts for an additional $147 billion in healthcare spending, or $1,429 per person (with obesity). [0] https://www.cdc.gov/obesity/data/adult.html https://www.cdc.gov/obesity/data/adult.html

Dumblydorr 6y ago
Obesity, CHF, smoking, poisoned by air pollution or ground water waste, cancer due to the above...sedentary lifestyle, non examined mental life, glued to the TV and basing all opinions on cable news, no exercise and crappy diets...it's not a good way that many americans live.
dan-robertson 6y ago
A counter argument I see sometimes is that the reason Americans spend more on healthcare compared to other rich countries is that American consumers spend more on just about everything than most other rich countries (and also earn more money). I don’t really know how much merit the argument has.
- standardUser 6y ago
  And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes? Seems like some of that excess spending yields us more returns than others.
  - quadrifoliate 6y ago
    The things you mentioned are almost all inversely related to better healthcare outcomes, to grossly oversimplify a contributing factor. * Bigger homes means you feel more comfortable being lazy and spending all your time indoors * Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one * Bigger TVs means you spend all day "watching the game" instead of going out and playing a sport. Once again, these are grossly oversimplified, but should drive home the central point that spending on some things can actually worsen outcomes of others.
    - epistasis 6y ago
      > Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one For many (most?) people in the US, the idea of walking anywhere of consequence from their home is simply ludicrous. Restaurant, convenience store, grocery store, all are completely inaccessible except by car. Suburb planning has explicitly disallowed that sort of living for most people. It has also made it nearly impossible to serve neighborhoods with any sort of reasonable public transit.
      - vishnugupta 6y ago
        > Restaurant, convenience store, grocery store, all are completely inaccessible except by car. This particular aspect of USA struck me as quite bizarre whenever I visited on business trips. More so as I’m from India where it’s almost a given that things that you need on a day to day basis (grocery, bakery, pharmacy, convenience store etc.,) are available within walking distance. Apart from an opportunity to get some fresh air it’s also a good way to interact with my neighborhood community. I assumed this is how it’d be in any developed country until I moved to Netherlands. It’s not too different from India at all in that respect here. So now I wonder, what factors lead to that kind of city planning in US. It was a real ordeal for me to get a meal outside in US, had to either walk for an hour or order taxi service (those were pre-Uber days).
        rgblambda 6y ago
        Initially U.S cities were built according to a grid plan (grids being the most efficient means of urban planning at the time). This also made public transport easier. Grids however do not work well for cars. In response to increasing car ownership, T junctions were introduced to improve flow of traffic. The car also made it possible for people to live far from their place of work, thus the popularisation of suburbs. Other countries followed suit.
        adjkant 6y ago
        > Other countries followed suit. What other countries? The US is very much an outlier. The only one I can think of is maybe Australia?
  - mistersquid 6y ago
    > And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes? Not to put too fine a point on it, but maybe "bigger $things" and "worse outcome" are on the same side of the graph.
- grecy 6y ago
  > American consumers spend more on just about everything than most other rich countries Do you have a source for that? In my experience living and working in a slew of countries around the world, the USA has the cheapest alcohol, cigarettes, cars, electricity, clothing, electronics, gas (and diesel), food at the supermarket, food at the restaurant and many other things of any developed country. Because taxes are so low, stuff in America is extremely cheap compared to countries with tax-funded healthcare, higher education, etc.
  - dan-robertson 6y ago
    I’m not saying things are more expensive but that the total spent is more. What do you think Americans do with their relatively higher incomes? Evidence would suggest that for the most part they aren’t just putting the difference straight into their savings accounts.
    - grecy 6y ago
      They're spending it on healthcare, and education for starters. But mostly they're buying the stuff I talked about above. Consumerism.
- evanpw 6y ago
  Here's a long data analysis making that argument: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/ https://randomcriticalanalysis.com/why-conventional-wisdom-o....
  - readthenotes 6y ago
    What I got from that is that Americans are price-gouged more.
- momokoko 6y ago
  Or even more simply a stronger currency valuation.
- tonyedgecombe 6y ago
  America spends 18% of GDP on healthcare, in the UK its about 9%. Arguably the UK could do with spending more but right now we get broadly similar outcomes for half the spending.
bluedino 6y ago
If we fixed our diet problems, I’m not sure if we’d either have e or healthcare costs, or if the industry would find other ways to fill in the gap
- vertbhrtn 6y ago
  I'd argue it's unfixable for low income workers. Excessive sugar in all the cheap food is a trap they can't avoid. They don't have money to buy better food and don't have time to shop and cook for themselves. That's assuming they recognize this problem at all.
  - jacobush 6y ago
    A) don’t subsidise sugar B) tax sugar
    - dominotw 6y ago
      > B It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor.
      - jacobush 6y ago
        Did Chicago stop corn subsidies in the US?
        dominotw 6y ago
        no? but wouldn't it have the same effect of burdening the poor more?
        jacobush 6y ago
        No
      - hagy 6y ago
        Since there is a higher incidence of smoking among poorer folks[0], couldn't the same argument apply to the massive sin tax on cigarettes? We justify such sin taxes as being to the benefit of discouraging a harmful health behavior and personally I see the same link with higher sugar consumption. [0] https://truthinitiative.org/research-resources/targeted-communities/tobacco-social-justice-issue-low-income-communities https://truthinitiative.org/research-resources/targeted-comm...
metalgearsolid3 6y ago
Personally I'm way more inclined to believe Americans are unhealthy because their health care system is too expensive, rather than the other way around. Obesity is treatable.
- dominotw 6y ago
  > Obesity is treatable. How?
  - lnsru 6y ago
    By fixing nutrition and adding some physical exercises. Though it’s slow, count 1 kg weight loss/week in average.
    - JamesBarney 6y ago
      This is repeated a lot but if you actually look at the research you find that physical exercise has very little effect(except maybe as a preventative). That nutrition in general has a small effect. And dieting has a larger effect but is only temporary, and no dietary interventions have shown any real success over the long term. Bariatric surgery is currently the only real effective treatment. With GLP agonists like semaglutide having similar effects at least in the near term.
      - lnsru 6y ago
        I lost recently 70 lbs without any surgery. Talking about extreme cases I have no idea, never met any people above 300 lbs. I can only guess, that start is always the same. Personally I am not a friend of surgical interventions.
        JamesBarney 6y ago
        Oh sorry I'm not arguing that it never happens, just that in every clinical trial I've seen that followed participants for 5 years it was so rare to keep the weight off that the average weight loss for the group was insignificant(clinically not statistically).
dominotw 6y ago
The most expensive conditions in terms of direct health care costs are diabetes, Alzheimer’s, and osteoarthritis. The most common chronic health conditions in the U.S. are hypertension (high blood pressure), dyslipidemia, and osteoarthritis. Obesity is by far the greatest risk factor contributing to the burden of chronic diseases in the U.S. [1] 1. https://milkeninstitute.org/reports/costs-chronic-disease-us#:~:text=In%202016%2C%20the%20total%20costs,diabetes%2C%20Alzheimer's%2C%20and%20osteoarthritis https://milkeninstitute.org/reports/costs-chronic-disease-us....
throwawayiionqz 6y ago
2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom. The fact that hospital/physicians charge as much and insurance accepts to pay is not due to some unhealthy habits or chronic diseases in the US. Edit: of course your point stands and the higher rate of chronic diseases makes it worse.
- war1025 6y ago
  > 2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom. Maybe I'm misremembering, but we had a ridiculous high deductible ($10k?) when we had our first kid, and I don't think we met it. That said, I complain about the price of healthcare and insurance to anyone who will listen, and I hope someday it gets sorted out. So far the only solution I've found is to get a better paying job, which isn't a solution for most people.
  - throwawayiionqz 6y ago
    Private hospital in NYC: Just the hospital "room and board" line is north of $40k: $13k per night of "enhanced nursery" for the newborn and around $10k per night for Mom. That's before all the doctors add their services. No idea how you can make it lower than $10k :) Where was that?
    - war1025 6y ago
      Iowa. I think the base rate here is about $1k / night. Could be wrong on that though. Our oldest is four and half now, so it's been a while. It's possible I just didn't read the bills correctly. Either way I'm sure it was less than what you describe.
    - lotsofpulp 6y ago
      My experience in one of the most expensive suburbs of NYC, at the most highly rated hospital in the state, a baby with standard 2 night stay and delivery and no complications cost $20k or so all together with about $5k out of pocket on a gold HSA plan a couple years ago.
take_a_breath 6y ago
Colonoscopies in the US cost about $2,500 out-of-pocket, even with insurance. Most other countries are under $1,000 for the same procedure.
- cpursley 6y ago
  $1,000 sounds high. I just had one this morning in Russia at a very nice modern private clinic. The entire thing including anesthesiologist was under $75 completely out of pocket. It was amazing to me compared to my experience with healthcare in the US (I'm an American) - they gave us a price up front.
- hef19898 6y ago
  No idea how much my public insurance paid my doctor, but in Germany these things are free for the patient.
JamesBarney 6y ago
We pay way more per procedure than other countries, we get more procedures, and we get more expensive procedures. I doubt obesity makes a very large difference because even though it increases morbidity I think it has a larger effect on mortality. If you're obese you might have to retire a few years early, but you'll also die even earlier missing out on years of being taken care of in a nursing home while you suffer from Alzheimer's.
chiefalchemist 6y ago
Agreed. Look at the CDC's leading causes of premature death. A significant number are preventable (i.e., diet and lifestyle). Interesting enough, many of these are diseases that Covid 19 does well to exploit. If you are in good health, the chances of being taken to the grave by Covid 19 are rare. What's odd is that the concept of comorbidies has been abandoned in the C19 era. There is little transparency when it comes to C19's co-conspirators. Editorial: It troubles me when article after article about the high price is insulin fails to mention demand; and that close to all the demand created by Type 2 is avoidable. Might there be manufacturer price gouging? Perhaps. But it's universally agreed that demand will increase price.

by knubie 6y ago

Dumblydorr 6y ago

Obesity, CHF, smoking, poisoned by air pollution or ground water waste, cancer due to the above...sedentary lifestyle, non examined mental life, glued to the TV and basing all opinions on cable news, no exercise and crappy diets...it's not a good way that many americans live.

dan-robertson 6y ago

A counter argument I see sometimes is that the reason Americans spend more on healthcare compared to other rich countries is that American consumers spend more on just about everything than most other rich countries (and also earn more money). I don’t really know how much merit the argument has.

standardUser 6y ago
And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes? Seems like some of that excess spending yields us more returns than others.
- quadrifoliate 6y ago
  The things you mentioned are almost all inversely related to better healthcare outcomes, to grossly oversimplify a contributing factor. * Bigger homes means you feel more comfortable being lazy and spending all your time indoors * Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one * Bigger TVs means you spend all day "watching the game" instead of going out and playing a sport. Once again, these are grossly oversimplified, but should drive home the central point that spending on some things can actually worsen outcomes of others.
  - epistasis 6y ago
    > Bigger cars means you are incentivized to drive 20 miles to a restaurant in comfort instead of walking over to a closer one For many (most?) people in the US, the idea of walking anywhere of consequence from their home is simply ludicrous. Restaurant, convenience store, grocery store, all are completely inaccessible except by car. Suburb planning has explicitly disallowed that sort of living for most people. It has also made it nearly impossible to serve neighborhoods with any sort of reasonable public transit.
    - vishnugupta 6y ago
      > Restaurant, convenience store, grocery store, all are completely inaccessible except by car. This particular aspect of USA struck me as quite bizarre whenever I visited on business trips. More so as I’m from India where it’s almost a given that things that you need on a day to day basis (grocery, bakery, pharmacy, convenience store etc.,) are available within walking distance. Apart from an opportunity to get some fresh air it’s also a good way to interact with my neighborhood community. I assumed this is how it’d be in any developed country until I moved to Netherlands. It’s not too different from India at all in that respect here. So now I wonder, what factors lead to that kind of city planning in US. It was a real ordeal for me to get a meal outside in US, had to either walk for an hour or order taxi service (those were pre-Uber days).
      - rgblambda 6y ago
        Initially U.S cities were built according to a grid plan (grids being the most efficient means of urban planning at the time). This also made public transport easier. Grids however do not work well for cars. In response to increasing car ownership, T junctions were introduced to improve flow of traffic. The car also made it possible for people to live far from their place of work, thus the popularisation of suburbs. Other countries followed suit.
        adjkant 6y ago
        > Other countries followed suit. What other countries? The US is very much an outlier. The only one I can think of is maybe Australia?
- mistersquid 6y ago
  > And as a result we have bigger homes, bigger cars, bigger TVs.... but worse healthcare outcomes? Not to put too fine a point on it, but maybe "bigger $things" and "worse outcome" are on the same side of the graph.
grecy 6y ago
> American consumers spend more on just about everything than most other rich countries Do you have a source for that? In my experience living and working in a slew of countries around the world, the USA has the cheapest alcohol, cigarettes, cars, electricity, clothing, electronics, gas (and diesel), food at the supermarket, food at the restaurant and many other things of any developed country. Because taxes are so low, stuff in America is extremely cheap compared to countries with tax-funded healthcare, higher education, etc.
- dan-robertson 6y ago
  I’m not saying things are more expensive but that the total spent is more. What do you think Americans do with their relatively higher incomes? Evidence would suggest that for the most part they aren’t just putting the difference straight into their savings accounts.
  - grecy 6y ago
    They're spending it on healthcare, and education for starters. But mostly they're buying the stuff I talked about above. Consumerism.
evanpw 6y ago
Here's a long data analysis making that argument: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/ https://randomcriticalanalysis.com/why-conventional-wisdom-o....
- readthenotes 6y ago
  What I got from that is that Americans are price-gouged more.
momokoko 6y ago
Or even more simply a stronger currency valuation.
tonyedgecombe 6y ago
America spends 18% of GDP on healthcare, in the UK its about 9%. Arguably the UK could do with spending more but right now we get broadly similar outcomes for half the spending.

bluedino 6y ago

If we fixed our diet problems, I’m not sure if we’d either have e or healthcare costs, or if the industry would find other ways to fill in the gap

vertbhrtn 6y ago
I'd argue it's unfixable for low income workers. Excessive sugar in all the cheap food is a trap they can't avoid. They don't have money to buy better food and don't have time to shop and cook for themselves. That's assuming they recognize this problem at all.
- jacobush 6y ago
  A) don’t subsidise sugar B) tax sugar
  - dominotw 6y ago
    > B It was tried and rolled back in chicago because it was deemed as unfairly targeting the poor.
    - jacobush 6y ago
      Did Chicago stop corn subsidies in the US?
      - dominotw 6y ago
        no? but wouldn't it have the same effect of burdening the poor more?
        jacobush 6y ago
        No
    - hagy 6y ago
      Since there is a higher incidence of smoking among poorer folks[0], couldn't the same argument apply to the massive sin tax on cigarettes? We justify such sin taxes as being to the benefit of discouraging a harmful health behavior and personally I see the same link with higher sugar consumption. [0] https://truthinitiative.org/research-resources/targeted-communities/tobacco-social-justice-issue-low-income-communities https://truthinitiative.org/research-resources/targeted-comm...

metalgearsolid3 6y ago

Personally I'm way more inclined to believe Americans are unhealthy because their health care system is too expensive, rather than the other way around. Obesity is treatable.

dominotw 6y ago
> Obesity is treatable. How?
- lnsru 6y ago
  By fixing nutrition and adding some physical exercises. Though it’s slow, count 1 kg weight loss/week in average.
  - JamesBarney 6y ago
    This is repeated a lot but if you actually look at the research you find that physical exercise has very little effect(except maybe as a preventative). That nutrition in general has a small effect. And dieting has a larger effect but is only temporary, and no dietary interventions have shown any real success over the long term. Bariatric surgery is currently the only real effective treatment. With GLP agonists like semaglutide having similar effects at least in the near term.
    - lnsru 6y ago
      I lost recently 70 lbs without any surgery. Talking about extreme cases I have no idea, never met any people above 300 lbs. I can only guess, that start is always the same. Personally I am not a friend of surgical interventions.
      - JamesBarney 6y ago
        Oh sorry I'm not arguing that it never happens, just that in every clinical trial I've seen that followed participants for 5 years it was so rare to keep the weight off that the average weight loss for the group was insignificant(clinically not statistically).

dominotw 6y ago

The most expensive conditions in terms of direct health care costs are diabetes, Alzheimer’s, and osteoarthritis. The most common chronic health conditions in the U.S. are hypertension (high blood pressure), dyslipidemia, and osteoarthritis. Obesity is by far the greatest risk factor contributing to the burden of chronic diseases in the U.S. [1] 1. https://milkeninstitute.org/reports/costs-chronic-disease-us#:~:text=In%202016%2C%20the%20total%20costs,diabetes%2C%20Alzheimer's%2C%20and%20osteoarthritis https://milkeninstitute.org/reports/costs-chronic-disease-us....

throwawayiionqz 6y ago

2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom. The fact that hospital/physicians charge as much and insurance accepts to pay is not due to some unhealthy habits or chronic diseases in the US. Edit: of course your point stands and the higher rate of chronic diseases makes it worse.

war1025 6y ago
> 2 nights at the hospital for delivering a healthy baby may cost $50k-$100k to the insurance for healthy baby and mom. Maybe I'm misremembering, but we had a ridiculous high deductible ($10k?) when we had our first kid, and I don't think we met it. That said, I complain about the price of healthcare and insurance to anyone who will listen, and I hope someday it gets sorted out. So far the only solution I've found is to get a better paying job, which isn't a solution for most people.
- throwawayiionqz 6y ago
  Private hospital in NYC: Just the hospital "room and board" line is north of $40k: $13k per night of "enhanced nursery" for the newborn and around $10k per night for Mom. That's before all the doctors add their services. No idea how you can make it lower than $10k :) Where was that?
  - war1025 6y ago
    Iowa. I think the base rate here is about $1k / night. Could be wrong on that though. Our oldest is four and half now, so it's been a while. It's possible I just didn't read the bills correctly. Either way I'm sure it was less than what you describe.
  - lotsofpulp 6y ago
    My experience in one of the most expensive suburbs of NYC, at the most highly rated hospital in the state, a baby with standard 2 night stay and delivery and no complications cost $20k or so all together with about $5k out of pocket on a gold HSA plan a couple years ago.

take_a_breath 6y ago

Colonoscopies in the US cost about $2,500 out-of-pocket, even with insurance. Most other countries are under $1,000 for the same procedure.

cpursley 6y ago
$1,000 sounds high. I just had one this morning in Russia at a very nice modern private clinic. The entire thing including anesthesiologist was under $75 completely out of pocket. It was amazing to me compared to my experience with healthcare in the US (I'm an American) - they gave us a price up front.
hef19898 6y ago
No idea how much my public insurance paid my doctor, but in Germany these things are free for the patient.

JamesBarney 6y ago

We pay way more per procedure than other countries, we get more procedures, and we get more expensive procedures. I doubt obesity makes a very large difference because even though it increases morbidity I think it has a larger effect on mortality. If you're obese you might have to retire a few years early, but you'll also die even earlier missing out on years of being taken care of in a nursing home while you suffer from Alzheimer's.

chiefalchemist 6y ago

Agreed. Look at the CDC's leading causes of premature death. A significant number are preventable (i.e., diet and lifestyle). Interesting enough, many of these are diseases that Covid 19 does well to exploit. If you are in good health, the chances of being taken to the grave by Covid 19 are rare. What's odd is that the concept of comorbidies has been abandoned in the C19 era. There is little transparency when it comes to C19's co-conspirators. Editorial: It troubles me when article after article about the high price is insulin fails to mention demand; and that close to all the demand created by Type 2 is avoidable. Might there be manufacturer price gouging? Perhaps. But it's universally agreed that demand will increase price.