5 ms·

We spend double, as a percentage of GDP, what any other rich country spends on health care, so that's not it.

heavyset_go 6y ago
Other first world nations spend half of what we do, and they have better outcomes and quality of care[1]. They are able to insure all of their citizens with it while the US doesn't. [1] https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ https://www.healthsystemtracker.org/chart-collection/quality...
- julienb_sea 6y ago
  Well, the US has better outcomes for employed, insured and non-overweight folks; dramatically lower wait times, better cancer survival rates and less competition for care. Expense is also a nonissue on employer insurance. Unfortunately the US aggregate outcomes are dragged heavily down by an unhealthy population and high barriers to care for the uninsured.
  - rsynnott 6y ago
    > Expense is also a nonissue on employer insurance. My impression was that many if not most Americans would have to pay an excess (not sure of the American term; money paid by an insured party on using insurance) for any medical care with their work insurance. Is this not the case?
    - deleted 6y ago
      [deleted]
    - trefoiled 6y ago
      This is true but complex. It depends on the type of service you receive. As a general rule, you'll need to pay a yearly deductible before receiving insurance benefits for non preventative care. This can be anywhere from $500 to $8000. High deductible plans are commonly referred to as "catastrophic" plans, because the deductible is so high, and the kind of people who purchase them are typically not wealthy, that their owners would only seek care in a true emergency where the service would exceed the cost of the deductible. After paying your deductible you will often also have a "co-pay" which is typically a flat rate based on the type of service. Something in the realm of $25 to $500. After that, many plans have something called "co-insurance" which is a percentage of the bill you are responsible for even if you have met your deductible. Say, 20%. Add all these charges and fees up, you'll keep paying them until you hit your "maximum out of pocket." So as an example, I was hospitalized a few years back in December while on what would be considered a "good" healthcare plan. I paid my $1000 deductible, a $250 co-pay for emergency room care, and co-insurance of several hundred dollars. I stayed a single night in the hospital and received a CT scan. I was given Tylenol, released the next day, and referred to a specialist. I wound up seeing the specialist in January, so my deductible reset. I was given another CT scan, so I had to pay my $1000 deductible again. The total bill for the entire process pre-insurance was in the realm of $80,000. After insurance, I paid $5000, which was my entire life savings at the time. I didn't hit my maximum out of pocket for either year, so I got lucky in a way. I could have had to pay double what I did.
      - rweir 6y ago
        > This is true but complex. It depends on the type of service you receive. I feel this is never adequately priced into these discussions. everything about healthcare in the US is expensive and complicated, even if you "have insurance", even if you have expensive, seen-as-good-insurance.
  - koyote 6y ago
    > dramatically lower wait times, better cancer survival rates and less competition for care. Expense is also a nonissue on employer insurance. Do you have a source for those statements?
- wang_li 6y ago
  Your source combines access and quality in order to put the US at the bottom. If you go further down the page you’ll see that the US is sometimes better and sometimes worse. (Apparently Canadian doctors have trouble delivering babies.) If you seek out other sources of information you’ll find that the US has the best survival rates for certain types of cancer. Supposedly the US also produces 50% of the new pharmaceuticals that reach the market.
im3w1l 6y ago
Maybe it's because of the US spending a lot chasing diminishing returns for rich people but little on impactful interventions for the poor.
xenihn 6y ago
It's not spent efficiently.
JimTheMan 6y ago
Your employer picks a plan for you, which isn't what you need. You go to your doctor, who then tries to treat you. But then has to fight an insurance company who wants treatment that isn't in your best interests or isn't covered by the employer plan. You get home and discover your Doctor is out of network. Pay up. You spend a million years fighting the insurance company. OR your insurance is good, so the doctor says, what the hell I will order that test that is nice to have. They'll cover it. Costs increase. Or you go to the emergency room, run up bills for the hospital and leave without paying. The taxpayer foots the bill. And the doctors pay through the teeth for their degrees and want a big return. They earn more than other countries in a significant way. All the incentives are out of whack and not in the public's interest.
- free_rms 6y ago
  Not to mention squads of clerks at every single doctor's office doing battle with entire armies at the insurers in a many-to-many clusterfuck of epic proportions over every single bit of care delivered.
  - Apocryphon 6y ago
    Also America is the most litigious society in the world [0], making medical malpractice suits an ever-present threat in everyone's minds; but tort reform does not help taxpayers, and hurts patients [1]. [0] https://statmodeling.stat.columbia.edu/2015/12/03/why-us-litigious/ https://statmodeling.stat.columbia.edu/2015/12/03/why-us-lit... [1] https://www.citizen.org/wp-content/uploads/medical_malpractice_fact_sheet.pdf https://www.citizen.org/wp-content/uploads/medical_malpracti...
    - free_rms 6y ago
      I'm not super educated on this but I thought that malpractice insurance basically "handled" the problem at a reasonable overhead compared to other gross inefficiencies.
      - gorbachev 6y ago
briantakita 6y ago
Or health care (the wrong type) is the problem...
stevesimmons 6y ago
The amount the US spends on healthcare is more than offset by the high proportion of people who have no cover. The % of US population covered by health insurance is around 84%, compared with most other rich countries, which are all at 100%. Additional, much of what you count as US health care spending is really health care administration - i.e. billing and finding reasons to deny care to the sick.
- TMWNN 6y ago
  >The % of US population covered by health insurance is around 84% That was pre-Obamacare. 91-92% of Americans have medical insurance, whether through their employers, or government programs like Medicare/Medicaid. >compared with most other rich countries, which are all at 100%. Nope. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers. The only such systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment.
yellowstuff 6y ago
A random blogger who no one's ever heard of explains this in excruciating detail and very persuasively: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/#rcatoc-diminishing-returns-to-spending-and-worse-lifestyle-factors-explain-americas-mediocre-health-outcomes https://randomcriticalanalysis.com/why-conventional-wisdom-o... He agrees with the linked article that lifestyle factors are what drives the worse health outcomes in the US relative to other wealthy countries. They're not primarily driven by differences in access to or effectiveness in health care. He also makes the case for a few other very unintuitive points: * Health care spending is a direct function of national wealth. If a country gets richer it spends more on health care, and every country at every time in modern history spends about the same amount on health care as a function of its wealth. * The US looks like an outlier in health care spending because GDP is not a perfect measure of wealth. Actual Individual Consumption is a less well-known but much more relevant measure of national wealth. AIC shows the US is more of an outlier in wealth, which makes its high health care spending less remarkable. * There's no magic bullet. Single payer nations pay less than the US mostly because they are less wealthy and health care spending is a function of wealth. Other countries have better health outcomes mostly because of demographics and culture, which can't be fixed by the health care system. And even though finding obvious waste and inefficiency in the US health care system is easy, at a macro level it doesn't look like the US is remarkably less efficient than other rich countries, and most spending goes towards things that patients want.
- MagnumOpus 6y ago
  > lifestyle factors are what drives the worse health outcomes So in addition to healthcare reform, the US needs public policy reform - to tackle obesity, prescription drug abuse and to tackle unskilled driving creating traffic deaths.
rsynnott 6y ago
I mean, any country could jump to the top of that league table by just building endless hospitals and immediately setting fire to them. There is still a question of value for money. There may also be an aspect of funny cost accounting there. One reason given for the rather high medical salaries in the US, for instance, is the fact that trainee doctors, dentists, etc tend to incur truly horrifying levels of student debt. > Now, [US] physicians graduate with a median $194,000 in student debt. This generally isn't the case in most developed countries, but in that case the state may be spending more on _education_.

Other first world nations spend half of what we do, and they have better outcomes and quality of care[1]. They are able to insure all of their citizens with it while the US doesn't. [1] https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/ https://www.healthsystemtracker.org/chart-collection/quality...

julienb_sea 6y ago
Well, the US has better outcomes for employed, insured and non-overweight folks; dramatically lower wait times, better cancer survival rates and less competition for care. Expense is also a nonissue on employer insurance. Unfortunately the US aggregate outcomes are dragged heavily down by an unhealthy population and high barriers to care for the uninsured.
- rsynnott 6y ago
  > Expense is also a nonissue on employer insurance. My impression was that many if not most Americans would have to pay an excess (not sure of the American term; money paid by an insured party on using insurance) for any medical care with their work insurance. Is this not the case?
  - deleted 6y ago
    [deleted]
  - trefoiled 6y ago
    This is true but complex. It depends on the type of service you receive. As a general rule, you'll need to pay a yearly deductible before receiving insurance benefits for non preventative care. This can be anywhere from $500 to $8000. High deductible plans are commonly referred to as "catastrophic" plans, because the deductible is so high, and the kind of people who purchase them are typically not wealthy, that their owners would only seek care in a true emergency where the service would exceed the cost of the deductible. After paying your deductible you will often also have a "co-pay" which is typically a flat rate based on the type of service. Something in the realm of $25 to $500. After that, many plans have something called "co-insurance" which is a percentage of the bill you are responsible for even if you have met your deductible. Say, 20%. Add all these charges and fees up, you'll keep paying them until you hit your "maximum out of pocket." So as an example, I was hospitalized a few years back in December while on what would be considered a "good" healthcare plan. I paid my $1000 deductible, a $250 co-pay for emergency room care, and co-insurance of several hundred dollars. I stayed a single night in the hospital and received a CT scan. I was given Tylenol, released the next day, and referred to a specialist. I wound up seeing the specialist in January, so my deductible reset. I was given another CT scan, so I had to pay my $1000 deductible again. The total bill for the entire process pre-insurance was in the realm of $80,000. After insurance, I paid $5000, which was my entire life savings at the time. I didn't hit my maximum out of pocket for either year, so I got lucky in a way. I could have had to pay double what I did.
    - rweir 6y ago
      > This is true but complex. It depends on the type of service you receive. I feel this is never adequately priced into these discussions. everything about healthcare in the US is expensive and complicated, even if you "have insurance", even if you have expensive, seen-as-good-insurance.
- koyote 6y ago
  > dramatically lower wait times, better cancer survival rates and less competition for care. Expense is also a nonissue on employer insurance. Do you have a source for those statements?
wang_li 6y ago
Your source combines access and quality in order to put the US at the bottom. If you go further down the page you’ll see that the US is sometimes better and sometimes worse. (Apparently Canadian doctors have trouble delivering babies.) If you seek out other sources of information you’ll find that the US has the best survival rates for certain types of cancer. Supposedly the US also produces 50% of the new pharmaceuticals that reach the market.

im3w1l 6y ago

Maybe it's because of the US spending a lot chasing diminishing returns for rich people but little on impactful interventions for the poor.

xenihn 6y ago

It's not spent efficiently.

JimTheMan 6y ago

Your employer picks a plan for you, which isn't what you need. You go to your doctor, who then tries to treat you. But then has to fight an insurance company who wants treatment that isn't in your best interests or isn't covered by the employer plan. You get home and discover your Doctor is out of network. Pay up. You spend a million years fighting the insurance company. OR your insurance is good, so the doctor says, what the hell I will order that test that is nice to have. They'll cover it. Costs increase. Or you go to the emergency room, run up bills for the hospital and leave without paying. The taxpayer foots the bill. And the doctors pay through the teeth for their degrees and want a big return. They earn more than other countries in a significant way. All the incentives are out of whack and not in the public's interest.

free_rms 6y ago
Not to mention squads of clerks at every single doctor's office doing battle with entire armies at the insurers in a many-to-many clusterfuck of epic proportions over every single bit of care delivered.
- Apocryphon 6y ago
  Also America is the most litigious society in the world [0], making medical malpractice suits an ever-present threat in everyone's minds; but tort reform does not help taxpayers, and hurts patients [1]. [0] https://statmodeling.stat.columbia.edu/2015/12/03/why-us-litigious/ https://statmodeling.stat.columbia.edu/2015/12/03/why-us-lit... [1] https://www.citizen.org/wp-content/uploads/medical_malpractice_fact_sheet.pdf https://www.citizen.org/wp-content/uploads/medical_malpracti...
  - free_rms 6y ago
    I'm not super educated on this but I thought that malpractice insurance basically "handled" the problem at a reasonable overhead compared to other gross inefficiencies.
    - gorbachev 6y ago

briantakita 6y ago

Or health care (the wrong type) is the problem...

stevesimmons 6y ago

The amount the US spends on healthcare is more than offset by the high proportion of people who have no cover. The % of US population covered by health insurance is around 84%, compared with most other rich countries, which are all at 100%. Additional, much of what you count as US health care spending is really health care administration - i.e. billing and finding reasons to deny care to the sick.

TMWNN 6y ago
>The % of US population covered by health insurance is around 84% That was pre-Obamacare. 91-92% of Americans have medical insurance, whether through their employers, or government programs like Medicare/Medicaid. >compared with most other rich countries, which are all at 100%. Nope. That's compared to 95-97% in other developed countries because there are always some people who fall through cracks, like (say) a Canadian who doesn't get a new provincial health care card after moving, or a German who neglects to buy into a new sickness fund after changing careers. The only such systems with actual 100% (or as close to it as possible) coverage is something like the UK NHS, which does not have a requirement to show a membership card (because, well, there isn't one) to receive treatment.

yellowstuff 6y ago

A random blogger who no one's ever heard of explains this in excruciating detail and very persuasively: https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/#rcatoc-diminishing-returns-to-spending-and-worse-lifestyle-factors-explain-americas-mediocre-health-outcomes https://randomcriticalanalysis.com/why-conventional-wisdom-o... He agrees with the linked article that lifestyle factors are what drives the worse health outcomes in the US relative to other wealthy countries. They're not primarily driven by differences in access to or effectiveness in health care. He also makes the case for a few other very unintuitive points: * Health care spending is a direct function of national wealth. If a country gets richer it spends more on health care, and every country at every time in modern history spends about the same amount on health care as a function of its wealth. * The US looks like an outlier in health care spending because GDP is not a perfect measure of wealth. Actual Individual Consumption is a less well-known but much more relevant measure of national wealth. AIC shows the US is more of an outlier in wealth, which makes its high health care spending less remarkable. * There's no magic bullet. Single payer nations pay less than the US mostly because they are less wealthy and health care spending is a function of wealth. Other countries have better health outcomes mostly because of demographics and culture, which can't be fixed by the health care system. And even though finding obvious waste and inefficiency in the US health care system is easy, at a macro level it doesn't look like the US is remarkably less efficient than other rich countries, and most spending goes towards things that patients want.

MagnumOpus 6y ago
> lifestyle factors are what drives the worse health outcomes So in addition to healthcare reform, the US needs public policy reform - to tackle obesity, prescription drug abuse and to tackle unskilled driving creating traffic deaths.

rsynnott 6y ago

I mean, any country could jump to the top of that league table by just building endless hospitals and immediately setting fire to them. There is still a question of value for money. There may also be an aspect of funny cost accounting there. One reason given for the rather high medical salaries in the US, for instance, is the fact that trainee doctors, dentists, etc tend to incur truly horrifying levels of student debt. > Now, [US] physicians graduate with a median $194,000 in student debt. This generally isn't the case in most developed countries, but in that case the state may be spending more on _education_.