8 ms·

Daily reminder that the US spends vastly more, per capita, in government heath expenditures[1], than any other country. We pay for socialized healthcare, and t

Daily reminder that the US spends vastly more, per capita, in government heath expenditures[1], than any other country. We pay for socialized healthcare, and then some, it's just that most of us don't get it. I view the problem as impossible to solve until there is a collapse. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

kgermino 5y ago
I don’t think that’s what that chart says. It’s combining Government and other compulsory expenses. I haven’t reviewed the report behind the chart but I’d expect the blue bar to include things like employer paid insurance premiums.
- ectopod 5y ago
  Looking at figures from two years ago, the US government was spending about $3600 per head and the UK government about $3000 per head. For the latter money everybody in the UK got free healthcare.
calvinmorrison 5y ago
Americans are also the fattest and least active 1st world country.
- nine_zeros 5y ago
  This argument is invalid because America is not a real 1st world country. It's only rich due to historical legacy of the dollar after WW2.
  - User23 5y ago
    America is rich for many more reasons than Bretton Woods. For most of the 20th century it had by far the greatest real productive and manufacturing base of any country in the world. The USA has been visibly declining for about 45 years sure, and is no longer the world leader in manufacturing, but it still has a huge and well-diversified economy. Since dollars represent, among other things, claims on a share of that economic output, demand for them is quite real and not just an historical artifact. And since no other country with a huge diversified economy is willing to run external deficits large enough to meet foreign demand for reserves, the dollar is pretty much the only good choice. There just isn’t enough gold to clear trade in a $80+ trillion global economy.
    - akimball 5y ago
      Price fixes that
    - nine_zeros 5y ago
      > For most of the 20th century it had by far the greatest real productive and manufacturing base of any country in the world. The USA has been visibly declining for about 45 years sure, and is no longer the world leader in manufacturing, but it still has a huge and well-diversified economy. Since dollars represent, among other things, claims on a share of that economic output, demand for them is quite real and not just an historical artifact. This is merely viewing the same thing from a US-centric perspective. From a rest of the world perspective, the largest competitors in EU were destroyed in WW2 (deservedly so imo), China was nowhere and India was impeded first by British colonization and then by Bretton Woods which only focused on EU nations. America is ahead but make no mistake that the gap is large only because WW2 destroyed other nations and Bretton Woods system was the first step in prevention of other nations from building up rapidly.
  - rocknor 5y ago
    Do you even know what 1/2/3 world means?
- zamalek 5y ago
  The obese and sedentary problem is one argument against public health care that made me really take pause on my beliefs. In places where public healthcare exists, there is also a huge amount of voluntary personal health responsibility. People look after their health, and expect the same of their neighbors. The current state of Americans would be an unreasonable burden on public healthcare. That being said, taxes pay so much for healthcare, that we'd probably still be able to pull it off.
  - sul_tasto 5y ago
    In addition, my understanding is that most healthcare expenses are incurred trying to prolong life in its last few weeks/months. It’s difficult to not “try everything possible “ for a loved one, when the end is near. However, I feel that often such sentiments are taken advantage of in the name of profit.
    - maxerickson 5y ago
      There's no social framework to do anything other than treat an elderly person that breaks their hip, never mind a legal one. That's a cost that is incurred towards the end of life without any 'trying to prolong life' involved, a surgery to do the repair is frequently going to immediately make the person more comfortable. And there's all sorts of similar things that just happen more often to older folks.
      - sul_tasto 5y ago
        My neighbor, who lived a very unhealthy lifestyle, underwent 4 heart surgeries and multiple other procedures before they literally couldn’t keep his body alive anymore. I’m not convinced he was treated humanely.
  - chrisseaton 5y ago
    Most people in the UK certainly don’t ‘look after their health, and expect the same of their neighbo[u]rs’. I think we have the most extensive public healthcare system in Europe but also are some of the least healthy. Don’t look to us for any ideas how to do your healthcare!
- amanaplanacanal 5y ago
  The rest of the anglo world is catching up fast. I think the US is just a leading indicator.
Olreich 5y ago
Let the government compete with private insurers, and that will be a step in the right direction. The further steps that meaningfully reduce per-capita spending... those are all way harder, which is saying something.
chadash 5y ago
Not sure I understand that graph. How is “voluntary” expenditure such a small piece of the bar for the US? My insurance premiums are outrageously high…
Y_Y 5y ago
For comparison, in 2019 the top four were (OECD data, in 2019 PPP-adjusted USD): USA - 11.1k, Switzerland - 7.7k, Norway 6.6k, Germany 6.6k. The next ten countries spent between 5k and 6k. The WHO data is similar. It's hard to get up-to-date number on healthcare outcomes, but the best countries seem to be spending in the range of 3k to 5k. See also: https://en.wikipedia.org/wiki/Health_system#International_comparisons https://en.wikipedia.org/wiki/Health_system#International_co...
syops 5y ago
I agree very much with your last paragraph. I believe this to be true for pretty much most things in the U.S. The incentives in the system are mostly misaligned. A collapse is the most likely thing to occur before positive change happens.
kasperni 5y ago
Not only is it the most expensive. It is also a lot less efficient than most other countries [1][2]. [1] https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly https://www.commonwealthfund.org/publications/fund-reports/2... [2] https://www.washingtonpost.com/world/2021/08/05/global-health-rankings/ https://www.washingtonpost.com/world/2021/08/05/global-healt...
- forgingahead 5y ago
  Price transparency was one of the great accomplishments of the Trump administration. It's a good first step, but there remains a lot to be done to bring some sanity to US medical pricing. Next step is to pass a law making it illegal to charge different patients differing prices for the same service.
  - ikerdanzel 5y ago
    At this point I have to say American that voted Dems old fool deserve what they getting or coming. Just like when voted Barry that spike up the insurance and medical bills. Already American got beaten in Agfhan. Wait and see a repeat of 911 (922?) now that those goat herders know American can be easily beaten simply by dragging it. Oh yeah, blame a President that did good for country back then. I am betting next 911 is somewhere on the westcoast.
  - lostlogin 5y ago
    > making it illegal to charge different patients differing prices for the same service. If a workplace or insurer says to a hospital “if all these people come for a checkup, what can you do in pricing?” Is that something that should be blocked?
    - cosmotic 5y ago
      Yes. What if your auto insurance company went to Ford and struck a deal, then you went to Ford to get a car and they said 'we don't know the price until you submit a claim'; you buy a car and submit a claim. It turns out your insurance company did a pretty lousy job negotiating and now you're stuck with the bill without any recourse. Ford makes out with a ton of money, so does your insurance company, and you lose.
bradleyjg 5y ago
The problem is intractable in no small part because most people are unwilling to acknowledge where the vast bulk of the money is going—-healthcare workers. They keep on looking for bad guys like insurance or drug company executives. There are some of these, and they do make a lot of money, but in the face of nearly $4 trillion in spending they don’t move the needle. The one million doctors do. The 3.8 million nurses do.
- someguydave 5y ago
  Yes, doctors, nurses, and administrators hold the entire country’s health hostage for maximal cash.
  - hirako2000 5y ago
    It just can't be that simple. Since there is a freer health market in the US than say in France, the staff costs would have come down with competition. I think what we have there is a very expensive medical school system. And things snow ball. Especially given a doctor role. A doctor studies and goes through practical training a good 8 years. That's college/uni + health center fees that stack up with interest over a long period of time. Doc then needs to make a living in accordance to his past effort, more than a living, get enough to earn the status he deserves. Now the thing is, taxes accounts for a lot given the high band income. So we could say the doctors are earning too much, but reality is 70% of their gross income goes to multiple tax tiers. 1/ income tax 2/ debt pay back 3/ insurer, continous training fees and other things that are sort of imposed on medical professional. I'm not a doctor, but I couldn't figure out how even a surgeon could justify such high pay, in the million dollar per year in many US positions. But looking comprehensively as the taxes imposed on them, everything makes sense, all they have left is 200k per year. Cashiers and other clerks earn a quarter this amount, but that's for any less than what doctors are making not many would go through all these hops and be privileged enough to even take the risk of such a financial investment. The argument that many doctors come from wealthy families doesn't invalidate the simple fact debt still exists and somehow needs to be paid back, and in most cases it does get paid back. Solution? Get rid of income taxes, make medical schools optional to practice, just make exams open to any participant, affordable education channels will pop up by themselves. Don't regulate medical malpractice, practicians should rather have their lives ruined instead, it's actually a stronger incentive to proper practice than having a big insurer paying the millions in settlement cases. The medical sector is far more tied to other industries and regulating costs than it looks. I only included 3 obvious contributors to high staff cost, there are numerous supply chains to look at to also account for other spendings that seem unavoidable but in reality pointless for health care.
GuB-42 5y ago
The question is: where is the money going? The sums are so high we are in macroeconomic territory. There may be a few billionaires with private jets and yachts here and there but this is a detail, we are in the trillions here. It is money that moves around, making the livehood of millions of people, you may be one of them, and it it is not the case, probably one of your friends and relatives. So what? Are doctors too well paid? Are health institutions inefficient? Are there too many useless medical procedures? Where is the money going where it shouldn't go? Or maybe it is just the price of really good health care.
- lotsofpulp 5y ago
  The question is: where is the money going? https://www.healthsystemtracker.org/health-spending-explorer/?display=U.S.%2520%2524%2520Billions&service= https://www.healthsystemtracker.org/health-spending-explorer... >Are doctors too well paid? https://www.medscape.com/slideshow/2020-compensation-overview-6012684 https://www.medscape.com/slideshow/2020-compensation-overvie... https://www.kaptest.com/study/mcat/doctor-salaries-by-specialty/ https://www.kaptest.com/study/mcat/doctor-salaries-by-specia... Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice. >Or maybe it is just the price of really good health care. I suspect this is the price of a small number of people getting really good care, while a somewhat larger number of people get decent care, and then a very large number of people get (or do not) get care, and when they do, it is with very high variance of quality.
  - learc83 5y ago
    Doctor’s salary only accounts for a small fraction of healthcare spending, so it certainly isn’t the cause. However my wife is a doctor who is fellowship trained, so she didn’t start making real money until she was 32. But she made a good bit above the median salary for many years before that. She also doesn’t feel like she sacrificed her 20s. She had plenty of fun, although she says med school was much harder than her engineering degree. And now she makes much more than I do as a principal engineer, and she works less than 30 hours a week. She doesn’t have to worry about interview prep or job hopping. She has absolute job security in any economy. She gets paid for continuing education. She is highly respected (people are much more impressed that I married a doctor than that I’m a principal engineer lol). There is a legal framework protecting her autonomy and decision making at work. Not even the CEO of the hospital can overrule her. In short, she is almost completely above the rat race, and is a true professional in ways that we (software engineers ) are not. I would 100% recommend our children become doctors.
ta988 5y ago
Not certain about the collapse, but it will certainly take a reduction of political polarization and less "repeat the lines of the party or radio host" mentality. But things have changed radically in the past already, look at the ADA and the end of segregation. So all hope is not lost, organized America can be strong and work in its best interest sometimes.
Dagonfly 5y ago
I'm not from the US, but from what I could gather: Since 2014 (ACA) that chart includes most private insurance payment under government/compulsory. You can see the same change in the WHO data [1]. Their database [2] lists for 2018 (per capita): - $4,089 "Transfers from government domestic revenue" (Medicare & Medicaid ?) - $3,642 "Compulsory prepayment" (ACA private insurance ?) - $1,267 "Social insurance contributions" - $1,626 "Other domestic revenues" Again, I'm not from the US so I don't know how to interpret those numbers. But it seems gov spending is >$4,089 which is already higher than most western countries with national health insurance. [1] https://apps.who.int/nha/database/country_profile/Index/en https://apps.who.int/nha/database/country_profile/Index/en (select USA) [2] https://apps.who.int/nha/database/Select/Indicators/en https://apps.who.int/nha/database/Select/Indicators/en (in indicators select everything under 'Health Expenditure Data' > 'Revenues', country USA, all years, unit 'current US$ per capita')
specialist 5y ago
Cited graph says "Government/Compulsory", not "Government".

kgermino 5y ago

I don’t think that’s what that chart says. It’s combining Government and other compulsory expenses. I haven’t reviewed the report behind the chart but I’d expect the blue bar to include things like employer paid insurance premiums.

ectopod 5y ago
Looking at figures from two years ago, the US government was spending about $3600 per head and the UK government about $3000 per head. For the latter money everybody in the UK got free healthcare.

calvinmorrison 5y ago

Americans are also the fattest and least active 1st world country.

nine_zeros 5y ago
This argument is invalid because America is not a real 1st world country. It's only rich due to historical legacy of the dollar after WW2.
- User23 5y ago
  America is rich for many more reasons than Bretton Woods. For most of the 20th century it had by far the greatest real productive and manufacturing base of any country in the world. The USA has been visibly declining for about 45 years sure, and is no longer the world leader in manufacturing, but it still has a huge and well-diversified economy. Since dollars represent, among other things, claims on a share of that economic output, demand for them is quite real and not just an historical artifact. And since no other country with a huge diversified economy is willing to run external deficits large enough to meet foreign demand for reserves, the dollar is pretty much the only good choice. There just isn’t enough gold to clear trade in a $80+ trillion global economy.
  - akimball 5y ago
    Price fixes that
  - nine_zeros 5y ago
    > For most of the 20th century it had by far the greatest real productive and manufacturing base of any country in the world. The USA has been visibly declining for about 45 years sure, and is no longer the world leader in manufacturing, but it still has a huge and well-diversified economy. Since dollars represent, among other things, claims on a share of that economic output, demand for them is quite real and not just an historical artifact. This is merely viewing the same thing from a US-centric perspective. From a rest of the world perspective, the largest competitors in EU were destroyed in WW2 (deservedly so imo), China was nowhere and India was impeded first by British colonization and then by Bretton Woods which only focused on EU nations. America is ahead but make no mistake that the gap is large only because WW2 destroyed other nations and Bretton Woods system was the first step in prevention of other nations from building up rapidly.
- rocknor 5y ago
  Do you even know what 1/2/3 world means?
zamalek 5y ago
The obese and sedentary problem is one argument against public health care that made me really take pause on my beliefs. In places where public healthcare exists, there is also a huge amount of voluntary personal health responsibility. People look after their health, and expect the same of their neighbors. The current state of Americans would be an unreasonable burden on public healthcare. That being said, taxes pay so much for healthcare, that we'd probably still be able to pull it off.
- sul_tasto 5y ago
  In addition, my understanding is that most healthcare expenses are incurred trying to prolong life in its last few weeks/months. It’s difficult to not “try everything possible “ for a loved one, when the end is near. However, I feel that often such sentiments are taken advantage of in the name of profit.
  - maxerickson 5y ago
    There's no social framework to do anything other than treat an elderly person that breaks their hip, never mind a legal one. That's a cost that is incurred towards the end of life without any 'trying to prolong life' involved, a surgery to do the repair is frequently going to immediately make the person more comfortable. And there's all sorts of similar things that just happen more often to older folks.
    - sul_tasto 5y ago
      My neighbor, who lived a very unhealthy lifestyle, underwent 4 heart surgeries and multiple other procedures before they literally couldn’t keep his body alive anymore. I’m not convinced he was treated humanely.
- chrisseaton 5y ago
  Most people in the UK certainly don’t ‘look after their health, and expect the same of their neighbo[u]rs’. I think we have the most extensive public healthcare system in Europe but also are some of the least healthy. Don’t look to us for any ideas how to do your healthcare!
amanaplanacanal 5y ago
The rest of the anglo world is catching up fast. I think the US is just a leading indicator.

Olreich 5y ago

Let the government compete with private insurers, and that will be a step in the right direction. The further steps that meaningfully reduce per-capita spending... those are all way harder, which is saying something.

chadash 5y ago

Not sure I understand that graph. How is “voluntary” expenditure such a small piece of the bar for the US? My insurance premiums are outrageously high…

Y_Y 5y ago

For comparison, in 2019 the top four were (OECD data, in 2019 PPP-adjusted USD): USA - 11.1k, Switzerland - 7.7k, Norway 6.6k, Germany 6.6k. The next ten countries spent between 5k and 6k. The WHO data is similar. It's hard to get up-to-date number on healthcare outcomes, but the best countries seem to be spending in the range of 3k to 5k. See also: https://en.wikipedia.org/wiki/Health_system#International_comparisons https://en.wikipedia.org/wiki/Health_system#International_co...

syops 5y ago

I agree very much with your last paragraph. I believe this to be true for pretty much most things in the U.S. The incentives in the system are mostly misaligned. A collapse is the most likely thing to occur before positive change happens.

kasperni 5y ago

Not only is it the most expensive. It is also a lot less efficient than most other countries [1][2]. [1] https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly https://www.commonwealthfund.org/publications/fund-reports/2... [2] https://www.washingtonpost.com/world/2021/08/05/global-health-rankings/ https://www.washingtonpost.com/world/2021/08/05/global-healt...

forgingahead 5y ago
Price transparency was one of the great accomplishments of the Trump administration. It's a good first step, but there remains a lot to be done to bring some sanity to US medical pricing. Next step is to pass a law making it illegal to charge different patients differing prices for the same service.
- ikerdanzel 5y ago
  At this point I have to say American that voted Dems old fool deserve what they getting or coming. Just like when voted Barry that spike up the insurance and medical bills. Already American got beaten in Agfhan. Wait and see a repeat of 911 (922?) now that those goat herders know American can be easily beaten simply by dragging it. Oh yeah, blame a President that did good for country back then. I am betting next 911 is somewhere on the westcoast.
- lostlogin 5y ago
  > making it illegal to charge different patients differing prices for the same service. If a workplace or insurer says to a hospital “if all these people come for a checkup, what can you do in pricing?” Is that something that should be blocked?
  - cosmotic 5y ago
    Yes. What if your auto insurance company went to Ford and struck a deal, then you went to Ford to get a car and they said 'we don't know the price until you submit a claim'; you buy a car and submit a claim. It turns out your insurance company did a pretty lousy job negotiating and now you're stuck with the bill without any recourse. Ford makes out with a ton of money, so does your insurance company, and you lose.

bradleyjg 5y ago

The problem is intractable in no small part because most people are unwilling to acknowledge where the vast bulk of the money is going—-healthcare workers. They keep on looking for bad guys like insurance or drug company executives. There are some of these, and they do make a lot of money, but in the face of nearly $4 trillion in spending they don’t move the needle. The one million doctors do. The 3.8 million nurses do.

someguydave 5y ago
Yes, doctors, nurses, and administrators hold the entire country’s health hostage for maximal cash.
- hirako2000 5y ago
  It just can't be that simple. Since there is a freer health market in the US than say in France, the staff costs would have come down with competition. I think what we have there is a very expensive medical school system. And things snow ball. Especially given a doctor role. A doctor studies and goes through practical training a good 8 years. That's college/uni + health center fees that stack up with interest over a long period of time. Doc then needs to make a living in accordance to his past effort, more than a living, get enough to earn the status he deserves. Now the thing is, taxes accounts for a lot given the high band income. So we could say the doctors are earning too much, but reality is 70% of their gross income goes to multiple tax tiers. 1/ income tax 2/ debt pay back 3/ insurer, continous training fees and other things that are sort of imposed on medical professional. I'm not a doctor, but I couldn't figure out how even a surgeon could justify such high pay, in the million dollar per year in many US positions. But looking comprehensively as the taxes imposed on them, everything makes sense, all they have left is 200k per year. Cashiers and other clerks earn a quarter this amount, but that's for any less than what doctors are making not many would go through all these hops and be privileged enough to even take the risk of such a financial investment. The argument that many doctors come from wealthy families doesn't invalidate the simple fact debt still exists and somehow needs to be paid back, and in most cases it does get paid back. Solution? Get rid of income taxes, make medical schools optional to practice, just make exams open to any participant, affordable education channels will pop up by themselves. Don't regulate medical malpractice, practicians should rather have their lives ruined instead, it's actually a stronger incentive to proper practice than having a big insurer paying the millions in settlement cases. The medical sector is far more tied to other industries and regulating costs than it looks. I only included 3 obvious contributors to high staff cost, there are numerous supply chains to look at to also account for other spendings that seem unavoidable but in reality pointless for health care.

GuB-42 5y ago

The question is: where is the money going? The sums are so high we are in macroeconomic territory. There may be a few billionaires with private jets and yachts here and there but this is a detail, we are in the trillions here. It is money that moves around, making the livehood of millions of people, you may be one of them, and it it is not the case, probably one of your friends and relatives. So what? Are doctors too well paid? Are health institutions inefficient? Are there too many useless medical procedures? Where is the money going where it shouldn't go? Or maybe it is just the price of really good health care.

lotsofpulp 5y ago
The question is: where is the money going? https://www.healthsystemtracker.org/health-spending-explorer/?display=U.S.%2520%2524%2520Billions&service= https://www.healthsystemtracker.org/health-spending-explorer... >Are doctors too well paid? https://www.medscape.com/slideshow/2020-compensation-overview-6012684 https://www.medscape.com/slideshow/2020-compensation-overvie... https://www.kaptest.com/study/mcat/doctor-salaries-by-specialty/ https://www.kaptest.com/study/mcat/doctor-salaries-by-specia... Based on what US doctors have to go through to start earning that pay, I would not say they are paid too well given the alternatives available to a person smart and driven enough to become a doctor in the US. For example, I would advise my kids that finance/tech/law/engineering has better a better pay to lifestyle ratio than becoming a doctor. Giving up your 20s and early 30s is an enormous sacrifice. >Or maybe it is just the price of really good health care. I suspect this is the price of a small number of people getting really good care, while a somewhat larger number of people get decent care, and then a very large number of people get (or do not) get care, and when they do, it is with very high variance of quality.
- learc83 5y ago
  Doctor’s salary only accounts for a small fraction of healthcare spending, so it certainly isn’t the cause. However my wife is a doctor who is fellowship trained, so she didn’t start making real money until she was 32. But she made a good bit above the median salary for many years before that. She also doesn’t feel like she sacrificed her 20s. She had plenty of fun, although she says med school was much harder than her engineering degree. And now she makes much more than I do as a principal engineer, and she works less than 30 hours a week. She doesn’t have to worry about interview prep or job hopping. She has absolute job security in any economy. She gets paid for continuing education. She is highly respected (people are much more impressed that I married a doctor than that I’m a principal engineer lol). There is a legal framework protecting her autonomy and decision making at work. Not even the CEO of the hospital can overrule her. In short, she is almost completely above the rat race, and is a true professional in ways that we (software engineers ) are not. I would 100% recommend our children become doctors.

ta988 5y ago

Not certain about the collapse, but it will certainly take a reduction of political polarization and less "repeat the lines of the party or radio host" mentality. But things have changed radically in the past already, look at the ADA and the end of segregation. So all hope is not lost, organized America can be strong and work in its best interest sometimes.

Dagonfly 5y ago

I'm not from the US, but from what I could gather: Since 2014 (ACA) that chart includes most private insurance payment under government/compulsory. You can see the same change in the WHO data [1]. Their database [2] lists for 2018 (per capita): - $4,089 "Transfers from government domestic revenue" (Medicare & Medicaid ?) - $3,642 "Compulsory prepayment" (ACA private insurance ?) - $1,267 "Social insurance contributions" - $1,626 "Other domestic revenues" Again, I'm not from the US so I don't know how to interpret those numbers. But it seems gov spending is >$4,089 which is already higher than most western countries with national health insurance. [1] https://apps.who.int/nha/database/country_profile/Index/en https://apps.who.int/nha/database/country_profile/Index/en (select USA) [2] https://apps.who.int/nha/database/Select/Indicators/en https://apps.who.int/nha/database/Select/Indicators/en (in indicators select everything under 'Health Expenditure Data' > 'Revenues', country USA, all years, unit 'current US$ per capita')

specialist 5y ago

Cited graph says "Government/Compulsory", not "Government".