12 ms·

Graphs that show America’s health-care prices are ludicrous

181 points by stollercyrus 14y ago

chucknelson 14y ago
A little too focused on raw dollars and not other factors. For instance, how does quality of these services relate to the prices?
- pepr 14y ago
  I'm pretty sure that a Swiss or UK physician does equally good job as his counterpart in the US.
  - youngerdryas 14y ago
    Using technology developed with US dollars.
    - robbiep 14y ago
      The US doesn't have a monopoly on medical innovation; Many of the big pharma companies are European: Of the top 12 Pharma companies 6 are from the US, but fully 50% are from European countries (http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie...) Many medical innovations have come from countries other than the US, and they continue to.
      - AlexeiSadeski 14y ago
        The US has a monopoly on paying for medical innovation.
        robbiep 14y ago
        Again, they absolutely do not. This would suggest that a significant percentage of the excess costs are going to medical innovation; instead at each step along the way (from hospital to insurer to reseller to medical device and pharmaceutical company) 15-30% is skimmed in admin and billing fees and other overhead. It is a total myth that the US is either the sole innovator or the sole supplier of funding for medicine. So who does fund significant medical research? On the most part private institutions (think howard hughes medical institute) and universities and their endowments, and federal and state government grants. There are significant research partnerships with pharmaceutical companies and they do spend huge numbers on R&D but significant quantities of this are iterative rather than truly innovative, which is work that is done more often by PhD's and postdocs as they have more to gain and less to loose by going out in a limb with their research. And this research goes on in every country in the world. The US may account for more than the rest of the world's aggregate defence spending but it is stretching it to suggest that the same is true for medical research.
        adventured 14y ago
        No it's not a stretch. It's accurate. Everything from basic cancer therapies to stem cells to the human genome were invented / discovered / cracked by US money. And it's a very, very long list that covers most types of advanced drugs and therapies in some form or another. Growing organs? Pioneered by US research. Robotic surgery? US money. It is however true that a lot of US medical costs are tied up in labor, namely healthcare workers and administration. Nobody wants to talk about what happens when you cut costs there however (unemployment, lower wages, et al.).
        eru 14y ago
        > Nobody wants to talk about what happens when you cut costs there however (unemployment, lower wages, et al.). The market will adjust. Other countries have lower costs there, and no worse unemployement (or general wage levels).
        EliRivers 14y ago
        Well then it's nice to see so much of that US money being spent overseas where a great many of the inventions /discoveries /cracks take place.
    - pepr 14y ago
      That would suggest US medical research companies are not properly compensated by their European customers. I don't think that's the case :)
  - cglace 14y ago
    Service goes far beyond just the physician.
- LeeHunter 14y ago
  "The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance." http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=all http://www.commonwealthfund.org/Publications/Fund-Reports/20...
- jandrewrogers 14y ago
  There are many things not factored into the graphs. Two that have been substantially quantified in healthcare economics literature: - Average survival rates and outcomes for non-trivial procedures and illnesses are excellent in the US compared to the rest of the developed world. If I have cancer in the US, my average survival rate is 65-70%. In the UK NHS, to use that as an example, it is 45%. The better diagnostics, treatments, and options in the US are naturally going to cost more money and Americans have it to spend. - The free-rider problem with pharmaceuticals. The vast majority of R&D cost is recovered in the US because it is one of the few markets in the developed world where drug companies can charge enough money to amortize their R&D costs. If Americans paid as much for drugs as the rest of the world, the pharmaceutical companies would go broke. That said, there are an enormous number of aspects of healthcare in the US that are just grossly inefficient, wasteful, and expensive. Americans pay an inordinate amount of money for healthcare, and more than they need to, but they also receive some benefits in terms of medical outcomes as well.
  - ux-app 14y ago
    If I have cancer in the US, my average survival rate is 65-70%. In the UK NHS, to use that as an example, it is 45% Do you have any links to studies that show this? The 20% gap seems extreme. better diagnostics, treatments, and options in the US It's really hard for me to believe that the US has better treatments than other 1st world countries which would result in 20%-30% decrease in mortality across the board. Once again I'd like to see some evidence. I could maybe understand if the US had much higher rates of testing which in turn resulted in higher rates of survivability. Many of these claims seem grossly over inflated. I'd be interested to see where you got the figures from.
    - jandrewrogers 14y ago
      The statistics actually come from the esteemed British medical journal Lancet. Google it; the over-performance of the US across a broad swath of cancers in that study attracted a lot of attention. As for why the US has better treatments, depending on how you measure it, 70-80% of all new biomedical R&D globally is done in the US. Consequently, if there is a new biomedical technology, it shows up in the US system first where they can capture the R&D investment. Most of the rest of the R&D is done in Asia. You are correct about one thing: the US has extremely high levels of diagnostic testing compared to the rest of the developed world. It is both part of the cost and also why survival rates are higher for many diseases. The survival rates are not just better treatments, it is also earlier diagnosis by virtue of heavy use of (expensive) diagnostic tests.
- ricardobeat 14y ago
  The US ranks #38 in health care quality worldwide, while also being the most expensive, and is last among developed nations: http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems http://en.wikipedia.org/wiki/World_Health_Organization_ranki... http://images.medicalbillingandcoding.org.s3.amazonaws.com/Medical-Costs-1.jpg http://images.medicalbillingandcoding.org.s3.amazonaws.com/M...
Strang 14y ago
Those graphs are terrible. Why bother comparing the USA's 95th-percentile prices to the average price of other countries? And why refuse to show any countries that are more expensive than the USA in any category? Very ham-fisted.
- chucknelson 14y ago
  I had the same feeling. A pretty typical case of data being carefully selected and presented to fit the argument, rather than presenting an objective view of things.
  - jff 14y ago
    Well, hey, it's exactly what the title advertises: "21 graphs that show America’s health-care prices are ludicrous". Objective? Unbiased? No guarantees are made :)
- ThomPete 14y ago
  You will not in the western world find any country that are more expensive than the american system as far as I am aware.
  - acadien 14y ago
    That's beside the point. The graphs are misleading. If the author simply let the data speak for itself, instead of biasing the visuals, it would be much more effective.
    - ThomPete 14y ago
      If there isn't any other country that is more expensive how is that besides the point? Another way to interpret the different numbers could also be simply a question of availability.
      - seanmcdirmid 14y ago
        China is probably more expensive at the high-end when considering bribes. But it does nothing to invalidate this chart.
crusso 14y ago
Of course our prices are ridiculous. We have a horrible hybrid government-market system that has completely divorced consumers from providers in terms of pricing. Consumers buy flat rate plans through their employers. They make use of services without much thought or knowledge of costs since they don't see bills. Doctors over-test and over-treat because it makes them money, patients don't protest the cost, and they're covered better legally. Insurance companies don't really care because they pass on their costs by increasing premiums. Employers don't care since they write off the benefit to their employees and pass on much of the costs through premiums. The entire mess is a runaway train with no brakes.
- deleted 14y ago
  [deleted]
- tptacek 14y ago
  I guess I'm not seeing where the government enters the picture here. Is it just the tax deductibility of group health insurance? If so, can you explain how the market would be structurally different if those premiums were taxed? For perspective, note that premiums have skyrocketed in the last 10 years, yet employers that offered group health insurance tend to still offer it.
  - rdtsc 14y ago
    > I guess I'm not seeing where the government enters the picture here. Government half-assed it. How? By providing neither complete liberalization and deregulation (a libertarian dream I hear often -- why can't my health insurance be like my car insurance...etc..etc), nor fixing prices (a la Japan) or providing free a healthcare alternative. It is the worse of both worlds it seems. All of the recent health care reforms are pretty much bullshit from what I can see if they dropped the single payer option. Without controlling the costs. Yeah I can insure my 26 year old children but my premiums have gone up 30%+ in last 2 years. It is like they are trying to plug holes in a hunk of Swiss cheese. "But we'll mandate them to give free preventive care checkups, we got them now! Everyone cheers. HMOs turns around, laugh and raise premiums by 30%.
pyre 14y ago
I think that some of these comparisons may be a bit unfair. All of the dollar amounts are expressed in USD, but cost of living is different in different parts of the world. It would be like comparing housing prices in the Bay Area to housing prices in Argentina just on dollar amounts in USD, without taking other factors into account. For instance, Argentina has $10 for an office visit. I'm not sure that a doctor would be able to make any kind of decent salary if they were only making $10/patient in the US. It would definitely incentivize the impersonal, "get done as fast as possible, don't spend a microsecond more," style of visit to the doctor.
- ricardobeat 14y ago
  I'd say cost of living in Argentina is 3-5x lower than the US. Even if you multiply all the AR values by 5x it's still ridiculous.
  - pyre 14y ago
    I'm not saying the numbers are reasonable. I guess I'm saying that the graphs would be more useful if they were somehow normalized for something like cost-of-living.
- teamonkey 14y ago
  The cost of living in France, the UK and Australia are comparable to the US. San Francisco and New York are very expensive to live in, but so are Sydney, Paris and London.
- anigbrowl 14y ago
  It would definitely incentivize the impersonal, "get done as fast as possible, don't spend a microsecond more," style of visit to the doctor. This never happens now, of course.
  - pyre 14y ago
    No need for the fatalist sarcasm. Do we really want to provide even more incentive for this to happen?
narrator 14y ago
What's funny about health care and to some extent education in the U.S is that the solution is NOT to spend more money. This is fundamentally at odds with the political ideology prevalent in this country which seems to think more money is the universally applicable and most effective solution to social problems.
- Retric 14y ago
  I think it's spending more money on X, and less on Y. One of the huge savings available for single payer systems is you can use random audits vs debating every single bill. Cover everyone and suddenly you don't need to fill out reams of insurance forms every time you see a new doctor etc.
ThomPete 14y ago
When I was diagnosed with a melanoma last year and had to go for my second operation someone proposed I went to this specialist. For reasons that are still unclear to me my insurance didn't cover it and I was told that if I did it out of pocket I would have to pay 3000USD for an initial meeting. I was also sent the price for my uncomplicated operation which was between 30.000USD and 150.000USD. This is for a stage 1 removal. Stage 2. started at 250.000USD and ended at 450.000USD Stage 3. and stage 4. well lets just say i stopped reading after stage 2. Now I am well aware that no one ever pay the list price, but it is to me (I am originally from Denmark) completely absurd the way the healthcare system is constructed. I also recognize that there are no easy solutions here. You can never spend enough money on healthcare. But you can certainly construct it differently than we have here in the US.
- prawn 14y ago
  My partner and I were Australians working for a couple of months in Scotland back in 2003. My now wife had had a melanoma removed while in Australia and we visited a doctor in the UK to have one of the follow-up checks. There was no cost. I believe there was compulsory insurance coming out of our UK earnings (NIS or whatever it's called) but the entire process was so easy it was suspicious. Can't even remember paperwork. Needed a check-up, got referred to the specialist and they just ran through it and off we went. The processes here in Australia are pretty simple too. At no point should people be fearful of checks/tests or treatment for their personal health because of cost.
  - arethuza 14y ago
    "Can't even remember paperwork" The only time I can remember any paperwork with the NHS is when my wife had a climbing accident in Glencoe and was taken by RAF helicopter to the hospital in Fort William - after a few days she was feeling OK so she wanted to sign herself out over the protests of the medical staff - so they had her sign something to prove that she was leaving, not them asking her to go (they really wanted her to stay for a few more days). The charming nurse's parting words were "Come back to Fort William, but don't come back here" :-)
- 14y ago
zht 14y ago
I was interning in California (I'm a Canadian citizen) when I felt compelled to go see a doctor because I spent about a week coughing up various different colours of phlegm (was awoken pretty much nightly with really bad hacking cough). I visited the walk-in clinic at Palo Alto Medical Foundation (in Palo Alto). I had travel insurance offered through my (Canadian) university supplement insurance plan (which for some reason wasn't in their system), so I was asked (albeit very politely) whether I'd like to pay for the visit in cash or credit card ($300 up front). The doctor listened to me cough and did a swab for a staph infection before diagnosing me with the common flu and advising me to come back if it didn't subside within another week. I guess in hindsight the visit cost much more than average (since $176 apparently is the 95th percentile cost for a routine doctor's visit), but it just seemed strange that seeing a doctor (not even emergency room) cost roughly half as much as an iPad.
- rdtsc 14y ago
  You got lucky. I was an international student. Had a terrible strep throat. Lived off campus. Called university, asked if going to a nearby emergency clinic would be covered. They said "yes". Did so. Got there, waited 1+ hours in the lobby. Then a young intern saw me for 5 minutes. Prescribed a codeine pill and sent me home. It turns out outside of campus clinic visit was not covered. I did not record the phone conversation. Got a $400 bill (in 1999 money!). Fuck you American medical system. Should have given them the wrong name or something. It seems they are out to rob people I wouldn't even feel back screwing them over. Charging a student who lives on rammen noodles $400 in 1999 could mean not being able to pay for housing or not being able to avoid food or books. Now I just avoid doctors as much as possible. It is irrational but I just feel like both insurance and doctors are out to screw me and take all my money. Sad thing is, my rational part of the brain understand that the next time I will see doctors might be in the emergency being unconscious or really sick (maybe I should carry a wallet with a fake name with me ;-)
  - voodoomagicman 14y ago
    As an international student, what would the consequences of just not paying that bill be?
beggi 14y ago
The American health-care system is ludicrous! My girlfriend and I are from Europe and we have been in the US for a year now while she finishes her university degree. Half a year ago she (we?) got pregnant, and we are paying more than triple the money for doctor visits than it would be back home. Not only that - but the money we're paying is just 20% of the "real" cost, the insurance she paid $7000 per year for is paying the rest. So we're paying $180 per visit and the "real" cost of each half an hour long doctor visit is about $900! Now you might argue it's better service, but in my very subjective view, I highly doubt it and it doesn't feel like it at all. To add insult to injury: We got a 3D sonogram and the amount we paid (mind you, 20% of the "real" cost) was twice the amount our friends at home have paid for 3D sonogram taken by a private company (and the government is not paying a cent). IMO, America is one fantastic country if you're rich - but it seems much much harder to live here than in Europe on meager salaries.
- tptacek 14y ago
  Careful. Hospitals and doctors often report the amounts that insurance companies report based on a master price list that bears no relation to what the insurers actually pay. Insurers are presumably fine with misleading reports that puff up their value.
  - zeidrich 14y ago
    Because that value is directly correlated with the price that insurance companies can charge consumers.
    - tptacek 14y ago
      I don't think that's true.
  - revelation 14y ago
    If they pay 20% of price A and the insurance theorethically covers 80% of A, but in actuality pays only B << 0.8 A, then that sounds like fraud.
fakeer 14y ago
The costs tell how capitalism ruined the capitalism and twisted it to work solely for the (already) capitalists who are/were on the upper deck of capitalist yacht. It's not just insurance cost - it's the entire healthcare system it seems that is complicated and made not very easily accessible. There's an answer to a question on Quora, by a guy who stayed in USA. Question is: What are some things that you can do in India but not in the US? Answer says: I can go to a doctor with no insurance, no paperwork...[1] I don't think it's very unsafe to assume that the healthcare is designed in a way to make it extremely costly and make it accessible only to the rich and paying(whatever the huge amount set) customers. Is it so true that USA doesn't have an dependent clinic or practitioner medical care culture? As in an independent doctor setting up his/her clinic or hospital and not associated with some BIG hospital clinic chain or just one mammoth+costly hospital. What about the state owned hospital or medical schools? Like those in state owned universities for example. How is the cost of treatment/check-up there? disclaimer: In no way it's comparison of quality of healthcare in two countries, it just discusses the way it is accessible. [1]http://www.quora.com/What-are-some-things-that-you-can-do-in-India-but-not-in-the-US/answer/Balaji-Viswanathan-2 http://www.quora.com/What-are-some-things-that-you-can-do-in...
- cpursley 14y ago
  What you describe is not capitalism. It's cronyism. The US healthcare market is far from a free market; hasen't been for 50 years.
  - repeta 14y ago
    Yes, what he described is not True Capitalism™.
    - AlexeiSadeski 14y ago
      Given that Smith created capitalism in order to argue against cronyism (NOT socialism), it seems odd to criticize capitalism for cronyism.
      - 14y ago
zht 14y ago
Another thing that I found extremely strange while living in the States. Seeing Walgreen's advertisements for flu shots (I think it was $19.99).
- peteretep 14y ago
  Why did you find that strange? Here in the UK I paid a similar amount for my flu vaccination
  - Gmo 14y ago
    I think it's the advertising part ... I know I had the same.
cpursley 14y ago
Seems like it's cheaper to fly to Argentina for health care. My wife goes back to Russia for dental care - 1/5 the price.
- shiftpgdn 14y ago
  Is it possible to have dental care done as a tourist? I'd rather visit Russia for a few days and have my teeth worked on than pay $2500 to have some cavities filled here.
  - Ras_ 14y ago
    Thailand & co. already excel in it. Research common search result stories like this: http://www.jaunted.com/story/2011/10/11/125413/89/travel/Travel+Confessions%3A+I+Was+a+Dental+Tourist+in+Thailand http://www.jaunted.com/story/2011/10/11/125413/89/travel/Tra...
  - cpursley 14y ago
    Sure Igor the dentist is about $400 for two cavities. Not joking at all. Ticket about $1,200 - accommodations about $800 for a week. Less in SE Asia.
cpursley 14y ago
They key take away here is there is a HUGE opportunity for a medical tourism startup that helps people find quality healthcare overseas (from US perspective).
- AlexeiSadeski 14y ago
  It's already decently popular.
iansinke 14y ago
Maybe I'm reading the graphs wrong, but they seem somewhat misleading to me: shouldn't the average (top of the blue bar, bottom of slightly greener blue bar) be what you're comparing to the others? The other columns are all strictly averages too, even though the prices are centrally set for many of the other countries. The US does come out more expensive, but not as much as the graphs might lead you to believe. It's like saying: In Australia the average student scored 43 points on a standardized test, but in the US, students in the 95th percentile got 150 points! Yeah, not so convincing. n.b. I say this all as a Canadian.
- Toadsoup 14y ago
  I agree that it is misleading. The charts show the average cost for each country, then for US it emphasizes the outrageous edge cases. A more fair representation would show all 3 segments for all countries. With the data presented, if we look at just the average costs the change is still significant but not as dramatic and shocking. Healthcare costs are a real issue and is totally jacked up in the US, but representations like this take away credibility from the argument they are trying to support.
aethertap 14y ago
I'd be interested to combine these charts with some other data that might be related, such as doctors' student loan and mortgage debt, per capita income, waiting times for various procedures, and maybe even a measure of how many citizens there are per doctor (as a way of determining relative barriers to entry for medical professionals). I don't really have a good sense about how all of those things stack up in other places, but I suspect the U.S. would be an outlier in some of those as well.
- dlo 14y ago
  I believe you are making the assumption that doctors are pocketing this money (or at least much of it). I am not saying that you are wrong, but I am saying that you need to identify this as an assumption and re-examine it. (As it turns out, you are wrong, but I don't have time to go into it right now :-P.)
  - aethertap 14y ago
    Actually I'm not making any assumptions (hence the reason I would like to see the data stacked up together). I don't know what it would look like, but I enjoy exploring ideas like that. I actually do know, in at least two cases, that the doctors aren't pocketing the money (the doctor friends I know are going to be living paycheck to paycheck for several years as they deal with the huge debts they incurred in the process of becoming doctors). The question I'm most interested in exploring with the above data is this: what are the relative costs and barriers to entry for medical professionals in all of these countries? It's my impression (could be profoundly wrong for all I know) that they are exceptionally high in the U.S., and if that is the case, then it would be a contributing factor to the high costs. There are obviously many other contributing factors, and I'm not proposing solutions here, just curiosity. I think you read more into my query that I meant to convey- I have nothing against doctors, or even against doctors making tons of money. I don't particularly like the disconnect between people and the prices of their medical care that happens as a result of our insurance model and I think that's also a major contributing factor to high prices. As you say, though, I don't really want to go into that here.
jwallaceparker 14y ago
Health insurance premiums in America are about to jump even higher because of two key points in Obamacare. 1: By 2014 it will be illegal for an insurance company to deny coverage to a customer with pre-existing conditions. This is great news for people with pre-existing conditions, but bad news for everyone else, who will have to cover the cost through increased premiums. 2: Obamacare carries a clause in which consumers may opt out of government-approved healthcare and pay a tax penalty instead. The CBO estimates that in 2016 the average penalty will be $1200 per year. In combination these two factors will create massive upward pressure on health insurance premiums. Healthy consumers who carry mainly catastrophic insurance will choose to drop their coverage en masse in favor of paying the penalty. After all, if they ever get really sick, they can always sign up for insurance because it's now illegal to deny coverage to someone with pre-existing conditions! This will drive insurance prices higher, as there will be an ever-shrinking pool of consumers paying premiums.
- yuhong 14y ago
  And unfortunately the Supreme Court ruled the tax penalty is the only penalty legal under the Constitution.
- yardie 14y ago
  I believe the long term goal is the deregulation of the health insurance market. Currently most states just have just 2-3 providers. The current providers are driving prices up because they have a, temporarily, captive market. Once more providers enter the market (because who wants to leave all that money on the table) the market should be self correcting.
umarafridi 14y ago
There are a number of differences between the US and all the other countries which may explain the costs. For example - Malpractice insurance costs in the US are much higher, the salaries for doctors are higher, the cost of their education is higher, living expenses can be higher... And because it is privatized - in the UK for example, the government can negotiate fees to bring down costs (for drugs, services etc). They can set prescribing guidelines so physicians don't just prescribe what they want and they can set treatment protocols and budgets so the physicians don't order unnecessary scans. All this brings down the overall costs.
justzisguyuknow 14y ago
Umm is it just me or does it not look ludicrous but just higher if you compare the AVERAGES to the other countries' AVERGAGES, rathr than out 95th Percentile to other countries' AVERGAES?
deleted 14y ago
[deleted]
verisimilitude 14y ago
No THIS graph shows that America's health-care prices are ludicrous: http://thesocietypages.org/graphicsociology/2011/04/26/cost-of-health-care-by-country-national-geographic/ http://thesocietypages.org/graphicsociology/2011/04/26/cost-...
- deleted 14y ago
  [deleted]
- socalnate1 14y ago
  Spot on.
- AlexeiSadeski 14y ago
  Life expectancy is not really related to health care.
  - lostlogin 14y ago
    Infant mortality is. And the mother's life certainly is too. But in general you do seem to be right. However this could be due to quality of life being hard to measure, because quality of life is related to healthcare, but damned if I can prove that.
    - dantheman 14y ago
      Infant mortality is calculated differently by different countries. What counts as infant mortality in the US often counts as a still birth etc in other countries.
      - nitrogen 14y ago
        I can't help but think that at least some of the people putting these statistics together know that and have corrected for it.
        AlexeiSadeski 14y ago
pbreit 14y ago
Comparing USA Average (the middle number), the prices actually don't seem bad at all considering that the USA has by far the best medicine in the world and a host of reasons why it runs high (legal, cost of education, free markets, high rate of elective procedures, center of advancements, etc).
- btilly 14y ago
  ...the USA has by far the best medicine in the world... Citation needed. The statistics that I've seen usually place the USA near the bottom of the industrialized world on things like life expectancy, child mortality, survival rate after open heart surgery, etc.
  - pbreit 14y ago
    Citation needed. Either way, some/many of the things you cite have to do with access to care, diet, smoking (yes, more than europeans), etc, not quality. Things like heart surgery mortality rates are tough to compare since the USA is well-known for performing more procedurs at the end of life. Not my favorite source but little reason to think it's way off: http://www.foxnews.com/opinion/2013/01/15/facts-about-americas-health-care-quality-that-world-doesnt-know/ http://www.foxnews.com/opinion/2013/01/15/facts-about-americ...
    - kalleboo 14y ago
      I find all these debates so difficult because it's so hard to interpret all the numbers. For instance, your article's numbers all seem to be based on outcomes for people who are seeing doctors. Maybe there's something about people who don't see doctors in the US which would cause the outcomes to be worse. Or maybe not. It's just impossible to trust anything, since everything can be interpreted in 10 different ways.
  - adventured 14y ago
    Near the bottom of the industrialized world? That's a pretty fantastic claim for data that involves so much fraud. For example, Japan's life expectancy is 83, right? Errr, nope not so much. You're no doubt aware of the vast fraud involved in Japanese welfare programs involving dead elderly. The US is within a small margin of difference with many of the other major industrialized countries when you adjust for fake reporting. The US happens to have one of the best data accuracy rates when it comes to reporting death - or did you think Bosnia and Russia really have a 50% lower infant mortality rate than the US (the same Russia whose men live to 60)? The US life expectancy is 78.5, that compares to 79.3 for South Korea, easily within a +/- margin of difference. The UK is 80, ditto Germany, again, it's trivially easy to skew these numbers artificially higher with fraud, but even in that case the difference isn't exactly dramatic. You're going to toast the US over a year variance on data that is not very accurate or proven? Yeah ok. And if you really want to get into the data: the US is the best country on earth when it comes to the top 85%, because the real problem with the US is poverty and diet among the bottom 15%. THAT is our real problem. If you compare the top 85% in each country, the US comes out at the top. But you're not interested in that discussion I'm sure.
jasonlotito 14y ago
Once again, pricing that ignores the real costs in other countries, what people really pay in the US, and most importantly, simply equate health care with a dollar amount. As someone who has lived in a two countries in those charts (one of those being the US), I can assure you those prices are not at all representative of reality. They also don't take into account quality of care, of which, I can again assure you, is vastly different. I left Canada precisely because of the abusive medical establishment that essentially abused my children.
rgejman 14y ago
The comments about the use of percentiles biasing the data are very true, in particular because there are effectively 3 pools of patients in the US: private/employer insured, Medicare/Medicaid and uninsured. Medicare and Medicaid pay far less than private (employer) insurance (and the uninsured frequently do not pay at all). As a result, many hospitals and outpatient physicians charge private insurance disproportionately more than what the services actually cost in order to cover the operational losses from medicare/medicaid and uninsured patients. It's astounding how many articles that discuss the "ludicrous" prices of health-care in the US fail to mention that the prices for goods and services billed to uninsured patients are designed to offset the losses from other patients. That $80 aspirin is $0.01 for the aspirin and $79.99 for the cost of the nurse to bring it to you and a variable $ amount that helps offset losses. The only fair analysis is to compare averages to averages, which in the US should include both charges to medicare/medicaid and private insurance. I'm not arguing that health care costs in the US are lower or even the same as in other countries, by the way. I'm merely trying to point out that the differences are not what they seem at first glance. More importantly: a brief look at the IFHP website and the report itself (http://www.ifhp.com/news153.html http://www.ifhp.com/news153.html) leads me to question whether medicare was even included in this dataset. The relevant lines from the report are "The International Federation of Health Plans was founded in 1968 by a small group of health plan industry leaders. It is now the leading global network in the industry, with more than one hundred member companies from twenty-five countries" and "Prices for the United States are calculated from a database with over 100 million paid claims that reflect prices negotiated between thousands of providers and almost a hundred health plans." Draw your own conclusions (or perhaps someone should contact them). Edit: I've emailed them to try and find out. I'll post back here what I find. Edit 2: Another document put together by IFHP in 2009 (http://tinyurl.com/bn9qtvm http://tinyurl.com/bn9qtvm warning: PDF) compares other countries to US private insurance and medicare separately. Medicare prices are far more in line with other countries than the averaged data would suggest.
michael_miller 14y ago
Another way to look at this is that the US is subsidizing the world's healthcare. Take the example of drugs in the linked article [1]. Given their pricing power in the environment, the article asserts that we pay 2x what other countries do for identical drugs, for no other reason than we aren't negotiating as a large group. As an anecdotal example, when visiting Beijing, I had some trouble breathing, so I went to a pharmacy to buy an inhaler. I didn't have insurance that worked in China, so I had to pay out of pocket. Not only did I not need a prescription, but I also only paid $4 for the inhaler, complete with medicine. The same inhaler + medicine costs $10 with insurance in the US (god knows how much without it). Tom Sackville, a UK politician quoted in [1] summed it up nicely: "We end up with the benefits of your investment. You’re subsidizing the rest of the world by doing the front-end research." [1] http://www.washingtonpost.com/blogs/wonkblog/post/why-an-mri-costs-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.html http://www.washingtonpost.com/blogs/wonkblog/post/why-an-mri...
- zaphar 14y ago
  The question is does the world lose out if we no longer subsidize the front-end research or would it just get redistributed?
  - sseveran 14y ago
    Who is going to big up the tab?
- deleted 14y ago
  [deleted]
- NoPiece 14y ago
  That's true of drugs costs, but it doesn't explain the expense of things like an office visit.
- robbiep 14y ago
  I believe this to be a fallacy: see my post further down https://news.ycombinator.com/item?id=5447890 https://news.ycombinator.com/item?id=5447890 Too much effort: didn't read? The summly version: Most of the excess expenditure in the US is not going to pharma and other device companies for research; it is instead being divided up by billing companies working for hospitals, doctors and other businesses in the supply chain. This should be obvious to anyone who looks at the charts and sees the mean cost vs the high and low end: companies are charging what they can when they can to the end user because there is no good advocate for the end user and they are up against a wall. I also expand on who does in effect pay for medics research and the answer is not the American consumer but mostly the taxpayers (and philanthropists to university endowments etc) of the world given that most of the research that advances medical knowledge, that is innovative rather than iterative research, is performed in universities.
adventured 14y ago
Just as one factor in healthcare costs in the US - I wonder if people talking about the expenses understand how much doctors and nurses make in most other countries compared to the US? Slash the costs, and one of the prime cuts is going to be that doctors and nurses will make 1/3 as much instantly. Nurses for example make 50% more in the US than in Germany, Norway, South Korea, France, and Canada to name a few.
- peteretep 14y ago
  Are American Nurses 50% better than those in other rich countries? Do American Doctors cause 3 times better outcomes than others?
mnazim 14y ago
I wonder how "not so well off" people pay for health care. What are the costs in government run hospitals? (I am from Kashmir. Consultation with the best doctors does not cost more than 5 - 8 USD and in most cases this amount is for 10 - 15 days regardless of the number of visits. And if you go to government run hospitals you can get the best consultation for half a dollar. Only problem we have is that the health care infrastructure - private and government combined - is overloaded. Not enough hospitals, not enough doctors, not enough equipments. )
- lilsunnybee 14y ago
  It depends on what income level you're talking about. Many low income people can't afford insurance and never receive healthcare until something catastrophic happens, and in that case they go to the emergency room. Hospitals are required to provide treatment (though there have been scandals surrounding this in the past), and so they will and then afterwards just bill the uninsured low income patient an insane amount. Debt collectors will then hound the individual or family for quite a while afterwards. Its a very efficient system. ;-)

181 points by stollercyrus 14y ago

A little too focused on raw dollars and not other factors. For instance, how does quality of these services relate to the prices?

pepr 14y ago
I'm pretty sure that a Swiss or UK physician does equally good job as his counterpart in the US.
- youngerdryas 14y ago
  Using technology developed with US dollars.
  - robbiep 14y ago
    The US doesn't have a monopoly on medical innovation; Many of the big pharma companies are European: Of the top 12 Pharma companies 6 are from the US, but fully 50% are from European countries (http://en.wikipedia.org/wiki/List_of_pharmaceutical_companies http://en.wikipedia.org/wiki/List_of_pharmaceutical_companie...) Many medical innovations have come from countries other than the US, and they continue to.
    - AlexeiSadeski 14y ago
      The US has a monopoly on paying for medical innovation.
      - robbiep 14y ago
        Again, they absolutely do not. This would suggest that a significant percentage of the excess costs are going to medical innovation; instead at each step along the way (from hospital to insurer to reseller to medical device and pharmaceutical company) 15-30% is skimmed in admin and billing fees and other overhead. It is a total myth that the US is either the sole innovator or the sole supplier of funding for medicine. So who does fund significant medical research? On the most part private institutions (think howard hughes medical institute) and universities and their endowments, and federal and state government grants. There are significant research partnerships with pharmaceutical companies and they do spend huge numbers on R&D but significant quantities of this are iterative rather than truly innovative, which is work that is done more often by PhD's and postdocs as they have more to gain and less to loose by going out in a limb with their research. And this research goes on in every country in the world. The US may account for more than the rest of the world's aggregate defence spending but it is stretching it to suggest that the same is true for medical research.
        adventured 14y ago
        No it's not a stretch. It's accurate. Everything from basic cancer therapies to stem cells to the human genome were invented / discovered / cracked by US money. And it's a very, very long list that covers most types of advanced drugs and therapies in some form or another. Growing organs? Pioneered by US research. Robotic surgery? US money. It is however true that a lot of US medical costs are tied up in labor, namely healthcare workers and administration. Nobody wants to talk about what happens when you cut costs there however (unemployment, lower wages, et al.).
        eru 14y ago
        > Nobody wants to talk about what happens when you cut costs there however (unemployment, lower wages, et al.). The market will adjust. Other countries have lower costs there, and no worse unemployement (or general wage levels).
        EliRivers 14y ago
        Well then it's nice to see so much of that US money being spent overseas where a great many of the inventions /discoveries /cracks take place.
  - pepr 14y ago
    That would suggest US medical research companies are not properly compensated by their European customers. I don't think that's the case :)
- cglace 14y ago
  Service goes far beyond just the physician.
LeeHunter 14y ago
"The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance." http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=all http://www.commonwealthfund.org/Publications/Fund-Reports/20...
jandrewrogers 14y ago
There are many things not factored into the graphs. Two that have been substantially quantified in healthcare economics literature: - Average survival rates and outcomes for non-trivial procedures and illnesses are excellent in the US compared to the rest of the developed world. If I have cancer in the US, my average survival rate is 65-70%. In the UK NHS, to use that as an example, it is 45%. The better diagnostics, treatments, and options in the US are naturally going to cost more money and Americans have it to spend. - The free-rider problem with pharmaceuticals. The vast majority of R&D cost is recovered in the US because it is one of the few markets in the developed world where drug companies can charge enough money to amortize their R&D costs. If Americans paid as much for drugs as the rest of the world, the pharmaceutical companies would go broke. That said, there are an enormous number of aspects of healthcare in the US that are just grossly inefficient, wasteful, and expensive. Americans pay an inordinate amount of money for healthcare, and more than they need to, but they also receive some benefits in terms of medical outcomes as well.
- ux-app 14y ago
  If I have cancer in the US, my average survival rate is 65-70%. In the UK NHS, to use that as an example, it is 45% Do you have any links to studies that show this? The 20% gap seems extreme. better diagnostics, treatments, and options in the US It's really hard for me to believe that the US has better treatments than other 1st world countries which would result in 20%-30% decrease in mortality across the board. Once again I'd like to see some evidence. I could maybe understand if the US had much higher rates of testing which in turn resulted in higher rates of survivability. Many of these claims seem grossly over inflated. I'd be interested to see where you got the figures from.
  - jandrewrogers 14y ago
    The statistics actually come from the esteemed British medical journal Lancet. Google it; the over-performance of the US across a broad swath of cancers in that study attracted a lot of attention. As for why the US has better treatments, depending on how you measure it, 70-80% of all new biomedical R&D globally is done in the US. Consequently, if there is a new biomedical technology, it shows up in the US system first where they can capture the R&D investment. Most of the rest of the R&D is done in Asia. You are correct about one thing: the US has extremely high levels of diagnostic testing compared to the rest of the developed world. It is both part of the cost and also why survival rates are higher for many diseases. The survival rates are not just better treatments, it is also earlier diagnosis by virtue of heavy use of (expensive) diagnostic tests.
ricardobeat 14y ago
The US ranks #38 in health care quality worldwide, while also being the most expensive, and is last among developed nations: http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems http://en.wikipedia.org/wiki/World_Health_Organization_ranki... http://images.medicalbillingandcoding.org.s3.amazonaws.com/Medical-Costs-1.jpg http://images.medicalbillingandcoding.org.s3.amazonaws.com/M...

Strang 14y ago

Those graphs are terrible. Why bother comparing the USA's 95th-percentile prices to the average price of other countries? And why refuse to show any countries that are more expensive than the USA in any category? Very ham-fisted.

chucknelson 14y ago
I had the same feeling. A pretty typical case of data being carefully selected and presented to fit the argument, rather than presenting an objective view of things.
- jff 14y ago
  Well, hey, it's exactly what the title advertises: "21 graphs that show America’s health-care prices are ludicrous". Objective? Unbiased? No guarantees are made :)
ThomPete 14y ago
You will not in the western world find any country that are more expensive than the american system as far as I am aware.
- acadien 14y ago
  That's beside the point. The graphs are misleading. If the author simply let the data speak for itself, instead of biasing the visuals, it would be much more effective.
  - ThomPete 14y ago
    If there isn't any other country that is more expensive how is that besides the point? Another way to interpret the different numbers could also be simply a question of availability.
    - seanmcdirmid 14y ago
      China is probably more expensive at the high-end when considering bribes. But it does nothing to invalidate this chart.

crusso 14y ago

Of course our prices are ridiculous. We have a horrible hybrid government-market system that has completely divorced consumers from providers in terms of pricing. Consumers buy flat rate plans through their employers. They make use of services without much thought or knowledge of costs since they don't see bills. Doctors over-test and over-treat because it makes them money, patients don't protest the cost, and they're covered better legally. Insurance companies don't really care because they pass on their costs by increasing premiums. Employers don't care since they write off the benefit to their employees and pass on much of the costs through premiums. The entire mess is a runaway train with no brakes.

deleted 14y ago
[deleted]
tptacek 14y ago
I guess I'm not seeing where the government enters the picture here. Is it just the tax deductibility of group health insurance? If so, can you explain how the market would be structurally different if those premiums were taxed? For perspective, note that premiums have skyrocketed in the last 10 years, yet employers that offered group health insurance tend to still offer it.
- rdtsc 14y ago
  > I guess I'm not seeing where the government enters the picture here. Government half-assed it. How? By providing neither complete liberalization and deregulation (a libertarian dream I hear often -- why can't my health insurance be like my car insurance...etc..etc), nor fixing prices (a la Japan) or providing free a healthcare alternative. It is the worse of both worlds it seems. All of the recent health care reforms are pretty much bullshit from what I can see if they dropped the single payer option. Without controlling the costs. Yeah I can insure my 26 year old children but my premiums have gone up 30%+ in last 2 years. It is like they are trying to plug holes in a hunk of Swiss cheese. "But we'll mandate them to give free preventive care checkups, we got them now! Everyone cheers. HMOs turns around, laugh and raise premiums by 30%.

pyre 14y ago

I think that some of these comparisons may be a bit unfair. All of the dollar amounts are expressed in USD, but cost of living is different in different parts of the world. It would be like comparing housing prices in the Bay Area to housing prices in Argentina just on dollar amounts in USD, without taking other factors into account. For instance, Argentina has $10 for an office visit. I'm not sure that a doctor would be able to make any kind of decent salary if they were only making $10/patient in the US. It would definitely incentivize the impersonal, "get done as fast as possible, don't spend a microsecond more," style of visit to the doctor.

ricardobeat 14y ago
I'd say cost of living in Argentina is 3-5x lower than the US. Even if you multiply all the AR values by 5x it's still ridiculous.
- pyre 14y ago
  I'm not saying the numbers are reasonable. I guess I'm saying that the graphs would be more useful if they were somehow normalized for something like cost-of-living.
teamonkey 14y ago
The cost of living in France, the UK and Australia are comparable to the US. San Francisco and New York are very expensive to live in, but so are Sydney, Paris and London.
anigbrowl 14y ago
It would definitely incentivize the impersonal, "get done as fast as possible, don't spend a microsecond more," style of visit to the doctor. This never happens now, of course.
- pyre 14y ago
  No need for the fatalist sarcasm. Do we really want to provide even more incentive for this to happen?

narrator 14y ago

What's funny about health care and to some extent education in the U.S is that the solution is NOT to spend more money. This is fundamentally at odds with the political ideology prevalent in this country which seems to think more money is the universally applicable and most effective solution to social problems.

Retric 14y ago
I think it's spending more money on X, and less on Y. One of the huge savings available for single payer systems is you can use random audits vs debating every single bill. Cover everyone and suddenly you don't need to fill out reams of insurance forms every time you see a new doctor etc.

ThomPete 14y ago

When I was diagnosed with a melanoma last year and had to go for my second operation someone proposed I went to this specialist. For reasons that are still unclear to me my insurance didn't cover it and I was told that if I did it out of pocket I would have to pay 3000USD for an initial meeting. I was also sent the price for my uncomplicated operation which was between 30.000USD and 150.000USD. This is for a stage 1 removal. Stage 2. started at 250.000USD and ended at 450.000USD Stage 3. and stage 4. well lets just say i stopped reading after stage 2. Now I am well aware that no one ever pay the list price, but it is to me (I am originally from Denmark) completely absurd the way the healthcare system is constructed. I also recognize that there are no easy solutions here. You can never spend enough money on healthcare. But you can certainly construct it differently than we have here in the US.

prawn 14y ago
My partner and I were Australians working for a couple of months in Scotland back in 2003. My now wife had had a melanoma removed while in Australia and we visited a doctor in the UK to have one of the follow-up checks. There was no cost. I believe there was compulsory insurance coming out of our UK earnings (NIS or whatever it's called) but the entire process was so easy it was suspicious. Can't even remember paperwork. Needed a check-up, got referred to the specialist and they just ran through it and off we went. The processes here in Australia are pretty simple too. At no point should people be fearful of checks/tests or treatment for their personal health because of cost.
- arethuza 14y ago
  "Can't even remember paperwork" The only time I can remember any paperwork with the NHS is when my wife had a climbing accident in Glencoe and was taken by RAF helicopter to the hospital in Fort William - after a few days she was feeling OK so she wanted to sign herself out over the protests of the medical staff - so they had her sign something to prove that she was leaving, not them asking her to go (they really wanted her to stay for a few more days). The charming nurse's parting words were "Come back to Fort William, but don't come back here" :-)
14y ago

zht 14y ago

I was interning in California (I'm a Canadian citizen) when I felt compelled to go see a doctor because I spent about a week coughing up various different colours of phlegm (was awoken pretty much nightly with really bad hacking cough). I visited the walk-in clinic at Palo Alto Medical Foundation (in Palo Alto). I had travel insurance offered through my (Canadian) university supplement insurance plan (which for some reason wasn't in their system), so I was asked (albeit very politely) whether I'd like to pay for the visit in cash or credit card ($300 up front). The doctor listened to me cough and did a swab for a staph infection before diagnosing me with the common flu and advising me to come back if it didn't subside within another week. I guess in hindsight the visit cost much more than average (since $176 apparently is the 95th percentile cost for a routine doctor's visit), but it just seemed strange that seeing a doctor (not even emergency room) cost roughly half as much as an iPad.

rdtsc 14y ago
You got lucky. I was an international student. Had a terrible strep throat. Lived off campus. Called university, asked if going to a nearby emergency clinic would be covered. They said "yes". Did so. Got there, waited 1+ hours in the lobby. Then a young intern saw me for 5 minutes. Prescribed a codeine pill and sent me home. It turns out outside of campus clinic visit was not covered. I did not record the phone conversation. Got a $400 bill (in 1999 money!). Fuck you American medical system. Should have given them the wrong name or something. It seems they are out to rob people I wouldn't even feel back screwing them over. Charging a student who lives on rammen noodles $400 in 1999 could mean not being able to pay for housing or not being able to avoid food or books. Now I just avoid doctors as much as possible. It is irrational but I just feel like both insurance and doctors are out to screw me and take all my money. Sad thing is, my rational part of the brain understand that the next time I will see doctors might be in the emergency being unconscious or really sick (maybe I should carry a wallet with a fake name with me ;-)
- voodoomagicman 14y ago
  As an international student, what would the consequences of just not paying that bill be?

beggi 14y ago

The American health-care system is ludicrous! My girlfriend and I are from Europe and we have been in the US for a year now while she finishes her university degree. Half a year ago she (we?) got pregnant, and we are paying more than triple the money for doctor visits than it would be back home. Not only that - but the money we're paying is just 20% of the "real" cost, the insurance she paid $7000 per year for is paying the rest. So we're paying $180 per visit and the "real" cost of each half an hour long doctor visit is about $900! Now you might argue it's better service, but in my very subjective view, I highly doubt it and it doesn't feel like it at all. To add insult to injury: We got a 3D sonogram and the amount we paid (mind you, 20% of the "real" cost) was twice the amount our friends at home have paid for 3D sonogram taken by a private company (and the government is not paying a cent). IMO, America is one fantastic country if you're rich - but it seems much much harder to live here than in Europe on meager salaries.

tptacek 14y ago
Careful. Hospitals and doctors often report the amounts that insurance companies report based on a master price list that bears no relation to what the insurers actually pay. Insurers are presumably fine with misleading reports that puff up their value.
- zeidrich 14y ago
  Because that value is directly correlated with the price that insurance companies can charge consumers.
  - tptacek 14y ago
    I don't think that's true.
- revelation 14y ago
  If they pay 20% of price A and the insurance theorethically covers 80% of A, but in actuality pays only B << 0.8 A, then that sounds like fraud.

fakeer 14y ago

The costs tell how capitalism ruined the capitalism and twisted it to work solely for the (already) capitalists who are/were on the upper deck of capitalist yacht. It's not just insurance cost - it's the entire healthcare system it seems that is complicated and made not very easily accessible. There's an answer to a question on Quora, by a guy who stayed in USA. Question is: What are some things that you can do in India but not in the US? Answer says: I can go to a doctor with no insurance, no paperwork...[1] I don't think it's very unsafe to assume that the healthcare is designed in a way to make it extremely costly and make it accessible only to the rich and paying(whatever the huge amount set) customers. Is it so true that USA doesn't have an dependent clinic or practitioner medical care culture? As in an independent doctor setting up his/her clinic or hospital and not associated with some BIG hospital clinic chain or just one mammoth+costly hospital. What about the state owned hospital or medical schools? Like those in state owned universities for example. How is the cost of treatment/check-up there? disclaimer: In no way it's comparison of quality of healthcare in two countries, it just discusses the way it is accessible. [1]http://www.quora.com/What-are-some-things-that-you-can-do-in-India-but-not-in-the-US/answer/Balaji-Viswanathan-2 http://www.quora.com/What-are-some-things-that-you-can-do-in...

cpursley 14y ago
What you describe is not capitalism. It's cronyism. The US healthcare market is far from a free market; hasen't been for 50 years.
- repeta 14y ago
  Yes, what he described is not True Capitalism™.
  - AlexeiSadeski 14y ago
    Given that Smith created capitalism in order to argue against cronyism (NOT socialism), it seems odd to criticize capitalism for cronyism.
    - 14y ago

zht 14y ago

Another thing that I found extremely strange while living in the States. Seeing Walgreen's advertisements for flu shots (I think it was $19.99).

peteretep 14y ago
Why did you find that strange? Here in the UK I paid a similar amount for my flu vaccination
- Gmo 14y ago
  I think it's the advertising part ... I know I had the same.

cpursley 14y ago

Seems like it's cheaper to fly to Argentina for health care. My wife goes back to Russia for dental care - 1/5 the price.

shiftpgdn 14y ago
Is it possible to have dental care done as a tourist? I'd rather visit Russia for a few days and have my teeth worked on than pay $2500 to have some cavities filled here.
- Ras_ 14y ago
  Thailand & co. already excel in it. Research common search result stories like this: http://www.jaunted.com/story/2011/10/11/125413/89/travel/Travel+Confessions%3A+I+Was+a+Dental+Tourist+in+Thailand http://www.jaunted.com/story/2011/10/11/125413/89/travel/Tra...
- cpursley 14y ago
  Sure Igor the dentist is about $400 for two cavities. Not joking at all. Ticket about $1,200 - accommodations about $800 for a week. Less in SE Asia.

cpursley 14y ago

They key take away here is there is a HUGE opportunity for a medical tourism startup that helps people find quality healthcare overseas (from US perspective).

AlexeiSadeski 14y ago
It's already decently popular.

iansinke 14y ago

Maybe I'm reading the graphs wrong, but they seem somewhat misleading to me: shouldn't the average (top of the blue bar, bottom of slightly greener blue bar) be what you're comparing to the others? The other columns are all strictly averages too, even though the prices are centrally set for many of the other countries. The US does come out more expensive, but not as much as the graphs might lead you to believe. It's like saying: In Australia the average student scored 43 points on a standardized test, but in the US, students in the 95th percentile got 150 points! Yeah, not so convincing. n.b. I say this all as a Canadian.

Toadsoup 14y ago
I agree that it is misleading. The charts show the average cost for each country, then for US it emphasizes the outrageous edge cases. A more fair representation would show all 3 segments for all countries. With the data presented, if we look at just the average costs the change is still significant but not as dramatic and shocking. Healthcare costs are a real issue and is totally jacked up in the US, but representations like this take away credibility from the argument they are trying to support.

aethertap 14y ago

I'd be interested to combine these charts with some other data that might be related, such as doctors' student loan and mortgage debt, per capita income, waiting times for various procedures, and maybe even a measure of how many citizens there are per doctor (as a way of determining relative barriers to entry for medical professionals). I don't really have a good sense about how all of those things stack up in other places, but I suspect the U.S. would be an outlier in some of those as well.

dlo 14y ago
I believe you are making the assumption that doctors are pocketing this money (or at least much of it). I am not saying that you are wrong, but I am saying that you need to identify this as an assumption and re-examine it. (As it turns out, you are wrong, but I don't have time to go into it right now :-P.)
- aethertap 14y ago
  Actually I'm not making any assumptions (hence the reason I would like to see the data stacked up together). I don't know what it would look like, but I enjoy exploring ideas like that. I actually do know, in at least two cases, that the doctors aren't pocketing the money (the doctor friends I know are going to be living paycheck to paycheck for several years as they deal with the huge debts they incurred in the process of becoming doctors). The question I'm most interested in exploring with the above data is this: what are the relative costs and barriers to entry for medical professionals in all of these countries? It's my impression (could be profoundly wrong for all I know) that they are exceptionally high in the U.S., and if that is the case, then it would be a contributing factor to the high costs. There are obviously many other contributing factors, and I'm not proposing solutions here, just curiosity. I think you read more into my query that I meant to convey- I have nothing against doctors, or even against doctors making tons of money. I don't particularly like the disconnect between people and the prices of their medical care that happens as a result of our insurance model and I think that's also a major contributing factor to high prices. As you say, though, I don't really want to go into that here.

jwallaceparker 14y ago

Health insurance premiums in America are about to jump even higher because of two key points in Obamacare. 1: By 2014 it will be illegal for an insurance company to deny coverage to a customer with pre-existing conditions. This is great news for people with pre-existing conditions, but bad news for everyone else, who will have to cover the cost through increased premiums. 2: Obamacare carries a clause in which consumers may opt out of government-approved healthcare and pay a tax penalty instead. The CBO estimates that in 2016 the average penalty will be $1200 per year. In combination these two factors will create massive upward pressure on health insurance premiums. Healthy consumers who carry mainly catastrophic insurance will choose to drop their coverage en masse in favor of paying the penalty. After all, if they ever get really sick, they can always sign up for insurance because it's now illegal to deny coverage to someone with pre-existing conditions! This will drive insurance prices higher, as there will be an ever-shrinking pool of consumers paying premiums.

yuhong 14y ago
And unfortunately the Supreme Court ruled the tax penalty is the only penalty legal under the Constitution.
yardie 14y ago
I believe the long term goal is the deregulation of the health insurance market. Currently most states just have just 2-3 providers. The current providers are driving prices up because they have a, temporarily, captive market. Once more providers enter the market (because who wants to leave all that money on the table) the market should be self correcting.

umarafridi 14y ago

There are a number of differences between the US and all the other countries which may explain the costs. For example - Malpractice insurance costs in the US are much higher, the salaries for doctors are higher, the cost of their education is higher, living expenses can be higher... And because it is privatized - in the UK for example, the government can negotiate fees to bring down costs (for drugs, services etc). They can set prescribing guidelines so physicians don't just prescribe what they want and they can set treatment protocols and budgets so the physicians don't order unnecessary scans. All this brings down the overall costs.

justzisguyuknow 14y ago

Umm is it just me or does it not look ludicrous but just higher if you compare the AVERAGES to the other countries' AVERGAGES, rathr than out 95th Percentile to other countries' AVERGAES?

deleted 14y ago

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verisimilitude 14y ago

No THIS graph shows that America's health-care prices are ludicrous: http://thesocietypages.org/graphicsociology/2011/04/26/cost-of-health-care-by-country-national-geographic/ http://thesocietypages.org/graphicsociology/2011/04/26/cost-...

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socalnate1 14y ago
Spot on.
AlexeiSadeski 14y ago
Life expectancy is not really related to health care.
- lostlogin 14y ago
  Infant mortality is. And the mother's life certainly is too. But in general you do seem to be right. However this could be due to quality of life being hard to measure, because quality of life is related to healthcare, but damned if I can prove that.
  - dantheman 14y ago
    Infant mortality is calculated differently by different countries. What counts as infant mortality in the US often counts as a still birth etc in other countries.
    - nitrogen 14y ago
      I can't help but think that at least some of the people putting these statistics together know that and have corrected for it.
      - AlexeiSadeski 14y ago

pbreit 14y ago

Comparing USA Average (the middle number), the prices actually don't seem bad at all considering that the USA has by far the best medicine in the world and a host of reasons why it runs high (legal, cost of education, free markets, high rate of elective procedures, center of advancements, etc).

btilly 14y ago
...the USA has by far the best medicine in the world... Citation needed. The statistics that I've seen usually place the USA near the bottom of the industrialized world on things like life expectancy, child mortality, survival rate after open heart surgery, etc.
- pbreit 14y ago
  Citation needed. Either way, some/many of the things you cite have to do with access to care, diet, smoking (yes, more than europeans), etc, not quality. Things like heart surgery mortality rates are tough to compare since the USA is well-known for performing more procedurs at the end of life. Not my favorite source but little reason to think it's way off: http://www.foxnews.com/opinion/2013/01/15/facts-about-americas-health-care-quality-that-world-doesnt-know/ http://www.foxnews.com/opinion/2013/01/15/facts-about-americ...
  - kalleboo 14y ago
    I find all these debates so difficult because it's so hard to interpret all the numbers. For instance, your article's numbers all seem to be based on outcomes for people who are seeing doctors. Maybe there's something about people who don't see doctors in the US which would cause the outcomes to be worse. Or maybe not. It's just impossible to trust anything, since everything can be interpreted in 10 different ways.
- adventured 14y ago
  Near the bottom of the industrialized world? That's a pretty fantastic claim for data that involves so much fraud. For example, Japan's life expectancy is 83, right? Errr, nope not so much. You're no doubt aware of the vast fraud involved in Japanese welfare programs involving dead elderly. The US is within a small margin of difference with many of the other major industrialized countries when you adjust for fake reporting. The US happens to have one of the best data accuracy rates when it comes to reporting death - or did you think Bosnia and Russia really have a 50% lower infant mortality rate than the US (the same Russia whose men live to 60)? The US life expectancy is 78.5, that compares to 79.3 for South Korea, easily within a +/- margin of difference. The UK is 80, ditto Germany, again, it's trivially easy to skew these numbers artificially higher with fraud, but even in that case the difference isn't exactly dramatic. You're going to toast the US over a year variance on data that is not very accurate or proven? Yeah ok. And if you really want to get into the data: the US is the best country on earth when it comes to the top 85%, because the real problem with the US is poverty and diet among the bottom 15%. THAT is our real problem. If you compare the top 85% in each country, the US comes out at the top. But you're not interested in that discussion I'm sure.

jasonlotito 14y ago

Once again, pricing that ignores the real costs in other countries, what people really pay in the US, and most importantly, simply equate health care with a dollar amount. As someone who has lived in a two countries in those charts (one of those being the US), I can assure you those prices are not at all representative of reality. They also don't take into account quality of care, of which, I can again assure you, is vastly different. I left Canada precisely because of the abusive medical establishment that essentially abused my children.

rgejman 14y ago

The comments about the use of percentiles biasing the data are very true, in particular because there are effectively 3 pools of patients in the US: private/employer insured, Medicare/Medicaid and uninsured. Medicare and Medicaid pay far less than private (employer) insurance (and the uninsured frequently do not pay at all). As a result, many hospitals and outpatient physicians charge private insurance disproportionately more than what the services actually cost in order to cover the operational losses from medicare/medicaid and uninsured patients. It's astounding how many articles that discuss the "ludicrous" prices of health-care in the US fail to mention that the prices for goods and services billed to uninsured patients are designed to offset the losses from other patients. That $80 aspirin is $0.01 for the aspirin and $79.99 for the cost of the nurse to bring it to you and a variable $ amount that helps offset losses. The only fair analysis is to compare averages to averages, which in the US should include both charges to medicare/medicaid and private insurance. I'm not arguing that health care costs in the US are lower or even the same as in other countries, by the way. I'm merely trying to point out that the differences are not what they seem at first glance. More importantly: a brief look at the IFHP website and the report itself (http://www.ifhp.com/news153.html http://www.ifhp.com/news153.html) leads me to question whether medicare was even included in this dataset. The relevant lines from the report are "The International Federation of Health Plans was founded in 1968 by a small group of health plan industry leaders. It is now the leading global network in the industry, with more than one hundred member companies from twenty-five countries" and "Prices for the United States are calculated from a database with over 100 million paid claims that reflect prices negotiated between thousands of providers and almost a hundred health plans." Draw your own conclusions (or perhaps someone should contact them). Edit: I've emailed them to try and find out. I'll post back here what I find. Edit 2: Another document put together by IFHP in 2009 (http://tinyurl.com/bn9qtvm http://tinyurl.com/bn9qtvm warning: PDF) compares other countries to US private insurance and medicare separately. Medicare prices are far more in line with other countries than the averaged data would suggest.

michael_miller 14y ago

Another way to look at this is that the US is subsidizing the world's healthcare. Take the example of drugs in the linked article [1]. Given their pricing power in the environment, the article asserts that we pay 2x what other countries do for identical drugs, for no other reason than we aren't negotiating as a large group. As an anecdotal example, when visiting Beijing, I had some trouble breathing, so I went to a pharmacy to buy an inhaler. I didn't have insurance that worked in China, so I had to pay out of pocket. Not only did I not need a prescription, but I also only paid $4 for the inhaler, complete with medicine. The same inhaler + medicine costs $10 with insurance in the US (god knows how much without it). Tom Sackville, a UK politician quoted in [1] summed it up nicely: "We end up with the benefits of your investment. You’re subsidizing the rest of the world by doing the front-end research." [1] http://www.washingtonpost.com/blogs/wonkblog/post/why-an-mri-costs-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.html http://www.washingtonpost.com/blogs/wonkblog/post/why-an-mri...

zaphar 14y ago
The question is does the world lose out if we no longer subsidize the front-end research or would it just get redistributed?
- sseveran 14y ago
  Who is going to big up the tab?
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NoPiece 14y ago
That's true of drugs costs, but it doesn't explain the expense of things like an office visit.
robbiep 14y ago
I believe this to be a fallacy: see my post further down https://news.ycombinator.com/item?id=5447890 https://news.ycombinator.com/item?id=5447890 Too much effort: didn't read? The summly version: Most of the excess expenditure in the US is not going to pharma and other device companies for research; it is instead being divided up by billing companies working for hospitals, doctors and other businesses in the supply chain. This should be obvious to anyone who looks at the charts and sees the mean cost vs the high and low end: companies are charging what they can when they can to the end user because there is no good advocate for the end user and they are up against a wall. I also expand on who does in effect pay for medics research and the answer is not the American consumer but mostly the taxpayers (and philanthropists to university endowments etc) of the world given that most of the research that advances medical knowledge, that is innovative rather than iterative research, is performed in universities.

adventured 14y ago

Just as one factor in healthcare costs in the US - I wonder if people talking about the expenses understand how much doctors and nurses make in most other countries compared to the US? Slash the costs, and one of the prime cuts is going to be that doctors and nurses will make 1/3 as much instantly. Nurses for example make 50% more in the US than in Germany, Norway, South Korea, France, and Canada to name a few.

peteretep 14y ago
Are American Nurses 50% better than those in other rich countries? Do American Doctors cause 3 times better outcomes than others?

mnazim 14y ago

I wonder how "not so well off" people pay for health care. What are the costs in government run hospitals? (I am from Kashmir. Consultation with the best doctors does not cost more than 5 - 8 USD and in most cases this amount is for 10 - 15 days regardless of the number of visits. And if you go to government run hospitals you can get the best consultation for half a dollar. Only problem we have is that the health care infrastructure - private and government combined - is overloaded. Not enough hospitals, not enough doctors, not enough equipments. )

lilsunnybee 14y ago
It depends on what income level you're talking about. Many low income people can't afford insurance and never receive healthcare until something catastrophic happens, and in that case they go to the emergency room. Hospitals are required to provide treatment (though there have been scandals surrounding this in the past), and so they will and then afterwards just bill the uninsured low income patient an insane amount. Debt collectors will then hound the individual or family for quite a while afterwards. Its a very efficient system. ;-)