4 ms·

It's highly misleading. It might be more useful to see an analysis of the marginal change in outcomes per spend, where spend is measured in terms of the averag

It's highly misleading. It might be more useful to see an analysis of the marginal change in outcomes per spend, where spend is measured in terms of the average wage hour in a particular country. The US certainly skews toward reduced efficiency for the purpose of better outcomes for some edge cases. The average fully insured American gets worse healthcare than the president, precisely because the risk/reward calculus of preventative care, emergency care, diagnostics, etc., is viewed to be different for the president compared to the average citizen. Put differently, ensuring the president's good health is done at the cost of a bit of efficiency. So efficiency is related to class, with the highest class people being able to "afford" lower healthcare efficiency as a kind of luxury. Correspondingly, in countries with much lower per capita income, it's possible to deliver healthcare that is remarkably good (say, roughly equal to early 1990s US standards) for a fraction of the price of modern care. Diseases of affluence get lots of health care spending, and many (like heart disease) offer low yield for each additional dollar. There are a few areas (some cancers) in which you'd very much prefer to be treated with 2013 medicine rather than 1992 medicine. To opine on this issue entails a significant value judgement about the relative importance of various diseases... effectively picking winners and losers, with every dollar saved in the name of efficiency offering a benefit to one person and causing harm to another...

grecy 13y ago
> say, roughly equal to early 1990s US standards If you think any Developed country in the world has healthcare equal to early 1990s US standards, you're very confused. If you're talking about Developing or undeveloped countries, why would you want to compare the richest country in the world to developing or undeveloped countries? I would have expected you to aim higher than the bottom of the heap.
- grandalf 13y ago
  I'm talking about developing countries... which I think should be praised for figuring out how to maximize efficiency and value to serve very poor populations at low cost. I was around in the 1990s (in the US) and at the time I thought the healthcare system did a pretty good job. A decade or two later and for most diseases, little has changed about the treatments/practices. So for 95% of healthcare issues, 1990s medicine is just as good as 2013 medicine. The fallacy upon which much of the cost bloat is built is the idea that all costs should be increasing b/c quality is increasing in some key areas (like cancer treatment). Ironically, the areas in the US that offer the biggest area for improvement are things like basic systems and process improvements... things like being sure someone helps the 70 year old patient walk the hall twice a day to retain mobility during a hospital stay (even if the reason for the hospital stay is something like a bad cold, a fall, or dehydration from vomiting). Most of the things that can offer significant outcome improvements are very low tech.
joe_the_user 13y ago
It's highly misleading. It might be more useful to see an analysis of the marginal change in outcomes per spend, where spend is measured in terms of the average wage hour in a particular country. Wow, it's amazing to me that a sentence with such contorted grammar and logic could be the start of the highest rated comment here. The US health care "system" has been discussed here a lot. Unless you've been asleep, you should know a variety of corrupt rent seekers suck more wealth here than the average GDP of a medium sized third world country. Yes, it's inefficient, it's supremely, ungodly inefficient. It might not be the largest "wealth-sink-hole" the world has ever known but it's up there. Yes, there's real health care and even cutting treatments on the edge of this monster. Whatever. The monster is real. And other, even marginally first world countries don't do this. http://en.wikipedia.org/wiki/Health_care_in_Australia http://en.wikipedia.org/wiki/Health_care_in_Australia
- grandalf 13y ago
  The simplest way to improve efficiency would be to crack down on end of life care abuses. However the population that benefits, senior citizens, is one of the most entrenched and powerful political lobbying groups in the US. There is something bizarre about the American psyche that leads us to overspend on end of life care. It makes no sense. Countries like France and Canada don't allow it and get huge efficiency gains b/c of it. Americans are also uniquely litigious. We expect doctors to be perfect and demand extreme degrees of training and accountability. The minute the smallest mistake is make (the kind which most of us make dozens of times per day in our normal jobs) we expect the legal system to assist us with revenge and remuneration. This not only ads tremendous cost but drives up the quality of doctors to the point where there are barely enough people qualified to go through medical training. Top tier med schools typically over admit and have to weed out a few students each year. Still others burn out b/c they could not handle the rigor. It would make sense for us to significantly lower the bar on physician quality and for the government to stop providing reimbursement for much of the costly end of life care that is now routine... but those solutions will never fly. Most of the critiques about our system (and this one, disguised as a plea for efficiency) are complaints about what has happened prices after the market has responded to all the incentives, psychologies, laws, etc. This leads to the proposed solutions usually being variations on price controls. Americans want to be fat, we want to smoke, we want to have our "insurance" pay $200K for our last week of life hooked up to a dozen machines while our semi-estranged families arrange time off work to fly in and not feel too bad about themselves for being absent from our lives..., and we want to be able to file a lawsuit if a 1 in 100 mistake occurs. These are the privileges that we pay top dollar for.

grecy 13y ago

> say, roughly equal to early 1990s US standards If you think any Developed country in the world has healthcare equal to early 1990s US standards, you're very confused. If you're talking about Developing or undeveloped countries, why would you want to compare the richest country in the world to developing or undeveloped countries? I would have expected you to aim higher than the bottom of the heap.

grandalf 13y ago
I'm talking about developing countries... which I think should be praised for figuring out how to maximize efficiency and value to serve very poor populations at low cost. I was around in the 1990s (in the US) and at the time I thought the healthcare system did a pretty good job. A decade or two later and for most diseases, little has changed about the treatments/practices. So for 95% of healthcare issues, 1990s medicine is just as good as 2013 medicine. The fallacy upon which much of the cost bloat is built is the idea that all costs should be increasing b/c quality is increasing in some key areas (like cancer treatment). Ironically, the areas in the US that offer the biggest area for improvement are things like basic systems and process improvements... things like being sure someone helps the 70 year old patient walk the hall twice a day to retain mobility during a hospital stay (even if the reason for the hospital stay is something like a bad cold, a fall, or dehydration from vomiting). Most of the things that can offer significant outcome improvements are very low tech.

joe_the_user 13y ago

It's highly misleading. It might be more useful to see an analysis of the marginal change in outcomes per spend, where spend is measured in terms of the average wage hour in a particular country. Wow, it's amazing to me that a sentence with such contorted grammar and logic could be the start of the highest rated comment here. The US health care "system" has been discussed here a lot. Unless you've been asleep, you should know a variety of corrupt rent seekers suck more wealth here than the average GDP of a medium sized third world country. Yes, it's inefficient, it's supremely, ungodly inefficient. It might not be the largest "wealth-sink-hole" the world has ever known but it's up there. Yes, there's real health care and even cutting treatments on the edge of this monster. Whatever. The monster is real. And other, even marginally first world countries don't do this. http://en.wikipedia.org/wiki/Health_care_in_Australia http://en.wikipedia.org/wiki/Health_care_in_Australia

grandalf 13y ago
The simplest way to improve efficiency would be to crack down on end of life care abuses. However the population that benefits, senior citizens, is one of the most entrenched and powerful political lobbying groups in the US. There is something bizarre about the American psyche that leads us to overspend on end of life care. It makes no sense. Countries like France and Canada don't allow it and get huge efficiency gains b/c of it. Americans are also uniquely litigious. We expect doctors to be perfect and demand extreme degrees of training and accountability. The minute the smallest mistake is make (the kind which most of us make dozens of times per day in our normal jobs) we expect the legal system to assist us with revenge and remuneration. This not only ads tremendous cost but drives up the quality of doctors to the point where there are barely enough people qualified to go through medical training. Top tier med schools typically over admit and have to weed out a few students each year. Still others burn out b/c they could not handle the rigor. It would make sense for us to significantly lower the bar on physician quality and for the government to stop providing reimbursement for much of the costly end of life care that is now routine... but those solutions will never fly. Most of the critiques about our system (and this one, disguised as a plea for efficiency) are complaints about what has happened prices after the market has responded to all the incentives, psychologies, laws, etc. This leads to the proposed solutions usually being variations on price controls. Americans want to be fat, we want to smoke, we want to have our "insurance" pay $200K for our last week of life hooked up to a dozen machines while our semi-estranged families arrange time off work to fly in and not feel too bad about themselves for being absent from our lives..., and we want to be able to file a lawsuit if a 1 in 100 mistake occurs. These are the privileges that we pay top dollar for.