Matt Yglesias points out in this post that US health care spending is much higher and the outcomes are poorer than countries with government run systems. So much for the efficiencies of the marketplace.
Yet for some reason, the debate in this country starts with the assumption that a government run system would be more costly. This assumption is demonstrably false ...
...but our media never seems to get around to mentioning that. It is not even true for the huge government run system already in place in the US, Medicare, which provides better care at lower cost than private insurers.
Why do you think that the discussion in this country continues to begin from this false premise?
Monday, June 15, 2009
US Health care costs
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23 comments:
The truth is that government often provides goods and services at lower costs than the private sector. The insurance industry, that sells health insurance at a profit, provides NO health care.
It is ridiculous that the insurance industry is now heavily lobbying congress to try to head off competition from the government because they know that their industry is de facto BUREAUCRACY! individuals are making millions without providing a scrap of healthcare.
I will give you a real life example, I was covered under my wife's health insurance and i was diagnosed with diabetes. OK, the doctor said "lose 30 lbs.and eat right" and your pancreas may "right itself" which it did. Meanwhile and a few years later my wife got cancer and passed away. I was left with a COBRA program that allowed me to get 18 months of inexpensive health insurance. After that I applied to get health insurance and low and behold with an existing condition it now will cost me nearly 10,000 per year to purchase health insurance because of a pre existing condition. Guess what? if I stay in shape I have no health problems - not even prescription drugs like pills or needles, (thank God), but no I don't have 10,000 per year for healthcare.
So I am one of the 15% of Americans without healthcare.
I would love to buy in to a government program that cared little about profit.
Another story, The last month of my wife's life was spent in a hospital. The bill was $380,000.
That is more than 12 years income for the average American. I would have gladly gone twelve years in debt (although our yearly income was far more than average) if I could have the results I wanted.
I was told 12 days before her death that she was terminal, I have come to believe that those doctors knew all month that she would not survive, but just like a crop in the field they maximized their yield (their blood money) and sent me on my way. 18 months later I got my dues necessary to keep me alive, (10,000 per year for a healthy 46 year old with a pre existing condition.)
You see people? It is not politics! It is life or death!
To keep me alive it will be 300,000 bucks if I live to be 76.
That's their blood money. Don't like it? Well they got that much for one month of my wife's life.
If I want 30 years I got to pay up to the profit machine called the US healthcare system. You might get a house for that(300,000) - I get some pills, and some vague promise until some bureaucrat (insurance executive) denies my treatment/operation. I hope it never happens to you.
I truly believe that something needs to be done with health care because there are just too many stories similar to what James has said, but the answer isn't clear to me. Our own state says that much of the financial problem is due to the forced medical plans we have adopted. This is their data and comment, not mine. How do we close on this so we can get to a good place?
SINGLE PAYER SYSTEM! The rest of the industrialized world and many developing nations have already done it and it works. Lower cost, better acess, better care and healthier living, more equity.
SINGLE PAYER SYSTEM! The rest of the industrialized world and many developing nations have already done it and it works. Lower cost, better access, better care and healthier living, more equity.
The only thing Mass. has done is to tell me I am now required to have health insurance. The state has free or low cost plans for low income individuals/families. It goes by your income which reflects the federal poverty level. Well if anyone has checked those numbers recently, you have to be in real trouble to qualify. For those who have a job or the means to pay, there are no reasonable plans out there unless you are able to get insurance through your employer. Mass. did nothing to make health insurance more affordable or improve the system. It only made it mandatory.
The ruth is government often provides goods services at lower costs? Have you looked at the postal service lately? Government has not proven that they provide anything efficiently. You people are in a dreamland. Are you ready to pay higher taxes for this coverage? This coming from the same crowd who would cut off there own fingers to avoid paying more taxes here in town and would not bat an eyelash at paying more taxes for this. Have you ever spoken to anyone in a socialistic healthcare system? The service is terrible and breeds mediocre healthcare providers. Thanks but no thanks I'll take my chances with what we have.
MYTH: “Better Care”
Another myth has to do with the quality
of care that patients receive. British ministers
of health have told British citizens for
years that their health system is the envy of
the world. Canadian ministers of health say
much the same thing. In fact, Canadian and
British doctors see 50 percent more patients
than American doctors do, and, as a consequence,
they have less time to spend with
each patient. In Britain, the typical general
practitioner barely has time to take your
temperature and write a prescription. And
even if they discover something wrong with
you, they may not have the technology to
solve your problem.
Among people with chronic renal failure,
only half as many Canadians as Americans
get dialysis, and only a third as many
Britons on a per capita basis. The American
rate of coronary bypass surgeries is
three or four times what it is in Canada,
and five times what it is in Britain.
Britain is the country that invented the
CAT scanner, back in the 1970s. For a
while it exported more than half the CAT
scanners used in the world. Yet they
bought very few for their own citizens.
Today, Britain has half the number of CAT
scanners per capita as we do in the United
States. A similar problem exists in Canada
MYTH: “MORE BANG FOR THE
BUCK”
Yet another myth is that although the
United States spends more on health care,
we don’t get more. That argument is often
supported by pointing to life expectancy,
which is not that much different among
developed countries, and infant mortality,
which is actually higher in the United States
than it is in most other developed countries.
What do we get for our money? The
first thing we need to do is separate those
phenomena that have little to do with
health care from those that do. In the
United States, life expectancy at birth for
African American men is 68 years, while for
Asian American men it’s 81 years. W e find
wide differences in life expectancy among
women, too. Nobody thinks that those differences
are due to the health care system.
What, then, would we want to look at if
we really wanted to compare the efficacy
of health care systems? We would look at
those conditions for which we know medical
services can make a real difference.
Among women who are diagnosed with
breast cancer, only one fifth die in the
United States, compared to one third in
France and Germany, and almost half in
the United Kingdom and New Zealand.
Among men who are diagnosed with
prostate cancer, fewer than one fifth die in
the United States, compared to one fourth
in Canada, almost half in France, and
more than half in the United Kingdom.
MYTH: “EQUAL ACCESS”
Perhaps no notion is more closely tied to
national health insurance than the idea of
equal access to health care. Every prime
minister of health in Britain, from the day
the National Health Service started, has
said that is the primary goal of the NHS.
Similar things are said in Canada and in
other countries.
The British government—unlike most
other governments—studies the problem
from time to time to see what kind of
progress they’re making. In 1980, they had
a major report that said, essentially: “We
really haven’t made very much progress in
achieving equality of access to health care in
our country. In fact, it looks like things are
worse today, in 1980, than they were 30
years ago when the British National Health
Service was started.”
Everybody deplored the results of
that report, and they all promised to
do better. There were a lot of
articles written, a lot of conferences,
and a lot of discussions.
Another 10 years
passed and they pondered
another report, which
said that things had deteriorated
further. Today
we are long overdue for
a third report, but no
one expects the situation
to have improved.
It’s true that racial and
ethnic minorities are underserved in the
United States. But we are hardly alone. In
Canada, the indigenous groups are the Cree
and the Inuits. In New Zealand, they are
Maoris. In Australia, the Aborigines. Those
populations have more health care problems,
shorter life expectancies, higher infant
mortality, more health care needs, and they
get less health care. When health care is
rationed, racial and ethnic minorities do not
usually do well in the rationing scheme.
A Canadian study showed vast inequalities
among the health regions of British Columbia.
In some cases, there were spending differences
of 10 to 1 in services provided in one
area compared to another. That probably
would not surprise most health policy analysts;
you just don’t usually get this kind of
data. But if we had the data, we would probably
find similar inequalities in access to health
care all over the developed world.
I’m especially interested in the elderly,
because I find that—not only in Britain
and Canada, but also in the United
States—when people have to make decisions
about who is going to get care and
who is not, they frequently choose the
younger patient. Surveys of the elderly
show that senior citizens in the United
States say it’s much easier to get surgery ,
see doctors, see specialists, and enter hospitals,
than say seniors in other countries.
MYTH: “LESS RED TAPE”
Then we have the myth that national
health insurance is an efficient way to deliver
health care. I hear this frequently repeated
by advocates in the United States.
Probably the most telling statistic for
hospitals is average length of stay. In general,
efficient hospitals get people in and
out more quickly. By that standard, the
U.S. hospital sector is the most efficient
in the world. And I think by many other
standards it would not be much in dispute
that the U.S. hospital sector is far more
efficient than the hospital sectors of other
countries.
In Britain, where at any one time there
are a million people waiting to get into
British hospitals, 15 percent of the beds are
empty, and another 15 percent are filled
with chronic patients who really don’t need
the services of hospital; they’re simply using
the hospital as an expensive nursing home.
So, effectively, almost one-third of the beds
are closed off to acute care patients.
A study compared Kaiser in California
with the NHS and concluded that, after
you make all of the appropriate adjustments,
Kaiser spends about the same per
capita on its enrollees as Britain spends on
its population. But the Kaiser enrollees
were getting more care, more access to
specialists, and other services.
We often hear that Medicare and Medicaid
are efficient. The government says
Medicaid only spends about 2 percent of
its budget on administration. But that ignores
all the costs that are shifted to doctors
and hospitals. When you incorporate
all those costs, it turns out that actually
Medicare is not very efficient at all.
Please cite the source of your comments. Where did this information come from?
From Yglesias' post "Per capita health spending in Switzerland is 68 percent of what we spend. And that’s the most expensive country! In Canada it’s 57 percent In Denmark it’s 51 percent. ... The idea would have to be that not only is our health care in some sense “better” than Danish health care, but that it’s actually twice as good in some sense"
I have friends in Germany and Canada who love their health care system. In the US, it seems doctors give drugs and expensive tests before trying alternatives. The drug companies are a big problem in the US!
My friends say they don't worry about medication or health care costs and say they are happy with their system. I'm sure you can find people from other countries who think differently, but there are those who do like it.
Frank,
Who is in dream land?
Take 44 cents to fed-ex or UPS and ask them for what you can get.
Nothing my friend, you can't even get a candy bar out of their employee
lunchroom for 44 cents.
The postal service is a little better, you buy a 44 cent stamp and place it on a letter. They come to your house every day and check if you left your letter in your mailbox, they drop of your bills and letters so you don't forget to pay your bills and get your electric turned off,and they bring you ads and even money saving coupons that could save you money. They take your letter and even if it says Hawaii they deliver it half way around the world!!!!! The person you wrote can also spend 44 cents and send you a letter. so for under a dollar you are communicating! For under a dollar. Try getting TV, internet, or ANYTHING for less money.
Frank, have you got anything better? Because your sounding pretty foolish on this issue.
I remember my elders telling me a movie cost a nickel in their youth.
Well now a movie costs 10 dollars.
I know stamps cost about a nickel when my elders were young, now they are only 44 cents. Get it? Frank. Are you complaining about movies Frank? I think you just complain about the government,
The postal service is the most efficient governmental (now quasi governmental) system of ALL TIME!
Anyone care to argue that point?
Frank, Your credibility is zero.
Thank You for listening, Sincerely,
Cliff Claven
It would seem to me that no system is perfect. There will always be disagreement about this issue. However, in the US, considered the greatest nation, why haven't we done a better job? Most people who are happy with our existing system are those who have great health care plans. It's like the woman who said to me that she doesn't want everyone to have health insurance because then all the good doctors would be too busy with other patients to see her. Certain states take care of the poor by providing better health care for them than most working people get. Other states do not. I'm not sure I want the government to control health care but I'm not happy about the insurance industry controlling it either. If you don't think they aren't, then your head is in the sand. There are too many problems with the existing system from abuses and inequities to malpractice insurance which has driven health care costs through the roof. Maybe it is time to overhaul the system and maybe the only way to do that is for the government to take over, set the standards, and then let private companies compete under the new guidelines. Of course this will never happen. Lobbyists, insurance companies, and the lawsuit lawyers will never allow it and no one in our government has the balls to actually do it.
James, it is clear to me you are a condescending fool. I know your type from a mile away. You think your clever but you are really nothing but a smart a##.
Here is an excerpt a few years ago from a watchdog group similar to the one most participants on this blog would join. CAGW:
In 1999, the price of a first class stamp jumped from 32 to 33 cents. Now the U.S. Postal Service (USPS) wants another penny per stamp. That's the bad news. The good news is that the review process could take as long as 10 months, ample time for Congress to rein in USPS by enacting some overdue postal reforms.
USPS claims to need the revenue because of falling mail volume. Such annual chicken-little warnings have consistently proven to be false. Actually, USPS has posted more than $5 billion in profits since 1995, and its 1997 annual report projected a growth rate in total mail volume of 3 to 4 percent per year over the next decade. Because USPS is legally required only to "break even," one could ask why it hasn't returned any of its profits to first-class mail customers in the form of lower stamp prices. Why does it continually raise prices instead?
The fact that USPS can ratchet up postal rates virtually at will despite its massive profits points to several significant problems with the Postal Service. It is a grossly mismanaged quasi-governmental agency with a protected monopoly on mail delivery, and almost no one has the power to oversee its activities, let alone block an increase in the price of stamps.
One need only look as far as USPS's own Office of Inspector General (OIG). In its most recent report, OIG identified well more than $1 billion in wasteful spending and mismanagement in the mail business alone. OIG has churned out hundreds of reports detailing an epidemic of mismanagement at USPS. Both the Postal Rate Commission and OIG have questioned the integrity of USPS data. For example, as it did during the last rate hike, USPS has tendered stale data to make its case, omitting from its projections revenues from the January 1999 increase, which are estimated to be in the $1 billion range.
USPS's for-profit ventures have also led to some costly dead ends. The General Accounting Office reported that in 1997 USPS squandered $84.7 million on competitive activities, like peddling t-shirts and hats festooned with the USPS logo and pre-paid phone cards. Its Global Package Link, Global Priority Mail programs, and electronic postmark system are all money losers. First-class mail is USPS's cash cow, so the penny increases in stamp prices are needed to underwrite failures on non-mail business ventures.
Further, USPS freely expands into private markets, using its monopoly advantage to compete unfairly against companies like Federal Express and United Parcel Service. Although USPS claims to fear the growth of the Internet, it is positioning itself to get a piece of the action. Postmaster General Henderson wants USPS to control online bill paying. Laughably, he warns that allowing a "private-sector company" to develop and own the platform for e-payments would be "a monopoly model," but that USPS should be the "trusted third party" that facilitates e-payments throughout the country. In a recent Washington Post article, the Postmaster General compared USPS to every other business in America.
Not true. USPS pays no taxes of any kind. It is exempt from federal antitrust laws, state zoning laws, vehicle licensing fees, and even parking tickets. It has access to below-market rates on credit, the right of eminent domain, and the backing of the full faith and credit of the U.S. government. Conservative estimates of the value of these subsidies exceeded $1 billion in 1997. One researcher observed that these subsidies force taxpayers to make a "down payment on the Postal Service's risks," a chilling thought in light of USPS's rampant inefficiency.
US Postal service cont.,
Who has the power to say no to the Postal Service? Virtually no one. In 1970, oversight of USPS was shifted from Congress to two appointed boards, the Postal Rate Commission and the USPS Board of Governors. However, the Commission can only make a "recommended decision" on rate increases. The last word resides with USPS itself. During the last rate case, Ed Gleiman, chairman of the Postal Rate Commission, seriously questioned the veracity of USPS data and saw no reason for an increase at all. Congress agreed and passed a nonbinding resolution rejecting the rate increase. The price of stamps went up.
USPS must not be permitted to act like a business when it's convenient and then demand that its captive customers bail it out when it fails. The Savings and Loan crisis of the 1980s was a painful reminder that the absence of oversight coupled with excessively favorable tax treatment is a toxic combination, encouraging risk, inefficiency and waste. The U.S. Postal Service needs a reality check and to be forced to account fully for all of its financial and business activities.
Here is a more recent article about how wonderful our postal service is operated:
http://www.forbes.com/2009/04/16/usps-postal-service-mail-opinions-contributors-monopoly.html
James, do you work for this monopoly?
and yet another one ...
http://goliath.ecnext.com/coms2/gi_0199-7349013/The-future-of-the-U.html
James, sounds like your credibility is in question.
Frank, you question whether the "same crowd" would be willing to pay more in taxes for health care. I already pay taxes for health care only it's not for myself. I pay for top rate health care plans for local, state & federal employees. I also pay taxes for health care for those who cannot afford it themselves. Then I have to pay for my own health insurance which runs $800. a month. Under the philosophy of the pro-override people, I should want national health care because the increase in taxes would actually be cheaper for me per month. I don't want the government in my life anymore than it already is. However our health care system is not working. The insurance and drug companies get wealthier and Americans get sicker. Working people pay for others to be covered but they are not always covered themselves. Doctors are steering patients towards more and more testing even though it is not necessary because they are afraid of lawsuits. Insurance companies are in control of the kind of treatment a patient can receive. If you are unfortunate enough to have a serious illness, you are battling the insurance company to cover your care. At the worst possible time in your life, you have to spend your time, if you are able, on the phone trying to get them to pay the bill they are responsible for. Letting the government run health care may not be the solution but the government needs to step in and make some drastic changes to stop this runaway train. The system is broken.
Anon 1:07, Amen to that.
what does being pro-override have to do with government run health care. not a thing.
Wow Frank -thanks for proving my point - you decry the postal service should be more like free enterprise and turn around and say they have to beg to raise the price of a stamp - does big oil fluctuate a whole penny in a year? Probably they had to raise the price of a barrel of oil because their postage was goin' up!
When all is said and done on health care reform, my health care quality will not improve, my insurance premiums will not decrease and I will be paying more through taxes or fees for health care options that I do not qualify for. I am not wealthy enough to afford really good coverage and I am not poor enough to qualify for assistance. Once again, I will feel like I am left holding the bag.
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