Wonder where the money went?

The new issue of Health Affairs is titled "The New Urgency To Lower Costs." I'm not sure it's really all that new except that it has become a major political obsession -- not to lower costs, that is, but to dump them from the federal government onto consumers.

Health Affairs, like a lot of the cool stuff I get to read, is not available to people who don't have a faculty appointment, but all you need to get the idea is the Table of Contents and the abstracts.

September 2011; Volume 30, Issue 9
The New Urgency To Lower Costs

Desperately Seeking Savings: States Shift More Medicaid Enrollees To Managed Care
John K. Iglehart

A Decade Of Health Care Cost Growth Has Wiped Out Real Income Gains For An Average US Family
David I. Auerbach and Arthur L. Kellermann

Lower-Income Families Pay A Higher Share Of Income Toward National Health Care Spending Than Higher-Income Families Do
Patricia Ketsche, E. Kathleen Adams, Sally Wallace, Viji Diane Kannan, and Harini Kannan

Higher Fees Paid To US Physicians Drive Higher Spending For Physician Services Compared To Other Countries
Miriam J. Laugesen and Sherry A. Glied

The Growth In Cost Per Case Explains Far More Of US Health Spending Increases Than Rising Disease Prevalence
Charles S. Roehrig and David M. Rousseau

Health Care Costs Are A Key Driver Of Growth In Federal And State Assistance To Working-Age People With Disabilities
Gina Livermore, David C. Stapleton, and Meghan O'Toole

Enrolling People With Prediabetes Ages 60–64 In A Proven Weight Loss Program Could Save Medicare $7 Billion Or More
Kenneth E. Thorpe and Zhou Yang

Not that real income gains for the average U.S. family were all that much over the past 10 years -- they would have been a little over 600 bucks, but it turns out that all but 95 bucks went to health care. That's including premiums, out of pocket, and taxes. Part of the reason it costs so much here is that physicians in the U.S. -- especially outside of primary care -- get paid a lot more than physicians in other countries. You may think that's as it should be, but we're just pointing it out. And we aren't spending more and more all the time because we're getting older, or sicker: it's because we're paying more all the time to deal with similar problems. And it's busting state budgets. And we could save a lot of money just by not being so fat. That's the story you can read off of the table of contents.

News to no-one, I hope. It's fine to spend more on health care if we get more for our money and we want to pay for those better outcomes, but we're only getting a little bit more for a lot more money. Instead of kicking old folks off of Medicare and giving them vouchers that won't pay the cost of what they need, and just kicking poor folks off of Medicaid and telling them to drop dead, we can get better results and spend less money at the same time.

We need universal, comprehensive, single payer national health care.