Map of life expectancy at birth from Global Education Project.

Tuesday, October 15, 2013

The real problem with health care in the U.S.

Here's a systematic analysis and a plausible tale told by Buz Cooper. In a pistachio shell:

Problem: U.S. spends more than 2X as much on health care as other affluent countries, gets worse health in return.

Buz says: :

1) Well, kinda, but U.S. is more affluent than most, so as a pct. of GDP we only spend 60% more.

My comment: Why does it follow that we should spend more on health care just because we're wealthier, if we aren't getting more for it? We don't eat six meals a day, or go to school for 30 years. If there's a "right" amount of health care we should just buy that much and spend more of our money on something else. But please go on.

 2)  The price of health care inputs is higher in the U.S. than elsewhere. Further correcting for that, we're only buying 31% more.

My comment: This is a good point, up to a point. On the other hand, given your point 1, incomes in the U.S. are higher than elsewhere so we would expect to pay higher salaries to doctors and nurses and EMTs and so on. But, on the other other hand, there's no reason why we should be paying higher prices for drugs and devices; and even in terms of our own general affluence, some medical specialties are definitely overcompensated. But either way yes, it's true that the higher spending doesn't entirely consist of higher consumption.

3)  The remaining 31% can be explained by general inequality. Poor people, of whom we have a lot compared to Europe and Canada, are less healthy and therefore need more health care.

My comment: Now you're talking. We need to spend much more, not less, on social welfare -- making sure that kids are well fed and educated; creating safe urban environments; providing affordable mass transit to connect people with jobs, and educational and cultural opportunities; providing affordable child care so parents can work safe in the knowledge that their children are well cared for; making sure decent housing is affordable for working people. And all that jazz. If we do that, we can get a huge return on our investment -- we'll save money on health care, have a stronger economy, and have healthier happier more fulfilled people. 

So why are we talking about doing the exact opposite? How did this moronic discourse come to rule our politics?


Daniel said...

So why are we talking about doing the exact opposite? How did this moronic discourse come to rule our politics?

When I was 10 years old I was stirred by President Kennedy's statement ...ask not what your country can do for you... I still am.

The social contract that binds us together as a community and nation has failed. Our toxic politics is a by-product.

Another question is why has our social contract failed?

Anonymous said...

My suggestion - Capitalism.
Originally businesses did only what would improve their own bottom line and nothing else. Their employees still believed in quaint ideas like 'loyalty'.
Now employees are catching on and are adopting the same attitude. So much for community and cooperation.
I suspect that capitalism fails the test of Kant's Categorical Imperative since it won't work very well if absolutely everybody does it.

Anonymous said...

Heh....In a sense, in rich countries everything costs more, hamburgers, parasols, housing or health care. And then there are freaky differences.

E.g. GPs in France earn less than half of GPs in Switz. but in terms of lodging, food, education for kids, comfort of life, they are just as well off. Maybe better, that depends on what one values, e.g. the cost of a flat screen / running two cars / having access to nature / sports / a larger house and garden / and on and on. Or conversely, for the Swiss, great public transport, the best internet, very cheap household machines, easy vacations in other climes, etc.

Yet CH spends double on its GPs. (Who btw are state controlled and don’t earn much.) So..what is the argument here? A good doc in Ethiopia earns peanuts in Int. comparisons but may have a nice house, a good living, a satisfying prof. life.

Sure there are masses of poor and underfunded for health care ppl in the US. But this is not really a ‘health’ problem, to solve it, one has address general politics, incl. immigration, cartels, monopolies, etc. etc.

I mean I know this is obvious so why mix it in?