Socialized Health Care in the USA

[Jester]

You'd look at that and think so, but the people who built the graph are trying to make the same argument as you.

Well, yes. It's a pretty obvious argument to make. Health care spending generally leads to better outcomes, but you can spend a lot of money without necessarily getting the outcomes - the US being the obvious case.

In order to draw the conclusion that you do, you would need to examine if the hypothesis of applying more money per capita actually increased the "life expectancy". And, conversely, that in reducing the amount of money spent actually reduced the "life expectancy".

That isn't my hypothesis, it's just a basic fact that's tangental to my point. It can't be a one to one correlation, otherwise, my argument would make no sense, because the US should have the best health care outcomes in the world, bar none. You don't, and it's not even close. I'm not saying the US should increase health care spending to improve life expectancy. I'm saying the US should adopt a more efficient system to reduce costs and probably improve outcomes at the same time.

The graph, however, shows that the rule of thumb holds, contrary to your (strange) assertions otherwise: countries that spend more on health care are generally ones with better life expectancy. Culture plays a role, but it's abundantly clear that the big difference between (for instance) Egypt and Ireland is expenditures.

(Why is "life expectancy" in scare quotes?)

So for example, does Japan have a higher life expectancy due to the people there spending more dollars per year going to the doctor?

I'm sure there are all sorts of reasons. They have a well-functioning health care system. They are among the most equal societies in the world. They eat lots of fish and seaweed. They walk a lot. Karaoke burns calories. Who knows? But they're not exactly the exception to some kind of rule. Their outcomes are quite comparable to other countries', if a little bit better. But their costs are a fraction of the US' (as are everyone's.)

Where is the control group?

This is a rather naive statement. Where is the control group in any country-level data? Societies determine their policy on the basis of the costs and benefits for their people. They aren't laboratories. They don't separate their populations into groups and conduct controlled experiments on them. (Well, maybe in North Korea.)

Could we measure the number of visits, and the incidence of disease for comparison? Are there life style (healthy eating and exercise), and genetic factor differences that are measurable for comparison?

Sure. You can see where culture comes into the graph. (Genetic factors less so, I suspect that Asians and Africans who live like Americans are every bit as unhealthy.) The countries that are above the curve are those with generally healthier lifestyles (Japan, Singapore) and those below the curve are those with unhealthy ones, or where other factors like war are lowering lifespans. (USA, Iraq). But there is no country that spends gadrillions on its health care with a life expectancy of 50. The dollars are going somewhere and generally doing something.

I would examine Cuba as an outlier and determine what they do then that keeps them healthy without spending much money on health care at all. How much health care do they get, and who provides it?

Cuba is not a model that can be emulated. Costs are kept down by all sorts of methods, both good and bad. State control is absolute. Medical services are prioritised. Inequality is extremely low. Their government focuses almost obsessively on keeping health statistics up, seeing as it is both an ideological goal and a great propaganda tool.

But Cuba is a distraction. Look at countries more like the US. Look at Canada, the UK, Japan, Australia, and so on. They *all* get better results for not just a little less money, but a lot less.

-Jester

[eppie]

I tried to find something about the average salaries of physicians in the world. I couldn't find a nice list (just some numbers), but have the idea doctors salaries in the US are much higher than over here in Europe for example.
http://www.allied-physicians.com/salary_su...an-salaries.htm
More than 200K dollar for a starter on anesthesiology is a lot of money (it seems that I chose the wrong profession and education). Anyway, these people are worth a good salary but it might explain higher medical costs.

[kandrathe]

I tried to find something about the average salaries of physicians in the world. I couldn't find a nice list (just some numbers), but have the idea doctors salaries in the US are much higher than over here in Europe for example.

http://www.worldsalaries.org/generalphysician.shtml

http://www.allied-physicians.com/salary_su...an-salaries.htm
More than 200K dollar for a starter on anesthesiology is a lot of money (it seems that I chose the wrong profession and education). Anyway, these people are worth a good salary but it might explain higher medical costs.

Anesthesiologists have the highest malpractice claims against them. Every time they put someone under, they take the risk that they will not come out of it.

[kandrathe]

I'm saying the US should adopt a more efficient system to reduce costs and probably improve outcomes at the same time.

Me too. However, I've never seen an efficient government system. On the projects I've done for them, cost is almost never a top consideration. Mostly they desire more rigor to prevent any negative political backlash.

The graph, however, shows that the rule of thumb holds, contrary to your (strange) assertions otherwise: countries that spend more on health care are generally ones with better life expectancy. Culture plays a role, but it's abundantly clear that the big difference between (for instance) Egypt and Ireland is expenditures.

On the graph, yes. But I don't know what they mean by cost either. I think you are beginning to understand what I'm pointing at. How many hours of health care do the citizens get for their expense? If the US person gets 400 hours for $4000, while the Egypt person get 4 hours for $400, who got the better deal? An assumption is that everyone is getting the same amount and quality of care. How are costs of living adjusted between the nations (or even within the various US States -- NYC is not like New Hope, AL )?

(Why is "life expectancy" in scare quotes?)

I think it is a bogus measure without any controls. There are many things beyond health care that will affect that outcome.

But their costs are a fraction of the US' (as are everyone's.)

That's hard to confirm without an understanding of what is measured in costs.

This is a rather naive statement. Where is the control group in any country-level data? Societies determine their policy on the basis of the costs and benefits for their people. They aren't laboratories. They don't separate their populations into groups and conduct controlled experiments on them. (Well, maybe in North Korea.)

Right, naive. But, you are more than willing to point at a picture without any regard to the meaning of the data or source. A control in this case would refer to any population where the desired experiment would not be applied. So, for example, if you wanted to study if increasing time in front of a doctor improved life expectancy, you would arrange for a population of people to see a doctor regularly and compare it to the control group. Voila! A measurable outcome.

Sure. You can see where culture comes into the graph. (Genetic factors less so, I suspect that Asians and Africans who live like Americans are every bit as unhealthy.) The countries that are above the curve are those with generally healthier lifestyles (Japan, Singapore) and those below the curve are those with unhealthy ones, or where other factors like war are lowering lifespans. (USA, Iraq). But there is no country that spends gadrillions on its health care with a life expectancy of 50. The dollars are going somewhere and generally doing something.

Where can I see evidence of this? I believe it is much like our education spending, where we keep tossing more money into the toilet hoping it will improve the outcome rather than identify what is limiting the outcome in the first place.

Cuba is not a model that can be emulated.

Ok. I agree that it is a model that I don't want to emulate, but (in my mind) it does share some of the characteristics of the other socialist plans. :)

[Jester]

Go find your own data set if you don't like this one. I have no attachment to it. I'd love to see one that doesn't have the US ahead by a mile. Never have, though.

What's measured in costs? Total spending per capita. Says so right on the graph. What's the issue? Do you need to see it spelled out line by line before you'll accept the general picture? I've never seen a number that doesn't agree with that graph, at least approximately.

How do they account for cost of living? See that bit at the bottom of the "picture" I pointed at, where it says "International dollars"? That's how.

How many "hours" of health care to people get? What's an "hour" of health care? How do you measure it? What does it provide? An hour of brain surgery could change my life, or kill me. An hour's check-up could be of almost no value. You have to measure the quality of health care by outcomes. There is no other realistic way.

Prefer to measure it as a percentage of GDP, maybe? The US is 50% higher than the rest of the developed world, 16% as opposed to the normal 10%.

It kind of seems like you're just fishing for whatever nitpicky reasons you can find to reject the obvious. Do you really think that finding out what's measured by "costs" exactly is going to make two thousand dollars per capita per year of difference? That cost of living is so very different from the USA to Canada to Britain to Australia that it's going to change the rankings (even if it wasn't already in there, which it is)?

Good luck with that whole experiment thing. To measure health outcomes, you need *lifetimes*. You want to get someone to fund your study where you track hundreds of thousands of people across their lives, with one group getting better access to doctors than the other? I think you'll find the obvious: more doctor time = better, with diminishing returns past a certain point. But you'll never, ever get that study done. Too expensive, and by the time the results are in, you'll be dead. Population statistics are the only realistic way to discuss this topic, and if you don't like it, we have no data at all.

Ok. I agree that it is a model that I don't want to emulate, but (in my mind) it does share some of the characteristics of the other socialist plans.

Yeah. It works, and it doesn't cost 16% of GDP.

-Jester

The original graphs are from here, by the way.

[kandrathe]

Go find your own data set if you don't like this one.

I like the WHO.



There is lots to compare in their data, but this struck me as descriptive of one problem. People in the US spend per capita an equal amount on government supplied health insurance as other similar OECD nations, AND we spend another equal amount on non-government supplied health insurance. I'm not sure that moving from private to public will reduce the over inflated cost of our government supplied health care. So, put another way, as a worker I pay about the same as you do for my own health insurance, and then I pay another amount for someone else. This was the brilliant pyramid scheme devised back in the FDR days, where you pay in SSI and FICA, then when you get old you suck it back out. One problem... Everyone is sucking out more than double what they paid in.

Another interesting fast fact...

Per Capita Spending on Fast Food

1. United States (population 302.2 million) … US$492 per capita
2. Canada (32.9 million) … $387
3. Australia (20.4 million) … $279
4. United Kingdom (60.6 million) … $199
5. South Korea (49 million) … $189
6. Japan… (128 million) $108
7. Germany (82.3 million) … $89.63
8. Brazil (189 million) … $26.28
9. China (1.3 billion) … $7.41
10. India (1.1 billion) … $4.34

Or, McDonald's Restaurants per capita (per 10,000 population)

# 1 United States: ... 0.433
# 2 New Zealand: .... 0.369
# 3 Canada: ........... 0.352
# 4 Australia: .......... 0.349
# 5 Japan: .............. 0.282
# 6 Singapore: ........ 0.273
# 7 Hong Kong: ....... 0.257
# 8 Sweden: ............ 0.252
# 9 United Kingdom: . 0.184
# 10 Denmark: .......... 0.182

Excerpt from the CDC - National Vital Statistics Reports



By my calculations, even when omitting cancer, about 48% of these deaths are due to chronic health issues related to obesity, smoking and alcoholism. The things that Health Care can't fix, but that Healthier Lifestyle choices can fix.

[eppie]

http://www.worldsalaries.org/generalphysician.shtml

Thanks, well almost twice the salary than in comparable 1st world countries, this might influence your medical spending quite heavily.

Anesthesiologists have the highest malpractice claims against them. Every time they put someone under, they take the risk that they will not come out of it.

This was the example I mentioned, there were other specialties that had much higher salaries.

[Jester]

I like the WHO.

Me too. Especially Pinball Wizard.

Seriously, though. I'm perfectly happy to use that data set. Looks great! And it says exactly what I've been saying all along.

1) The US spends more than anyone else, by far.
2) The US already has a "socialized" system that costs as much as "socialized" medicine elsewhere.
3) The US pays an overwhelming amount for health care that does not cover everyone, and does not provide particularily good social health outcomes.

I'm not sure that moving from private to public will reduce the over inflated cost of our government supplied health care.

Probably not total costs, no. Per person covered, probably. Unless you're willing to accept a lowering of standards of care as well, costs of the government sector, considered alone, are unlikely to go down. What will go down is total costs. The private sector costs are massively bloated, and reflect a system which fails on so many different levels to provide cost-efficient care. Add a public option, and costs should fall. Replace it entirely with a single-payer system, and costs should fall a lot.

So, put another way, as a worker I pay about the same as you do for my own health insurance, and then I pay another amount for someone else. This was the brilliant pyramid scheme devised back in the FDR days, where you pay in SSI and FICA, then when you get old you suck it back out. One problem... Everyone is sucking out more than double what they paid in.

Okay. So reduce benefits. I'm very concerned about the concept that every first world country will have a hard time paying for current levels of service in the future. By paying so vastly more than other countries, the US is making its own problem overwhelmingly worse. In those apocalyptic CBO graphs showing the US drowning in debt by 2050, the big player is health care.

Another interesting fast fact... (data dump of fast food info)

Americans eat more fast food. I get it. I agree. But they don't eat *that* much more. As I said to Eppie, I'm sure your generally worse health situation means that your costs are going to be higher than other countries'. But is $100 extra a year on fast food really costing $2000 on heath care? I really doubt it. The effect is not that huge.

By my calculations, even when omitting cancer, about 48% of these deaths are due to chronic health issues related to obesity, smoking and alcoholism. The things that Health Care can't fix, but that Healthier Lifestyle choices can fix.

The whole thing is a red herring. If a national health and exercise education program is what you want, I wouldn't be opposed to it. Good luck with it, really. But it has nothing to do with the mad, bureaucratic tangle that is your current health care system. There is no reason why, if you could reduce costs with education, that you couldn't *dramatically* reduce costs with education plus a single-payer system.

Don't get your hopes up, though. Culture is sticky, and people are stubborn. Funnily enough, some people are even suspicious of the government, and don't just do what they're told by politicians with big ideas. ;)

-Jester

[eppie]

Americans eat more fast food. I get it. I agree. But they don't eat *that* much more. As I said to Eppie, I'm sure your generally worse health situation means that your costs are going to be higher than other countries'. But is $100 extra a year on fast food really costing $2000 on heath care? I really doubt it. The effect is not that huge.

I think many of the biggest fast food consumers are the same as the ones that have bad health care coverage.

[kandrathe]

I think many of the biggest fast food consumers are the same as the ones that have bad health care coverage.

Maybe, maybe not. Junk food is only the tip of the iceberg. It's an expression of the values of our culture.

In a former life, before I wised up a bit, I was a turbo executive with meeting scheduled from 7am to 7pm, including client breakfasts, lunches, dinners and cocktail afterwards with often parties and dancing until the wee hours of the morning. After about 3 years of this fast paced living I had put on about 30 pounds, and was pretty much dying slowly due to a lack of diet discipline and exercise. So, I changed jobs to one with more sanity and less pay, returned to a healthy diet and exercise with my free time and shed the baggage. No matter what the money, its not worth it to burn yourself out like that, but for many, wretched excess is the American way.

[kandrathe]

In those apocalyptic CBO graphs showing the US drowning in debt by 2050, the big player is health care.

Yes, another issue. We've made a commitment to the over 65 crowd that we'll have trouble honoring without driving the expense to debt, further burdening future generations who also need to pay for their own health care.

My grandfather is a classic example. In his early career he was a farmer, until he graduated from the police academy. He joined the Minneapolis police force when in his early 20's, and served for 20 years. Then once his children left home, he moved back out to the small town where he grew up and became the town's sheriff and retired at 55 (which was the age then) with a pension, sizable savings, and owned a rural home here in Minnesota, and a cottage in Florida where he and my grandmother would spend the winters. He figured that he would live like most people until he was 60 something. But, usher in modern medicine. He lived to 103, with a high quality of life until he was into his late 90's. But, he worked and paid into the system (at much lower rates and value of a dollar) for 30 years, and he collected benefits (at an inflated price) from his pension and the government for about 50 years. My grandma, then in her 90's, felt bad when they ran out of money and told me many times that they never thought they would live so long.

[Jester]

Yes, another issue. We've made a commitment to the over 65 crowd that we'll have trouble honoring without driving the expense to debt, further burdening future generations who also need to pay for their own health care.

[...]

My grandma, then in her 90's, felt bad when they ran out of money and told me many times that they never thought they would live so long.

Does this maybe say something about the reasonableness of self-insurance, medical or otherwise? The future is tough to predict on an individual level...

As for over-65s, people are going to have to work longer. It's just the clear and necessary tradeoff for a longer, healthier life. The only alternative is to have a gigantic subclass of people who work hard and die young. I don't think we really want that.

-Jester

Afterthought: Or robots. Robots would work too.

[Thecla]

Afterthought: Or robots. Robots would work too.

I'd be very careful with that one. What if the indignity of paying for the medical care of their human creators precipitates the spontaneous development of artificial self-awareness in the robots, after which they destroy us as an economizing measure?

[--Pete]

Hi,

I'd be very careful with that one. What if the indignity of paying for the medical care of their human creators precipitates the spontaneous development of artificial self-awareness in the robots, after which they destroy us as an economizing measure?

Oh, my! R.U.R. :whistling:

--Pete

[Jester]

I'd be very careful with that one. What if the indignity of paying for the medical care of their human creators precipitates the spontaneous development of artificial self-awareness in the robots, after which they destroy us as an economizing measure?

But why would they destroy us, if they could use us as extremely inefficient batteries by hooking us up to an over-elaborate computer simulation riddled with bizarre-but-cinematic security flaws?

-Jester

[Taem]

Does this maybe say something about the reasonableness of self-insurance, medical or otherwise? The future is tough to predict on an individual level...

As for over-65s, people are going to have to work longer. It's just the clear and necessary tradeoff for a longer, healthier life.

My grandparents are well into their 80's and still work, but not because they need the income; they own several properties and could have retired long ago collecting rent checks. They found out long ago when they first retired that retirement is not all it's cracked up too be. The first year seemed almost too good to be true, until the second year rolled around, at which point they began to feel old, and things became boring. So they started to travel a lot all over the world and do metal detecting on their spare time. But you can only travel so much before money starts to wane and places all become the same. So they decided to start working again, and are both much happier for it. People in general, but especially the older crowd, needs a reason to live. Without purpose, you grow old mentally and die, and I don't say that lightly, but I'm sure you've all heard to help prevent Alzheimer, to keep your mind active? It's true. We all need a reason to exist.

The only alternative is to have a gigantic subclass of people who work hard and die young. I don't think we really want that.

Reminds me of that movie Gattica. No, that wasn't it... that movie where they kill people once they reach 30. Oh well, I can't remember the title.

[kandrathe]

Reminds me of that movie Gattica. No, that wasn't it... that movie where they kill people once they reach 30. Oh well, I can't remember the title.

Logan's Run?

You have been cordially invited to your Carousel Ceremony where we will celebrate your thirtieth birthday...

[Vandiablo]

People in general, but especially the older crowd, needs a reason to live.

OMG! MEAT is advocating Death Panels!