Comments on: Health Costs

By: Sebastian Holsclaw

Sebastian Holsclaw — Mon, 12 Jan 2004 19:49:41 +0000

“Jesus, Sebastian, the statistic lumped marketing and advertising together? That’s a shocker!” Good God zizka, can you read? The lumped marketing, advertising and administration . Just ask the oh so efficient universities how much of a cost administration can be if you want to analyze how stupid it is to combine those catagories.

By: roger

roger — Mon, 12 Jan 2004 00:57:43 +0000

There’s a fascinating book by a Canadian researcher, Edward Shorter, on the ‘sensitivization’ of the patient body. According to Shorter, who is working with doctor’s interviews with patients over the last fifty years, we passed from a stage, in the fifties and sixties, when Doctors were briefly seen as demi-gods (the golden age of medicine, according to Jame Le Fanu—the age when the basis of contemporary medicine, from heart surgery to antiobiotics, was laid down) to a period of patient liberation, so to speak, when the patient became impatient of pain. Hence, the interesting myth of the queue. Of course, in the US, queueing is done by simply avoiding medical care because it is unaffordable. When a system—like the vastly superior Canadian system or Swedish—is posited on “universal care,” that previously hidden queue, household by household, is revealed. Those people who defend the U.S. healthcare system as one in which the market allocates health care are usually very ignorant of the particulars of the health care market—and in particular, the transformation of health care into a compensation package offered by employers. This is a classical instance of what Joseph Stiglitz won the Nobel Prize for—asymmetrical information. It certainly doesn’t make for a free market. It probably couldn’t—the ROI on medical care, without the insurance companies and the monopolistic grip of Big Pharma and the rest of it—that is, a truly competitive system, taken away from its biggest client base, the corporation—would collapse. What we need is a robustly socialist health care system, combined with a robustly private health care system—something like what we have with the mail system, with Fed-ex’s competing with the Post Office to provide a delivery service that has the scale to accomodate the poorest and the private businesses to accomodate the richest. It won’t be a perfect system, God knows—but there is no perfect system. And it would be much better than the patchwork of government interventions and private markets existing today.

By: Markku Nordstr�m

Markku Nordstr�m — Sun, 11 Jan 2004 20:25:31 +0000

Ophelia: the uninsured certainly have a voice in the US. This blog is proof of that. The dead Scandinavian citizens who did not get the health care they needed because they were wait-listed certainly don’t have a voice now. A more telling example is the 15,000 elderly who died in France last summer, – the national health care system failed them. It is axiomatic of a welfare state’s raison d’etre that ALL must be taken care of: otherwise, the welfare state model is a failure. Your arguments fail to convince me that the US model is far inferior to the European welfare state model, when it comes to health care. I assume it has to do with selective, ideologically-based reasoning.

By: Nicholas Weininger

Nicholas Weininger — Sun, 11 Jan 2004 17:16:01 +0000

hope: thanks (even though I’m not Kevin). That goes a long way toward filling some of the gaps I’ve mentioned in earlier comments. Mmm, tasty data. The 1960 numbers are, as I expected, interesting and relevant. US per-capita health care spending then was much higher in dollar terms, but not so much as a % of GDP; the US was near the top in % of GDP but not nearly so far out of line with everyone else as it is now. Now in 1960 the US had what by today’s standards is a pretty completely free-market health care system. At least some of the other countries in the comparison already had socialist systems. So these historical data argue against the proposition that a private system must necessarily impose a much heavier economic burden than a socialist one. Also noteworthy is that in the more recent data sets, reflecting the availability of new medical technology, richer nations (Germany, US, Switzerland) tend to be near the top of the %-of-GDP numbers. Perhaps as nations grow richer, their peoples tend more and more to demand, in effect, luxury healthcare: extraordinary end-of-life interventions, cutting-edge technology, surgery with no waiting list. This sort of stuff costs a lot of money but tends not to show up in the aggregate quality measures beloved of the advocates of socialism. Access to MRIs, for example, does nothing to improve infant mortality and probably doesn’t do much for life expectancy at birth. On those measures where it does show up, the US indeed beats out the rest: the report gives two examples, life expectancy at 80 and waiting times. All of which serves to reinforce my skepticism about the degree to which socialist health care would reduce costs in the US, even compared to our current sorry semi-private mockery of a system. The popular demand for expensive stuff would still be there, and socialism would remove the last obstacles to foisting the costs of said expensive stuff off on other people.

By: grayson

grayson — Sun, 11 Jan 2004 02:47:26 +0000

Fascinating comparison of the US and Canadian models of healthcare at http://www.matthewholt.net/2003_11_09_archive.html#106833375755001170

By: hope

hope — Sun, 11 Jan 2004 02:34:58 +0000

Kevin Brancato asked for a source that looks at health costs and quality across countries. See http://content.healthaffairs.org/cgi/reprint/19/3/150.pdf

By: Zizka

Zizka — Sun, 11 Jan 2004 00:33:07 +0000

Jesus, Sebastian, the statistic lumped marketing and advertising together? That’s a shocker! I’m always amazed when defenders of the American system point out that the American market is being used as a cash cow to keep everyone else’s drug prices low.

By: Kevin Brancato

Kevin Brancato — Sat, 10 Jan 2004 23:04:37 +0000

Is there a current authoritative book that examines, in depth and impartially, the differences in health care cost, quality, and quantity across countries?

By: nectarine

nectarine — Sat, 10 Jan 2004 21:11:27 +0000

Anon, I think your experience is fairly typical. Were the guys relatively young as well — 20s & 30s? At that age, many of us aren’t so good at long-range planning or risk assessment; hanging on to more cash by gambling on good health and good luck seems like a wise financial decision. I’ve read a few suggestions for dealing with this, such as keeping income tax refunds unless the payer can prove insurance enrollment. Kind of like making proof of car insurance a requirement for registering the car. (Ophelia, they intend to not pay the ER bill by just flat-out not paying it. Construction workers tend to be a pretty mobile population; they probably count on being gone before the collection agency catches up. )

By: Ophelia Benson

Ophelia Benson — Sat, 10 Jan 2004 18:25:37 +0000

Also, this is interesting – “Don’t believe the hype about welfare state based healthcare being the best solution:” I’m always fascinated by rhetoric. The ‘hype’? What hype? Surely in the US there is far more ‘hype’ about the evils of ‘socialized medicine’ than there is about its virtues. Am I wrong about that? And if I am – if there is more hype in favour of a national health than there is against it – why don’t we have it?

By: Ophelia Benson

Ophelia Benson — Sat, 10 Jan 2004 18:21:58 +0000

“At least in the US, the ones that are outside the system… still have a voice.” No they don’t. Not really. Because the axiom of US politics is that money buys you access [to politicians]. It doesn’t (the bromide goes) buy you results (in fact it does, but put that aside), but it does buy you access. Well, poor people don’t have the money to buy access any more than they have the money to buy health insurance. Insurers, on the other hand, do. So no, the uninsured really don’t have much of a voice.

By: Nicholas Weininger

Nicholas Weininger — Sat, 10 Jan 2004 17:46:08 +0000

Some more data missing here: long-term time series on health care spending as % of GDP, and in constant dollars per capita, for the industrialized countries. Many of the socialist systems in other countries have been around for many decades now, longer than health care costs have been a big issue in the US; surely people have been keeping records on this stuff for a long time. It would be very useful to see whether the gap in spending levels existed in, say, 1964 (and what the life expectancies, infant mortalities, etc. were at that time, too), and how it’s changed since then. It is at least plausible that the US has high costs partly as a result of being, perhaps for cultural reasons, an “early adopter” nation when it comes to health care. Early adopters of any sort of thing tend to pay much more and get less than those who wait for the cheap mass-market versions. And in the last couple of decades there’s been a whole lot of stuff to adopt early.

By: Ophelia Benson

Ophelia Benson — Sat, 10 Jan 2004 17:11:50 +0000

“In meetings to convince employees to take the insurance, they claimed they could go to the emergency room for free anyway, so why get insurance? (I assume they were just planning to never pay the bill.)” Really – that’s interesting. Did other employees at the meetings point out how idiotic that is? It’s not all that easy just to never pay the bill, after all – unless you are in fact destitute. Did anyone point out that they could lose their savings, cars, credit, etc? I’m not disputing your account; I’ve met idiots too, I know they’re out there. I’m just curious.

By: Markku Nordstr�m

Markku Nordstr�m — Sat, 10 Jan 2004 17:08:21 +0000

Don’t believe the hype about welfare state based healthcare being the best solution: people are dying in Scandinavia because they can’t get the health care they need in time. The system is so overburdened that countries often export their patients to other countries to relieve the pressure. Should that happen in the US, the people responsible would be singled out faster than you can say “lawsuit!” But as the state is responsible for everything in Scandinavia, the possibilities for redress – and reform – are quite limited. Even the media in Scandinavia plays along, usually burying the stories – and the issues they raise – into innocuous articles about unfortunate incidences. Yes, people fall through the cracks in a national health care system, too: the dead. At least in the US, the ones that are outside the system… still have a voice.

By: Nicholas Weininger

Nicholas Weininger — Sat, 10 Jan 2004 15:12:51 +0000

Very few of the anecdotes I’ve seen have mentioned end-of-life care or care patterns vis-a-vis extraordinary interventions for extremely sick people. These are major, major cost drivers in the US, and tend to be ignored by people who express perplexity at the US system’s costs. I once worked as a programmer for an HMO. I recall running some statistical analyses on a large claims data set and finding that about 1% of all claimants were responsible for 50% or so of claim dollars. I expressed surprise at the time, being new to the industry, and was told that this was entirely typical. Most anecdote tellers on any side of the debate, I think, seem not to have much experience in that 1% or understanding of who they are—and this severely lessens the relevance of said anecdotes to the cost/efficacy question.