I could spend the next several years trying to understand this issue. This page is just a placeholder for me to post links to interesting facts and articles right now.
A Freakonomics podcast "How to Fix the Hot Mess of U.S. Healthcare" in March 2021 talks to Marty Makary, a surgeon at Johns Hopkins and the author of "The Price We Pay: What Broke American Healthcare -- and How to Fix It"."
As we've noted before on this show, even doctors respond to incentives, and the incentives in our healthcare system encourage procedures more than prevention. But it's not just unnecessary procedures that Makary is talking about. Over the past two decades, the number of prescriptions issued in the U.S. has nearly doubled.
As our healthcare system was becoming prolific at dispensing pills and procedures, it was also becoming a massive industry. Today it includes more than 18 million workers, and it's still growing faster than nearly any other sector. The jobs have followed the money: over the past two decades, the price of hospital services has outpaced inflation by an average of nearly 3.5 percent each year. Before Covid hit, hospital systems were making record profits. So were insurance companies, with the average American family of four paying about $20,000 a year for coverage. Many insurance firms have done even better recently, as the pandemic led patients to put off non-essential care. So if you consider the primary stakeholders of our healthcare system -- healthcare providers, insurance companies, and patients:
The U.S. has the biggest G.D.P. in the world, and we also spend the biggest share of our G.D.P. on healthcare -- about 17 percent, or $3.5 trillion a year. Among other O.E.C.D. countries, the average expenditure is 8.8 percent; after the U.S., the next-highest is Switzerland, at 12 percent. Now, you could look at America's massive healthcare expenditure and think: how great is it that we choose to spend so much of our money taking care of ourselves and our loved ones; for all that money, we must be absurdly healthy! But we're not. U.S. rates of infant mortality and maternal mortality are shockingly high; we also have high rates of obesity, diabetes, and cardiovascular diseases; life expectancy in the U.S. does beat out Russia, India, all of Africa, and parts of Eastern Europe, but we're lagging Western Europe, Canada, Australia, Japan, South Korea -- as well as Greece and Iceland.
So what, exactly, are we getting for all those pills and procedures? Or maybe the better question is: why do we need so many in the first place? Here's one clue: the U.S. does not spend much money on prevention. The Centers for Disease Control and Prevention -- it's right there in the name -- the C.D.C. spends just $1.2 billion a year for "all chronic disease prevention activities." That is less than $4 per person. Today on Freakonomics Radio: what would you do if you wanted to get better health outcomes without spending the trillions we currently spend?
An article, "Even the Insured Feel Strain of Health Costs", in the NY Times Sun. May 4, 2008 says:
Health plans can cost $10,000/year with a $1,000 deductible.
In one employer's health plan, employees are obliged to pay up to $4,000 of their families' annual medical bills, on top of about $1,600 a year in premiums. Five years ago, their employer paid all the premiums and they were responsible for only about $2,000 of their familiesO medical bills.
They did not say whether the 16% figure in the chart below included an employer's contribution to health insurance.
Deloitte Center for Health Solutions
Government vs Private systems:
- Life expectancy - World Health Organization
Accidental deaths, homicides, obesity and infant mortality are higher in the US lowering Life expectancy.
a 2008 Harvard study showed that life expectancy actually declined in a substantial number of counties from 1983 to 1999, particularly for women. Most of the declines are in the Deep South, along the Mississippi River, in Appalachia and the southern Plains and Texas.
- Infant Mortality (deaths per 1,000 births) at whale.to/a/inf1.html
- Physician Visits - OECD, 2008
- Preventable Deaths (per 100,000 people) - "Measuring the Health of Nations: Updating an Earlier Analysis" (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine.
France is Healthcare leader
A study, entitled "Measuring the Health of Nations: Updating an Earlier Analysis," was written by researchers from the London School of Hygiene and Tropical Medicine. It looked at death rates in subjects younger than 75 that could have been prevented by timely and effective medical care.
Health-Care Systems: Lessons From The Reform Experience, 2003
Anti Government Healthcare:
Pro Government Healthcare:
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