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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.



  • From 1980 to 2007 Spending on healthcare in the U.S. has quadrupled while the overall economy has slightly more than doubled.
    Healthcare expenses went from about 8% of disposable income to over 16%
  • The typical family health insurance plan costs $12,000 a year or more.
  • Household Health Spending as a Percentage of Personal Income in the U.S. has gone from 4.8% in 1987 to 5.9% in 2003.
  • Medicare Household spending on healthcare (Kaiser Family Foundation kff.org/medicare/)
    Age Amount %
    65-69 $4,069 12.3%
    70-74 $4,185 13.1%
    75-79 $4,420 14.2%
    80+ $4,457 17.2%
  • Retirees will need an estimated $635,000 (per couple over age 65) to cover healthcare costs in retirement.
  • Nearly 46 million Americans, or 18 percent of the population under the age of 65, were without health insurance in 2007
  • Over 8 in 10 uninsured people come from working families.
  • The Institute of Medicine, in a series of reports published in 2004, concluded that 18,000 people in the USA die each year because they lack insurance.
  • How to pay for healthcare for the uninsured.

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"."

Makary says,
"We did a national survey asking physicians across the country, what percent of medical care, in your opinion, is unnecessary? The average answer was 21 percent. If one in five services delivered in any industry is entirely unnecessary, you'd say that's where the waste is and that's where we need to focus."

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.
Did disease really double? No, we have a crisis of appropriateness.

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 big players are doing extremely well. The stakeholders are making a ton of money except for one stakeholder, which is the patient.

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:

US Canada France Cuba
% of GDP 16% 10% 11%
Life expectancy 78 81 81 78
Infant mortality 6.6 4.8 4.3 6.4
Physician Visits 4 5.9 6.4
Preventable Deaths 115 89 76
Obesity 23% 14% 9%
- 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
Teen motherhood is almost three times higher in the U.S. than it is in Canada and teens are more likely to have low birth weight babies which have higher mortality.

- 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

Health-Care Systems: Lessons From The Reform Experience, 2003

  • In countries with public-integrated systems, efficiency-related reforms have included: introducing separate purchaser and provider functions, better alignment of incentives with objectives through contracts, decentralised decision making, greater competition among providers and, more recently, benchmarking against best-performing hospitals. While the positive impact of such policies has most often been weakened by continued central control, tight spending limits and tighter supply constraints than elsewhere, these policies generally have been sustained, despite subsequent reforms in many countries.
  • Experiments with competition among providers have been less successful and reforms have been reversed in those countries where they were introduced.

Get the facts about the stability and security you get from health insurance reform | Health Insurance Reform Reality Check at whiteHouse.gov
  Frequently Asked Questions (FAQ's)
O.E.C.D (Organisation for Economic Co-Operation and Development)
  Health-Care Systems: Lessons From The Reform Experience, 2003

The National Coalition on Health Care (NCHC)
Statistics at HealthcareProblems.org

Anti Government Healthcare:
Myths About Socialized Medicine at Accuracy in Media (AIM)

Pro Government Healthcare:
Medicare for All: Explanation of Single-Payer
John Geyman: "Facts" About American Health Care Revisited
Why We Need a Public Health-Care Plan - WSJ 6/24/09
US Medical System: The Worst in 19 Industrialized Nations

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last updated 10 Aug 2009