Why are our heath care costs so very high, as compared to other countries?

Wonderful rebuttal, as usual.

Oddly, these problems -- to the extent that they exist at all and shouldn't actually be taken as evidence of how desperate those seeking somehow to explain away the US's sorry last-place ranking are -- would not favor any one country in particular over another.

Only in the US?

Dead is dead. It doesn't matter which element of the system fails. WE RANK LAST!

LOL!!!

It would be more hoinest than you apparenly care to be to state that the US and other developed countries are all tracking along the same path, but with the US a few years ahead of the others and developing countries not lagging at all far behind the wealthier group either.

It has nothing to do with the state of our national health care system, that's the beef. It's a crude and meaningless diversionary tactic and nothing more. Obesity will do what it does. The system will either continue to stink, or we will continue the recently-begun process of at least trying to do something about it. All of those developed countries whose unhealthy and also rising obesity levels rival our own have national health care systems that deal with all of their various health problems more effectively than ourt system does, and they all do it at a lower cost.

More meaningless drivel. Blacks will continue to live in this country at about their present levels regardless of what health care system we have. Unless it is your intent to implement a health care system that is based upon the idea of deporting a lot of blacks.

No one with any sense is singing the praises of either obesity or the US health care system.

And being an uninformed, uncritical couch potato is not an acceptible substitute for actually doing (or having done) the necessary legwork. Which itself isn't actually all that hard, since the evidence of substandard performance by the US is virtually everywhere.

The point is that public opinion polls are not a refutation of mounds of actual evidence. No serious person would even attempt to put forward such a contention. Most people have not got the first idea of what sort of health care they actually receive. Lack of any sort of medical sophistication at all on the part of consumers is one of the factors that distorts health care markets away from the efficient mechanism that they would need to be for any of your impossible dreams to come true.

 

So I looked up some basics on the Japanese system and it doesn't appear to be the panacea you make it out to be. Mock me if you choose for citing Wikipedia, but here's an excerpt:

So if I understand correctly, the Japanese have up to a 30% copay on everything, costs are higher without a referral, private insurance supplements the national coverage, some costs are not covered by the universal plan, and there have been issues with access as well as patients seeking treatment for "relatively minor problems." My first search didn't turn up anything regarding the quality of outcomes in Japan, but I'll continue to dig a little deeper. Feel free to point me towards some better sources.

 

Here is a much more robust discussion of the shortcomings of the Japanese system:

McKinsey Quarterly (must register to view entire article - registration is free)

Some excerpts:

 

Question? When did our health cares costs start rising drasticallty?
I remember 30-40 yrs ago, a lot of hospitals and such were religion run non-profits. Now seems like all hospitals are for profit. Any correllation?

 

And one more from The Economist: Healthcare in Japan - Not all smiles

 

A single payer, like the Post Office that lost $20,000,000,000.00 over the last couple of years? Or Amtrak that costs over $1100.00pp for a cross country trip and takes over 4 days? But has NEVER broke even since inception in 1971? And has received Billions from the taxpayer to keep operating even tho they have missed EVERY deadline to show a profit or stop operating?

Those kinds of single payers?

Or single payers like Medicare and Medicaid? Our total per capita health care spending is about $8000. Which includes the Medicare/Medicaid spending. But both Medicare, old people, and Medicaid, young people, cost the taxpayers about $10,000. per person covered. So the single payer is 20% higher and it is the only system that has VERY STRICT price controls on providers. In fact the government doesn't control the price, they simply inform the providers how much the government will pay. And require by law that the provider accept that reimbursement. They pay less than half whet normal charges are, yet they end up costing 20% more.

That's a good system in your book?

 

Excellent response, Dan40.

This is very true: "In fact the government doesn't control the price, they simply inform the providers how much the government will pay. And require by law that the provider accept that reimbursement."

Surfer Joe is now speechless!

 

Check the graph again. When it gets steeper, that means the rate of increase is rising.

What you said was: The increase in prices is due to several factors (aging population, poor personal health, etc.). The problem with health care is sick people. Without them, we'd be fine.

Then why do you assert that there is some sort of delicate pricing mechanism that is in danger of being disturbed. Do you not know that free markets are suboptimal in the presence of imperfect information?

More that the basic procedure was subject to price-shaving while more than those shavings was being added onto the price of the new quality options that were then heavily pitched to consumers.

No, they don't. In fact, your "simple market fundamentals" hold only in certain types of markets, and sellers go to great lengths to minimize the degree to which markets that they sell into are in fact among those.

And once again, people are not shielded from the cost of their medical care. They see the bills for the full amount, plus what their insurers paid and what they paid. They also see the premiums they pay as those go out the door. This Stosselism that people are somehow clueless as to what their health care costs is more mindless garbage. People who are not John Stossel of course tend also to make medical decisions based on more that just the basis of price.

Too late to go back and edit this, I'm afraid...
The free market works! It works for cars, computers, cellphones, food, etc., so why wouldn't it work for healthcare!?

Ah, sweet paranoia! How have things worked out for the French, Germans, Taiwanese, and all those others to whom the US is a laughing stock?

 

They may see the full amount (if they care to look) but they have little incentive to manage the costs paid by insurance. And of course they make decisions on more than the basis of price - if they're paying a $30 copay either way, they'll likely seek out the highest quality, most expensive care since everything beyond $30 doesn't really concern them.

 

And completely factual. Your empty allusions and self-serving assertions do not constitute "proof" of anything except for your comically massive ego. If you want to pretend that making claims is the same as substantiating them, then I'm more than happy to let you wallow in your narcissistic folly for the remainder of this discussion.

Irrelevant. The metric is arbitrary and subject to numerous shortcomings, hence it is not a reliable healthcare indicator.

Of course not, and that was never my point. You tried to imply that "death by amenable causes" does not discriminate between black/white, lean/fat, etc., but that simply isn't true, because certain groups have a higher propensity to establish comorbid complications; obesity, for instance.

Of course it matters which element of the system fails because we have both private and public elements in our system. You can't very well use "death by amenable causes" to attack the private element of the healthcare system when the metric cannot establish which element of the healthcare system performs sub-optimally. HELLO!?

Which is irrelevant. We're the fattest, and being fat is bad for your health. This would help to explain, in part, our disproportionately higher healthcare costs. Or are you seriously trying to argue that less obesity would NOT result in lower healthcare costs for our country?

You keep bringing up costs as a measure of success. Our disproportionately higher obesity rates can help to explain our disproportionately higher costs, hence, it is not a failure of our system but a simple symptom of our populace's composition.

Asserting your empty opinion as fact AND engaging in outlandish hyperbolic misrepresentation? Anymore logical fallacies and blatantly dishonest tactics you want to employ?

My point is that there are subsets of our population who skew our healthcare indicators down because of things like lifestyle and genetics. It has virtually nothing to do with the alleged failures of our healthcare system; people who are genetically predisposed towards certain ailments, or who are engaged in unhealthy lifestyles, will negatively impact our national life expectancy, infant mortality rate, and healthcare costs REGARDLESS of the system. That is the point! A point you seem pathologically incapable of getting.

You are IGNORING and DISMISSING it as a contributing factor to our relatively sub-optimal healthcare outcomes. You are doing this because it undercuts your partisan attacks on our healthcare system.

You expect me to research and substantiate YOUR CLAIMS? Your ego is totally out of control. Really, get over yourself.

If you have no desire to substantiate your claims, then I'm more than happy to leave it at that, which is to say you haven't provided a shred of evidence to support anything you've said or asserted.

Public opinion polls pertaining to the provision of healthcare are extremely relevant when you're talking about radically altering the manner in which healthcare is provided. As it stands, a large majority of Americans are quite satisfied with the quality of care they receive as well as their health insurance. Your response to this seems to be that Americans are too dumb to competently assess the quality of the healthcare they receive, but this argument could be made for virtually any industry that Americans rely on, whether it is finance, law, or even education. Of course, I wouldn't put it past you to want to nationalize those services either...

 

Do the math yourself. The highest percentage increase in costs occurs between 1970 and 1980.

I guess simple logic is too much for you to grasp.

We have higher costs because we have MORE unhealthy people as a percentage of our population than do other countries. We have MORE unhealthy people because we have more obese and elderly as a percentage of our population, which is NOT a failure of our healthcare system but a simple consequence of (a) poor choices and (b) demographics. Nationalizing our healthcare system will do nothing to mitigate either of these factors, a point that has repeatedly gone over your head.

Because imperfect information exists in every transaction and interaction between consenting individuals, but the market's pricing mechanism (i.e., supply and demand) still works better than any system which has been heretofore devised by man despite this "shortcoming". There is no way to eliminate this "imperfect information" because it is an inherent and fundamental part of human existence. That doesn't mean we can't attempt to mitigate it with limited government interventions into the market, but it's not excuse to abandon it entirely as you want to do. And "sub-optimal" is just a statist euphemism for "imperfect", which is inherent to any man-made system, private and public.

Empty speculation, your specialty.

Indeed! They do go to great lengths to inhibit competition in markets. One of their favorite tactics is to use the police powers of the state to obtain favors and create barriers to entry for the marginal firm.

I see. So, you don't think people are capable of competently assessing the quality of their healthcare, but when it comes to assessing the finances of their healthcare, well, they're just regular whiz-kids who measure and balance every penny.

Once you've resolved that glaring contradiction in your logic, explain how "seeing the bills" is the same as actually having to pay them yourself. I've seen bills to my insurance company before, but it wasn't the same feeling I had when the bill was addressed to me. I'm assuming the effect is largely the same for everyone else.

And where does that necessarily imply the market "should be left to itself"? There isn't some universal definition of a "free market" that everyone must adhere to. For an anarchocapitalist, "free market" has a different meaning than for a minarchist or a Federalist or monetarist. The common theme underlying the concept of a "free market" is of supply and demand, but how it operates in practice can vary between schools of economic thought. Sorry if I don't fit into your narrow and rudimentary left-right paradigm.

Seeing as how we're subsidizing their national defenses, it's no wonder they can afford a universal healthcare system. Of course, I'm not opposed to the idea of a universal healthcare system in the US, I simply feel it should be done through the Amendment process instead of the perverted, extra-constitutional progressive parliamentary trickery that was used to ram Obamacare down our throats.

 

Greed, disregard for the ACTUAL well-being of human beings and worship of wealth.

We need a system with a PUBLIC option or Single Payer right now!

 

You like the Japanese system? Interesting...



Their rate of death by amenable mortality seems to be relatively high. It's only when ischaemic heart disease is included that Japan's ranking improves.



The reason for this improvement? Their diet, which is rich in omega-3 fatty acids. That's why the age-adjusted death rate resulting from ischemic heart disease in Japan has been estimated to be one-sixth that observed in the United States.

Again, variables such as diet are able to better explain the disparity in healthcare outcomes between countries than their differing healthcare systems.

 

You would consider this rational behavior? Just because you have an out-of-pocket cost of $0, you are really going to go out of our way to spend all this extra time in dropping the car off over and over so that people can install and replace things that you know full well you don't need and that won't help your car? By the way, if some inept shift work by a kid could wreck the transmission in your expensive sports car, you were hosed for that as well.

If these visits were so frequent for you to have lost count of them, you should perhaps have asked the pediatrician where the line was in his mind. How bad should it be before you need to come in? Very young children are of course quite susceptible to ear infections, and if left untreated, they sometimes do and sometimes don't become an actual problem. But if you would have welcomed a financial incentive to cut back on such visits, what was it that stopped you from simply cutting back without one?

Let's get over this "moral hazard" addiction. It's almost as bad as the "obesity" addiction that's been going around. The cost that people either do or do not react to in these scenarios is the old Fall Over and Die problem. In comparison, potential far-in-the-future dollar costs are a trivial matter, whether insurance is involved or not. How much added incentive should we expect them to provide? And of course, nearly all people do in fact take walks, and they do sometimes eat both burgers and salads. Inventing a stylized world in which people routinely behave only to irrational extremes is probably not the best way to look at these problems.

If you survey aging Americans about what is important to them, one of the first and most important things you will hear is that they do not want to become a burden to their kids. You are trying to use outliers as your examples. It is likely enough that more people would favor assisted suicide for themselves in a terminal situation than would want to follow this every-last-second-at-all-costs mantra that you suggest.

Quite commendable. Much more than a couch potato would do, for instance.

 

My premium was a sunk cost - the marginal cost (to me) of that visit was very small. Because of that, I probably used the doctor more than I should have - perhaps bad for the system as a whole, but clearly a good deal from my point of view. Insurance encourages us to overconsume when the choice of "to visit or not visit the doctor" is up to the insured.

Ask them if they do not want to become a burden to the insurance company or the government and see if they give a similar response. This is my point entirely - when someone else is paying for it, cost is no obstacle.

 

A survey? Weren't you just telling me how irrelevant opinion polls are?

Medical care at the end of life consumes 10% to 12% of the total health care budget and 27% of the Medicare budget.

Doesn't sound like an "outlier" to me.

 

Very good response, bradm98.

 

The point was to question the claim that insurance is reserved to that against catastrophic losses. That Cousin Bertie's birthday present somehow might get lost in the mail is hardly likely to qualify as a catastrophe. We meanwhile already have the examples of auto and homeowners insurance to point out that insurance is not limited to things that a policyholder has no control over.

From all I can see here, you are simply claiming that insurance against catastrophes exists. That's been plain enough from the outset. The problem is in claiming that any other type of insurance either does not or should not exist. Insurance underwriters make money by issuing policies. Somewhere, there is someone who will insure you against just about any risk you can think of. There just aren't all these qualifiers you are trying to attach to it.

A rational person would use OTC medications first. Most people know that a cold will go away on its own within 7-10 days even if you do nothing, and the OTC stuff does tend to provide welcome symptomatic relief in the meantime. Only when the condition did not improve within a reasonable period of time would such a person conclude that maybe this was not just a simple cold and that maybe a checkup to rule out pneumonia or some staph infection or other would be warranted. That decision under those circumstances would be warranted on several levels. And once again, going to the doctor's office is not like stopping off at your local tavern or ice cream parlor. Nobody pushes other things aside in order to make room for the special treat and pleasure of going to see the doctor.

 

You didn't say "at first signs of a tummy ache" either, and for the obvious reason that no one at all goes to the emergency room at the first sign of a tummy ache. Meanwhile, severe and even mildly persistent abdominal pain is an event that very much does warrant urgent medical attention. Suggesting that those who heed such an important sign by getting themselves to an ER or clinic for an exam are needlessly driving up health care costs is at best rather disingenuous. Just about as disingenuous as claiming that popping over to the ER for a few hours of unpleasant waiting around and filling out paperwork is somehow cheaper for people than the ten seconds it takes to pop a Pepto.

 

"Tough choices" goes right up there with "moral hazard". It's become so overused, tainted, trite, and hackneyed as to be meaningless. Maybe try wearing out "difficult decisions" for a change.

Prosthetics meanwhile come in a range of capabilities and costs. They are typically prescribed based on lifestyle. A 65-year old will not need the fancy-pants features that a 25-year old might and so doesn't get them But since such a large number of these super-expensive models is going to young people who have had a leg blown off in Iraq or Afghanistan, maybe one of those "tough choices" you want us to start making is to tell all of them that they'll just have to make do with a wooden pegleg from now on. Think of the reductions to health care costs, after all!

Already answered. Rehab for a hip replacement for instance involves about two months of arduous 3-times-a-week sessions, and patients are very happy to reach the point of graduation. Nobody at all comes in for the fun of it. They don't need you to throw them out. Therapists by the way require training and education similar to that of medical doctors. They just get paid much less.

 

What would you consider to be a 'reliable healthcare indicator'; perhaps one which ranks the USA higher than last? First, perhaps? Would you consider that as 'reliable'? I'm guessing you would.

http://thepatientfactor.com/canadia...zations-ranking-of-the-worlds-health-systems/

You're still 37th in the WHO rankings, but racing ahead of lowly Cuba in 39th! Whichever way you choose to spin those figures 37th, in the world, for a nation which touts itself as the 'best' in everything, is nothing short of an embarrassment and evidence of deep failings.

 

/

Yes, I disagree. First of all, the notion that actions in the corporate world are somehow all tied to profit is bunk. Nobody who has been there believes it. There is all the graft, conceit, corruption, politicking, turf-warring, and interpersonal backstabbing there that anyone could want. It's a shame there isn't a FOIA that applies to the private sector. Corporates campaign for promotion and politicos campaign for retention. Corporates try to sell more widgets, while politicos have rather more serious matters on their plates, but that's about as "very different" as it gets.

Maybe yours is different, but the DMV where I am is a piece of cake. I can do almost everything online, and the few things that I do have to go in for in person are handled about as well as I could expect. Problems are triaged as you walk in the door, and you are ticketed for service by staff who specialize in that area. Service tends to be quick, effective and courteous. Probably means that their budget ought to be slashed.

Meanwhile, all large organizations are bureaucracies. Saying that the Marine Corps is bureaucratic is a tautology. It would be different if you wanted to claim that the bureaucracy in the Marine Corps is more poorly run that that at Microsoft, but you might get some argument about that coming out of the Seattle area.

Performance is high in more public areas than just the Marine Corps, and the fact that big numbers are associated with it does not mean that it comes at exhorbitant costs.

 

Once again, you are very correct, Ethereal.

These facts are particularly true.

"We have higher costs because we have MORE unhealthy people as a percentage of our population than do other countries. We have MORE unhealthy people because we have more obese and elderly as a percentage of our population, which is NOT a failure of our healthcare system but a simple consequence of (a) poor choices and (b) demographics. Nationalizing our healthcare system will do nothing to mitigate either of these factors, a point that has repeatedly gone over your head."

 

Good, but I did not claim Japan was some sort of nirvana. They are merely kicking our butts, just like most other developed countries. Japan and each of the others has its own problems to deal with, the principal one in Japan being the already-mentioned spending too little on health care. Wow! Glad we're not in that sort of a bind, eh?

No, wikipedia is in at least a great many cases a very good source, particularly as a start point for more detailed research.

Co-pays and the like vary by procedure and patient income. They tend to apply at the front end for consults, diagnostics, and the like. The national system ends up paying 80-85% of total costs each year. Total costs run in the range of 8-9% of GDP versus our 16-17%.

 

17thAnd K - listen, you're clearly a smart guy (or gal) but it really sounds like you have an axe to grind. You're glossing over or completely ignoring the elements that don't fit your ideology, and arguing about exceptions and tangents to the arguments other people put forward. The fact of the matter is that when something costs less, people typically consume more of it. Healthcare is no exception, and more healthcare is not always better.