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

Pretty much a recap of my earlier posts, including the absence of a gatekeeper, that point having been the reason Japan was singled out for attention to begin with.

The "shortcomings" claimed are meanwhile problems that health care systems tend to have in common. People who should be admitted to hospitals aren't, there is too much service in one locale and not enough in another, demographics are increasing overall demand. Japan has those problems. We do too. In the meantime, they are getting better overall care and paying barely more than half of what we do for it.

 

From what I read about the Japanese system, "spending too little" on healthcare has resulted in patients being turned away multiple times, patients waiting hours for a 3-minute consult, doctors abandoning the hospitals for private clinics, over-treating, over-prescribing, and lower quality of care.

So yes, I'm glad we're not in that sort of a bind.

 

See the above. No system will provide nirvana, and if you could produce one, it would soon enough be outdated and need adjustment. As a more familiar parallel, the Social Security Act on the books today looks nothing like what was passed in 1935. In the intervening years, it has been tweaked, overhauled, and modified to meet changing conditions, yet for 70 years it has kept American seniors out of dire financial straits, just as was envisioned for it at the beginning. Health care systems are the same sort of animal. Challenges will arise, and systems must grow and morph and adapt to suit their new surroundings. Where Japan's system has been around for a mere fifty years, Germany's national health care system dates from 1883 and it is still going strong. They too have of course made changes along the way.

 

Dude, you might want to look up what "single payer" means in this context. Maybe go here and let some doctors tell you...

 

Too bad the same can't be said for Cessna, who just gave his usual ringing endorsement to a poster who doesn't know what single-payer is and apparently thinks that Medicaid is for young people to boot.

 

Yes, this is the case in Funhouse-Hall-of-Mirrors-Land. There, it is quite common for patients to reject the course of treatment recommended by doctors as medically most appropriate for the patient's conditions on the grounds that there is actually a more expensive option out there, and since it too would be free to the patient, the fact that it isn't the appropriate option for them means nothing, so let's pick that more expensive one anyway. This is because in Funhouse-Hall-of-Mirrors-Land, people are not motivated by their own health interests, but rather by a strangely perverse interest in somehow spending as much money as possible that isn't their own instead. Would you like to hear how the auto and homeowners insurance industries work out in Funhouse-Hall-of-Mirrors-Land?

 

Odd then that rates of amenable deaths are and have for decades been a standard measure for comparison of health care performance. You'd think that thousands of highly trained professionals around the world would have realized all this irrlevance and unreliability by now. I'm sure they'll all be changing their tune now that you've pointed these important problems out for them though.

Amenable causes are those where death can be consistently averted through proper and timely medical intervention. A health care system that is effective reaches, diagnoses, and successfully treats people with things like bacterial infections, anemic deficiencies, and appendicitis before they die from them. Efficient systems do this at a reasonable cost. Systems that are neither effective nor efficient are more expensive yet prevent many fewer such deaths. Guess which one we are.

CLUE: Our system is a mess. It achieves much too little and costs much too much. Public, private, or space-alien operated, we pay too much for too little. The rest of the developed world is getting a much better deal.

Obesity is not a healthful thing. Neither is spending excessive amounts of time in the sun. Would you like to blame our health care failures on people with nice tans? The US health care system is here to treat and maintain the health of US people, be they tan, fat, black, or smokers. While our system provides high quality care to the wealthy, it provides low quality care to most, and no care at all to too many. On an overall basis and as compared on one individual measure after another to the health care systems in other countries, our system performs poorly and costs more. That's not much of an endorsement.

No one is talking about that to begin with. We are talking about altering the way in which health care is paid for. In Germany -- where they eat all that artery-clogging heavy, greasy, fatty food and regularly stop off at the konditerei for a hefty booster dose of fat mixed with sugar -- you can see any doctor you want. You can work with any specialist you want. You can typically walk-in off the street or make a same-day appointment. Overall German outcomes are better than ours, and the overall cost of their care is lower. What is different there is the means by which health care is paid for.

That's funny...all I hear about is griping over rapidly rising deductibles and co-pays and more money disappearing from paychecks every year. Nobody complains about that sort of thing where you are? Otherwise, you might as well appeal to a public opinion poll over what the value of pi is when you can determine it rather precisely simply by dividing a circle's circumference by its diameter.

Nobody is nationalizing anything. No hospital takeovers, no drafting of medical personnel into some forced national service corps, no denial of market access to drug and device manufacturers. Even insurance companies still have no public sector competition. Your sky-is-falling notions have no basis in reality.

 

You're being disingenuous now. Defensive medicine plays a part - that is, it's not always the patient that chooses the more expensive option. But if the patient is already at the doctor for what appears to be an ankle sprain, why wouldn't he request the MRI "just to be sure" if there's little or no additional cost? The "free" MRI is clearly in the patient's health interests, but the benefits to the system as a whole may not outweigh the costs. If I told you I'd give you a car for $20,000 and then said you could choose a Toyota or a Ferrarri, which would you choose? Even if the Toyota is adequate and recommended I assume most rational people would pick the Ferarri - why do you think that is "Funhouse-Hall-of-Mirrors" logic? That seems like basic economics and human behavior to me.

 

Yup, too mnay sick people are screwing up our numbers.

Japan has much higher smoking rates than we do. So do Belgium, Switzerland, Austria, Denmark, and Italy. They all also have a higher median age than the US does. Your claims don't survive scrutiny.

And you attempts at economics don't even merit comment.

 

You are indeed correct, bradm98.

This only way we can get our health care costs in America under control is to raise the co-pay and increase the yearly deductible for each person.

If people have no "skin in the game" they will always insist on the most expensive procedure that is available to them. If they have to pay for a quarter of these costs that are billed to the U.S. taxpayers, they will more ofen than not change their minds!

It is foolish and very wasteful to do otherwise!

"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 the liberals and socialists in this group fail to understand."

 

I pointed out that their system has no gatekeeper. Also that they obtain a range of health outcomes that are superior to those obtained in the US for barely more than half the cost.

Japan is actually fourth lowest among 16 developed countries for whom amenable death data are available for 2007 at 61 per 100K. France is first at 55 per 100K, by the way. The US is, well, 16th with 96 per 100K.

So, you want to improve the usefulness of these long-standing statistics by eliminating as many diseases that make the US look bad as you have to until the US doesn't look so bad anymore? That's certainly an interesting if entirely pointless approach.

 

Great comment on all accounts, Ethereal.

Well done!

 

Only in dollar terms. You still had to lose soemthing like a couple of hours schlepping a kid whom you knew wasn't actually sick across town, sitting in the waiting room, then talking with the pediatrician, only to be told what you had already known when you walked out the door, and then schlepping the kid back home again. Maybe you just get off on that sort of thing? Most people don't. Most people have to be encouraged to go to a doctor at all and try to go as infrequently as possible regardless of cost.

Me, I don't like liver. You could put it on sale for $0 per pound, and I still wouldn't buy any. Wouldn't matter what a "good deal" it was. Now, I do like Wheaties. I'll eat those a couple of times a month. So if you put those on sale for $0 a box, I'd take a couple. I wouldn't take take ten, however, because of the incovenience of storage and the fact that I probably wouldn't be all that interested in that last box somewhere around 2017 or whatever. It might be well to remember that the law of diminishing returns works really quickly when the initial value itself is low or negative.

That case has not been made. Stossel hasn't made it, you haven't made it, nobody has made it. And I still don't see definitions of concepts such as "overconsume" and "unnecessary". So far, it seems that if you go to the ER for severe abdominal pain and it turns out to be constipation, that's unnecessary. And I suppose that if you went because of sharp pains in your chest and left arm and it turned out to be an oblique strain, that would be unnecessary as well. But if you went and it turned out to be an appendix about to burst or a heart attack in progress, then it would be necessary?

Hang around a hospital for a while. Hang around a hospice. Who clings desperately to life? Young and middle-aged people who would otherwise have many years yet to live. The aged have come to terms long ago with their mortality. This demographic is suggested to be simply draining the system dry with their greedy demands to live just one more hour, when it is far more likely that they are pulling the tubes out of their own arms, refusing further care, and asking only that they be given enough pain medications (these are very cheap, by the way) so that they might live out their final hours and minutes in relative peace and comfort.

 

When you do illegal drugs all your life and drink too much, you should expect no less.

 

Do you have regular brain farts? I know what a single payer is. In health care it is Universal Health care. In Amtrak it is the govt, in the USPS it is the govt. In the Army, it is the govt. Do you have recurring pains?

 

Depends on what you are trying to measure, doesn't it. If you are trying to determine facts, opinion polls aren't worth a hoot. If you are trying to gauge people's opinions, then there might be some role for opinion polls to play.

Let me explain to you how the elderly ultimately die. You imagine it as something like an airplane descending from 30,000 feet to touch down at last on that final runway. A few people do die like that. Very few. For the clear majority, they are flying along smoothly when suddenly the engines fail and the plane plummets to just a few thousand feet before the pilot is able to pull her out of the dive, then returning the plane to more or less normal flight. Perhaps not at 30,000 feet, but close. Then sometime later the engines fail again, and the whole earlier scenario is replayed in full detail. Eventually, this saga of alternating crisis and recovery to near-normal ends when the pilot just can't quite right the plane, and the trip is finally over. That's how most elderly people die. Now you tell me which time of crisis it is when you want to cut off funding for the flight.

The other point is over terminal care when everyone knows that the end is somewhere near at hand. You imagine costly tubes and machines and then more tubes and machines in some last-ditch effort to hold the Alamo when this sort of thing is about the least likely choice that a person in those circumstances will make. When you see that, it is more likely to be some relative unable to face reality making decisions for a patient who can no longer do so for him- or herself. Always good to make your wishes known in advance and to back that up by having a living will.

 

Once again, you are a useless toadie, Cessna. One who is backing a dead horse, by the way.

 

According to these same experts, the metric is (a) "inexact" and (b) incapable of determining which element of the system performs sub-optimally. In other words, it has no relevance to the relative performance of our healthcare system.

Do let us know when you find some evidence to support your claims.

Yes, obesity is not healthful. Quite the opposite of healthful. And when you have a population that is disproportionately obese relative to other modern nations, it would only make sense that you end up spending more money on healthcare than they do regardless of the healthcare system.

Which is inextricably related to the manner in which it is provided. For example, healthcare is provided differently under a fee-for-service plan than it is under a capitation plan. The latter payment method incentivizes healthcare providers to administer as little care as is medically necessary because the less care they provide the more money they make.

We eat more artery-clogging heavy, greasy, fatty food than the Germans do, as evidenced by our higher obesity rates. The genetic composition of our population is also radically different than Germany's. But what do genetics have to do with healthcare outcomes? Probably nothing!

Government meddling usually causes prices to rise.

Then be more specific. Which universal healthcare model are you so enamored with that you think it should replace our current system? Like I said, I'm not opposed to the idea of universal healthcare in the US. What I'm opposed to is the progressive obsession with big central government as a panacea to all our problems and the blatantly dishonest and corrupt processes that entail their efforts to expand the state. If Obamacare is any indication of how progressives plan to usher in universal healthcare, then I will remain vehemently and intractably opposed to their statist wet-dream.

 

Right, because YOU say so. After all, in your world, simply asserting your opinion as fact and making empty references to "fact" and "data" are adequate substitutes for substantiating your assertions with ACTUAL evidence.

 

Are you just too dumb to get the obvious point I'm trying to make? Let me spell it out for you.

You use these numbers as "proof" of our healthcare system's relative inefficiency and lack of efficacy, but those numbers are easily explained by factors that have nothing to do with our healthcare system. It wouldn't matter if we had the most perfect healthcare system on the planet if we had a populace that was disproportionately obese, we'd still see poorer healthcare outcomes and higher costs relative to other nations.

Let me know when you've wrapped your head around that staggeringly complex argument.

Japan has one-sixth the incidence of ischemic heart disease than the US, which is easily attributed to a diet rich in omega-3 fatty acids, which are extremely beneficial for cardiovascular health. So, even though they smoke more than us, their diet is able to compensate because it is far more heart healthy than ours. They're also genetically different and less obese.

Maybe instead of simplistic "economist" analyses of healthcare issues, you should look at it like a biologist or a medical professional instead.

I accept your concession.

 

Someone needs to dismount their ideological tricycle and do some RESEARCH..

MEDICAID is for young people, and adolescents and adults up to Medicare age, 65.

MEDICAID is medical welfare paid for by the US Govt. It covers all ages up to the Medicare qualifying age of 65. And beyond if the person fails to qualify for Medicare.

For anyone to NOT know that clearly displays their complete lack of knowledge on the subject or their deep ideological brainwashing to believe lies. Or both.

Both Medicare and Medicaid, 2 very different programs ARE single payer Govt programs.

"Government funded programs include:

Medicare, generally covering citizens and long-term residents 65 years and older and the disabled.
Medicaid, generally covering low income people in certain categories, including children, pregnant women, and the disabled. (Administered by the states.)"

Not a lot of over 65 preggers women that I know of.

They, MEDICARE & MEDICAID cover about 90 million people together and they cost over $900 billion per year, and have existed for up to 48 years. So our US single payer govt health care has more expense experience, more coverage experience, and more establishment experience that ANY other country's total health care experience, plus we have over 221 million people using our private health care system as well. Simply put, we have vastly more GOVT health care experience that any other country. Canada, often promoted by the UHC aficionados covers one third of the number of our govt health care and for less than half as long.

What results do we observe from all our experience? Our total cost per person is about $7800. Our govt health care cost is OVER $10,000. per person. The cost of govt health care is part of the overall $7800 pp total cost. The $7800 pp total cost is NOT included in the govt health care costs. Take the govt health care costs out of the total $7800pp cost and we get $6904.pp PRIVATE health care costs while govt health care is well over $10,000 pp. So our single payer govt system costs 31% more than our private health care.

You may claim that our Govt health care covers poor people and old people and that is why it costs 31% more pp. I counter that with the FACT that our govt health care has strict reimbursement policies that DO NOT exist in the private sector. The govt under Medicare pays less than half the normal charges of health care and the providers CANNOT, by law, even ask for more from the patient. Medicare pays closer to 30% of charges than 50% of normal charges. Medicaid pays EVEN LESS to providers.

So you may make all the claims you wish about Japan or Sweden, but we already KNOW how govt health care works here. And without the multi Trillion dollar private health care system in place to give underlying support to our govt health care. The govt system would collapse.

 

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

We're the one that run it by the profit motive.

If your priority is profit that's what you'll get.

If what you want is good health care, you have to make THAT your top priority, instead of profit.

 

No, no axe. I don't have any personal, professional, or financial interest in health care itself. I do like to the see the truth of almost any matter brought to light, however.

Ideology has nothing to do with it. I doubt I could even describe an ideology that I supported. It is fairly easy of course to find some that I don't support, but fact and reason don't always lead one off to the same spot, you know. I've meanwhile glossed over plenty of fluff, and if anything actually relevant got mixed in, that was unintentional.

The above is a generalized claim about human economic behavior that is based on a simplifying assumption of there being a direct, singular, and consistently functioning relationship between two factors.

There isn't such a relationship with respect to price and health care or in fact between price and very much of anything else either. You will sometimes see the behavior you expect and sometimes you will not. People tend in fact to be reluctant consumers of health care except when they desperately need it. Then at last they will readily do what they are told. Until they deem themselves recovered. The degrees of this personal reluctance vary over time and distance and according to individual experience, but in addition to the rare cases of hypochondria that float around at one end of the scale and have gotten plenty of mention in this thread, there is a whole array of resistance levels that exist en masse at the other end that has not previously been discussed, merely alluded to, usually by me.

In the broader picture meanwhile, price reductions may well have little or even no effect at all because they have to be translated into any market through the complex function of price-elasticities of demand that currently exist within the relevant price intervals. Even if supply curves are exactly as drawn in simplistic Econ 101 courses, real world demand curves most definitely are not. They are individual and cantankerous creatures whose even established behavior can change very quickly. Something to keep in mind the next time someone tells you something is a matter of simple supply and demand. There is actually no such thing.

 

You are very correct, Dan40.

Medicaid and Medicare would not exist if not for the private health care providers. This is why the Democrats early on abandoned their utopian and impractical goal of a single payer system.

They did the cost comparisons and decided our nation simply could not affort it! As you correctly stated, our single payer govt system costs 31% more than our private health care system.

 

We have all those things as well.

Lower than what?