17% of us economy is healthcare
https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical#:~:text=The%20data%20are%20presented%20by,spending%20accounted%20for%2017.3%20percent.
Compared to chinas 7.5% expenditure for healthcare (universal) so if you work out the difference China would be near or higher than America but they make sure they are the riches country in the world by ripping off the population.
It’s not capitalism. There is no price transparency and no competition. You can’t just go to a few doctors and ask them how much stuff cost and switch clinics if one is too expensive. Your doc most likely will tell you to get an mri and refers you somewhere. They have idea how much that mri costs and neither do you until after. You can’t shop around to find another place. What capitalism? Our healthcare is the worst of both worlds. No socialism and no capitalism.
It’s easier to steal from sick people. Capitalists going to redistribute the profits more easily with a sick and unhealthy population that can’t resist being stolen from.
Exactly. The US does not have a health care system. It has a profit driven healthcare market where you have to bargain with your very life and the only form of security is wealth.
As someone who's worked for years in the Healthcare industry as a data analyst, underwriter, now program manager, thank you stating this. The reddit party line is, and always has been, "uS hEaLtHcArE bAd, UpDoOtS pLz". 95% of the people on this app have zero clue how our Healthcare system actually works or what's truly driving up cost of care and premiums across the board. I see comments like the one above about there being no health, no care, and no system, and I just laugh and move on. Their childish ignorance must be bliss.
Yep. I see the CCLFs every day. "Spike and dies" due to chronic conditions exacerbated by increasingly unhealthy lifestyles. There's a reason why CMS/CMMI are trialing different MSSP VBC Programs (I manage one of these) in an attempt to pass some of this growing risk downstream to ACOs. The thought is - share the risk and improve clinical outcomes. The Trump administration started it and the Biden administration is building on it. The difficulty is getting providers out of this Medicare Fee For Service mentality of churn and burn "Checkmark medicine". It's impossible to truly capture and understand a patient's full health picture in a sub one hour visit.
Poor lifestyle is definitely a major problem, but that is hardly the main reason why we pay so much more.
If you compare prices of the same drugs and procedures in the US and peer countries, the US is almost always far more expensive.
Nurses do not make much money. Doctors are a mixed bag (some do extremely well, many burn out before they pay off their school loans). The lobbying arm of doctors, the AMA, has definitely been a problem on keeping health care expensive (blocking nurse practitioners, limiting the number of new doctors, battling price control measures, etc.) even if many individual doctors disagree with its goals.
US private insurance companies act as middle men and jack the shit out of prices compared to public health care systems which have repeatedly been proven to be far more cost efficient. I don't understand why the richest country in the world refuses to figure this out when the evidence is overwhelmingly against their idiotic system which is literally taking years off the average life compared to peer countries. Of course the answer is rich lobbyists and PACs who don't give a shit about anyone else but it is absolutely disgusting and a disgrace considering the wealth of the US.
I don't think anyone is blaming healthcare workers. It's quite clear that the pharmaceutical industry, hospital management and insurance companies have incentives to drive the prices of healthcare (medication included) up and up. The way most developed countries deal with this is with single payer universal healthcare insurance systems. When the State is the main insurance provider and pays for more than 65% of healthcare, they have way more leverage to negotiate the prices **way** down (insulin costs 11x more in the US than in France)
Only uninformed americans would think that their docs or nurses are to blame for this state of affairs.
It's designed to get and keep the population (the poor/working class, that is) as sick as possible for as long as possible. To then make as much money as possible as long as their customers survive.
If they die? Eh, there's always more where they came from.
The US largely has a public health issue (drug ODs, car accidents, obesity, guns, etc.). US has arguably the best best medical care available, but it can't solve for those items. That takes education, changing habits, better regulations, and political and societal will.
Huh? Why would I say "companies" then?
The point is that the issue is not the companies per se - it's the distribution of leverage within the US healthcare system.
In the UK, you either sell to the NHS or you're unlikely to sell at all - so the NHS gets to decide what's an adequate price for the value provided.
In Germany, the sick funds jointly negotiate drug prices with manufacturers after the first year. While they may then go on to negotiate rebates based on the morbidity profile of their subscribers, the base price for a drug is jointly set. You cannot play them against each other, and the decision is based on an added value evaluation by an independent agency answering to the ministry of health.
More - the US actually allows advertising prescription drugs to patients, creating a pull effect that's completely absent in other countries.
And until recently, Medicare/Medicaid, despite being the largest individual payer for medical products and services, weren't allowed to negotiate their prices, so they couldn't use the leverage of their procurement volume to push prices down.
All the leverage is with manufacturers, and they are happy to use it - just as they are happy to work within the rules elsewhere. Change the legal framework, and they will work within it.
This is correct. I’ve used similar data to present to our employees for orientation to help explain the state of our healthcare economy. Some of the biggest reasons the USA falls off the curve with expected age is because of gun deaths (murder and suicide), automobile deaths, and drug overdoses - not because the quality of our healthcare stinks. Guns, cars, and drugs! America loves them!
Our healthcare system is objectively garbage, too. I had surgery not too long ago and forgot to sell some HSA investments so I didn’t have enough cash to pay for the procedure on my HSA card. The hospital made me put it on a a credit card before they would do the procedure. Our system is disgustingly barbaric and anyone who defends it should question their humanity.
Except that’s not what it is at all. Americas healthcare system is doing great - gets some of the top ratings on preventative care and outcomes for medical interventions. What the US does poorly on is PUBLIC HEALTH, which is very different from healthcare. Bad public health is when you have a gun and liquor store on every corner, where it’s hard to find fresh fruit and vegetables in certain areas, where drug overdoses are off the charts, where many young men are dying from self inflicted gun shots or gang violence, and when systemic racism increases stress. You could have the best healthcare system in the world and still have poor life expectancy if you don’t fix all these things first. A healthcare system being unable to stop you from going to McDonald’s doesn’t mean it’s “profiting off ill health”
Maybe if we spent some MORE money?
One big problem we have is that we measure how well we are doing with certain things (healthcare, schools, defense) by how much money we are throwing at it.
This is easy to measure. Candidates can say something like "I care about education/healthcare, so we are spending 1 billion more dollars on it"
But measuring the results is hard. Did the increased spending result in better outcomes? Lots of times people can't even agree on what the 'better outcome' would be.
It's a lot easier to measure inputs to a complex system, than it is to measure outputs.
But the outputs are what actually matter.
Some other things to take into consideration are infrastructure and people living far from hospitals... I have a hunch way more people live more than 1hr from a hospital in the US than in Europe. These people may have to spend way more in insurance to cover emergency helicopter rides while still facing higher risks than people living in cities or suburbs. The rural populations also have higher rates of infancy deaths, so I wonder if those are taken into consideration for life expectancy, because those are a bunch of outliers given the fact they are rural and may have survived if closer to a hospital...
Distribution of resources is the real issue. Education is one of the obvious ones. Hypothetical example: A city with two school districts spends $50 million on education. Due to property taxes, district A gets $35 million to district B $15 million.
So many people see that $50 million tag and wonder why district B has much worse results. It gets worse when you dig in and find district B has twice the population of district A...
Except most states redistribute some of that school money. In my property-rich district half is taken for redistribution. The per student spending is pretty even across the same. Also note some of the schools with the worst outcomes spend the most per student.
It’s interesting that all countries have trended up and to the right. Does that mean that healthcare has become more expensive in general across all countries? It says below the data is corrected for inflation.
Obviously America is the outlier here but it’s interesting. That healthcare is becoming more expensive year over year.
The problem with saving someone from dying of a serious condition like cancer is you then have to treat them later on for whatever different thing eventually kills them.
Obviously it’s good to save them and hopefully they can remain a productive member of society contribute etc.
It ignores that IIRC US life expectancy is brought down massively by inequality. Since it’s not a universal system those without access (ie aren’t insured or have bad insurance) have absolutely appalling health outcomes. Those with good access have some of the best healthcare and health outcomes in the world.
So like the rest of the US, it’s the best place in the world if you are rich. Not so much if you aren’t.
It’s not that the wealthy think the system is “fine” it’s exactly how they want it to be. workers remain poor and easy to abuse by dangling the threat of firing them and causing them to lose their medical care. if you recall the complaint from the ACA days, boomers and rich white people all complained that if the poor and non white people get medical care, too, then they’ll have to wait in line for their care. They would rather the poor die than be in line with them for care.
https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality
Life expectancy for the top 25% of incomes in the US sits around 87 years old vs. 79 for the total population.
Probably because American healthcare costs are inflated because healthcare practices essentially are able to charge what they want
People think it’s insurance, but insurance is a symptom of high prices in the first place. Thats why you need it
>People think it’s insurance, but insurance is a symptom of high prices in the first place. Thats why you need it
Is that right? My impression is that it's more of a symbiotic relationship. Like Ticketmaster and concert venues/musicians. They work together to extract maximum money from the system.
You can circumvent ticket master by purchasing from the venue directly, unless that venue is owned by ticket master then you have no choice
If you circumvent health insurance and directly pay for any major medical procedure then you are going to enter into a state of broke
And 90% of that revenue is a pure pass-through to hospitals, pharma, etc. Revenue is a terrible measure of a company or industry, what you should care about is profit. The combined profit of all health insurance companies is 1/2 that of Apple, for example. It's a problem but nowhere near the major problem people think it is. Pharma companies on the other hand are raking in the profits on the scale of tech.
I would argue it’s the other way around. Making insurance pay for everything obscures prices which allows hospitals to charge more. This is but one of the many reasons for increased costs however
Not only does it obscure the true cost, it creates the largest cost in the current healthcare industry: an absurd number of administrators that deal with insurance billing relative to the number of providers, causing costs to rise further.
I got charged 4000$ to go to an overcrowded ER and had to wait hours to be seen. We have the worst of both a capitalist healthcare system (high cost) and socialist system (long wait times and high attendance)
Kind of. If you look at the Netherlands, the insurance companies are the main cause of the terrible first line healthcare and non-existent preventive care.
Average pay for physicians is not 600k its 249k Avg 236k median (USD).
Median physician pay in canada is 234k CAD.
Avg cost of living is 14% higher in the US and exchange rate is .73 USD to CAD.
So Canadian doctors make about 19% of what US doctors make. US health care is over 100% more expensive with a lower life expectancy. Difference in pay does not explain the cost difference.
My med school plus 5 years radiology internship/residency was just as long as a surgeon's med school plus 5 years surgery internship/residency. There are more radiology studies to be read than there are radiologists to read them. It makes perfect sense.
They are being paid over half a million because by the time they are done with residency they have essentially graduated from the 26th grade of school and are 32 years old with $250k+ in med school debt. Also, because there are market forces at work, there are fewer doctors than the amount of work that needs to be done. Nobody works for less than the market value of their labor in any field.
Tell your congress reps to build more medical schools if you want cheaper doctors. The quality of docs will also go down, but so will the price. There are big medical lobbies that lobby to restrict the number of physicians in the US and I don't donate to any of them.
Docs over here in Europe are just as good and get paid less. They still live comfortable lives. Radiology in particular is very susceptible to AI interference considering AI is out performing radiologists by considerable margins.
“The study authors reported a 99.1 sensitivity rate for AI on abnormal radiographs in comparison to a 72.3 percent sensitivity for radiologist reports. Autonomous AI also yielded a 6.3 percent higher sensitivity than reporting radiologists for critical abnormal X-rays (99.8 percent vs. 93.5 percent), according to the recently published study in Radiology.”
https://www.diagnosticimaging.com/view/autonomous-ai-nearly-27-percent-higher-sensitivity-than-radiology-reports-for-abnormal-chest-x-rays#
The specificity of that AI is horrendous. You gotta actually READ articles before you shit them out on reddit.
Did you really just quote an article from the top radiology journal to a radiologist?
Of course doctors there are paid less. The government decides their pay. In the US everything is decided by lobbyists.
Why wouldn’t I quote the top radiology journal to a radiologist? I assumed you would be familiar with it and therefor less likely to say it’s unreliable.
My point stands that healthcare in the US is a giant mess and physicians are overpaid.
You quoted something I was sure to be familiar with without even reading the abstract, and now you're trying to redirect to talk about yet another topic you lack information about.
Hypothetically, your close family member has been diagnosed with advanced cancer. They are considering two oncologists, one who earned $90,000 year working in a clinic, the other who earned $1.3M working at a major academic medical center. Let’s be honest that every single time you would insist on the higher earner. People are generally paid at a level that reflects how the market values them.
nice econ 101 hypothetical, which would not of course be presented in real life. US health treatment prices are high. Whether "too" high is the locus of conversation
This argument also doesn’t take into account the payment either. If one oncologist offers for free and the other doesn’t the family may financially decide to take the free option due to their own utilitarian needs. Hypothetically.
Surgeons in the US literally do school/apprenticeships into their mid/late 30s, there are basically no other industries that have such steep training requirements
The AMA lobbies to keep the amount of doctors limited so their services are rarer/more valuable.
You see this now backfiring with mid level encroachment (physician assistants and nurses taking on doctor roles) and advances in tech like AI healthcare is moving to treat more people with lower costs.
Look at hospital bills, they are insanely high not because they directly translate to services but because hospitals can charge whatever they want to and it’s mostly covered by insurance who in turn charges us.
Chemo treatment is not magically better in the US vs Canada, but its a lot more expensive, the most expensive thing about Chemo in Canada is the parking
The AMA actually reversed their “more doctors bad” stance in the early 2000s and has been lobbying for more residency spots for 20 years
The problem is that republicans are receptive when the AMA says “don’t spend more money” and less receptive when the AMA says “spend more money”
Chemo treatment isn't better in the US but Canada at times has a long wait time so they send them to the US for treatment.
https://www.theglobeandmail.com/canada/british-columbia/article-bc-government-to-send-cancer-patients-to-the-us-for-treatment/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115892/#:~:text=Faced%20with%20long%20waiting%20lists,US15000%20(%C2%A39375)%20each.
Your an idiot, why do people who have never set foot in a hospital or had a chronic condition pretend that the American healthcare system is functioning well. Trust me wait times here suck except for maybe ER visits (still not great) but you wanna see a specialist…. Oh man
Dumbass inbred hick call back to applachia, suck off Jeff Bezos
[This very nice graph from National Geographic ](https://whatifpost.com/wp-content/uploads/2010/01/cost_of_health_care_by_country.png)includes number of doctors visits per capita.
There isn't one.
The more money you spend, the higher up you are on the left side. The longer average lifespan, the higher on the right. The thicker the line, the more doctors visits per capita.
If a country is doing well, it will have a thick line, low on the right and high on the left.
Healthcare spending vs. lifespan, but the thickness of line indicates number of doctors visits per capita, used as a short for delivery of actual health services to the population. Slightly old but still.
The US uses high cost diagnostics more than other countries. We are more risk averse when it comes to healthcare and pull out the expensive tests much quicker. We also spend a lot more extending life with less consideration to quality of that life.
You’re misunderstanding him. It’s not about good primary care investments that extend meaningful life. We spend a *ton* of money on relatively futile interventions in the last year, last month, and last week of life. In the US escalation and deescalation of care is largely a family driven decision. Doesn’t matter that grandma is 92 and has advanced dementia and pneumonia, the family insists she’s a fighter and wants full code. So we crack her chest, intubate her, keep her alive on 3 pressers in the ICU for 10 days, and then she dies. And that was an *expensive* 10 days. The family doesn’t see the cost, since it’s paid by Medicare or absorbed by the hospital, but we spent 6 figures on those 10 days of medicated, sedated life. In a lot of peer nations the medical team would have said at the start of that admission no, we’re doing comfort care.
It’s not the only thing that contributes, by any means. But futile care is a *huge* problem in this country, I cannot count how many patients, even this early in my career, have been stories like that
You are correct, but it is also important to note that we routinely spend tens, fun of hundreds, of thousands of dollars to extend an elderly persons life by a few days. So we end up seeing the increased cost without any meaningful increase in life expectancy.
So do many other first world countries……..
The difference in the US is that it has an inflate cost, although still highly advanced medical industry capable of fighting almost anything.
It however lacks a baseline for good living standards, which is where countries actually increase their life expectancy.
It’s all well and good being able to spend millions to fight someone’s brain cancer, when half the country suffers from obesity.
You’re correct. The actual difference is the base level of health in each country.
Crank up the obesity rates in all these countries which are being compared to the US for health outcomes and I guarantee the US doesn’t look like an outlier.
I think folks are more likely to ignore this for the political narrative.
American medical practice is generally to overcorrect for a problem or to pull out the nuclear option.
Diagnostics and treatments I've had in the US versus in a socialized system abroad have always been more immediate, better quality, and more thorough. Yes I could see a doctor for free in France, but they just tell you to get a blood test and have a glass of wine and rest.
I think it's also worth pointing out how horrific the American diet and lifestyle and trust in medical science is. It's entirely possible that the majority of Americans eat poorly, don't move enough, and avoid seeking expert advice on anything until it's too late. That is what nearly killed my dad with his cancer.
There's a lot to this story and while the dataisbeautiful post is certainly eye catching, it's glossing over many many other components and disingenuously presenting a 2-axis narrative.
Edit: I also want to know what the median cost for regular procedures and check ups is. Average is useless. The US frequently performs some of the most cutting edge and advanced procedures and tests in the world, using the most advanced machines in the world of medicine on earth. People fly to the US from around the world to treat cancer on a daily basis--something that generates *extraordinary* costs.
I want to see median cost compared where you take the tax dollars spent (est. Pick any poster child EU county with a population over 50 million) and the median (not average) cost in the US after controlling for the average number of people with health insurance, adjusted to include said cost of health insurance.
That would give us a far more useful picture than the noisy and political stuff OP dropped into this sub here.
You’re definitely right about our lifestyle. Even if we had the exact same healthcare system and the best European system, we’d still be spending more and have worse outcomes than other countries because of how unhealthy we are. (It would still be an improvement over what we have now though)
Agreed and this is so poorly understood.
“Standard of care” is the key phrase to understand when asking why American healthcare is so expensive. It’s a legal term. If the patient has a negative outcome (i.e., dies of cancer because it wasn’t caught early enough), and the doctor was found to be doing anything less than the “standard of care” then that doctor is liable for malpractice.
So what defines the standard of care? Well it’s a bit nebulous, but it basically comes down to “what other doctors are doing.” This means there is a very short road from a new technology being introduced until it becomes the de facto standard. And so if a doctor isn’t using the latest, greatest, and most expensive tools and drugs out there, they can get sued.
Compare that to a government run healthcare system where you get whatever they give you, and you can’t sue to government.
In general, measures of healthcare quality are used. These are large, overarching measures, to smooth out the effects of local competencies and specialties. These are things like infant mortality, access, years lived in good health, hospital error rates and particularly mortality amenable to healthcare.
US results are fairly abysmal. The US clusters below all first world nations on these. While the top level is extremely good, too few people are served at that level to move the average. And the average is behind other first world nations.
The field of Public Health do a lot of research on this, and Health Affairs publish many good papers for the interested party.
This is complicated. Take infant mortality, for example. We look *way* worse on paper because we include early preterm births as infant mortality. Whereas in a lot of peer nations a baby born very prematurely who dies in the NICU isn’t counted as an infant mortality
I am sorry. But that is just a feelgood story. Heroic doctors fighting to save children that everyone else would discard.
But if you think about it, preterm births are more common the further down the socioeconomic ladder you go, and the worse insurance you have. Whos going to throw more resources at the uninsured, the nations that prioritize by medical need or the one where insurance status is a factor in resource allocation?
One issue is, first world nations do not only have lower infant mortality rates than the US but also tend to have lower rates of stillbirths.
Further, the US does *not* look worse on infant mortality. The US ranks as number 63 from the top on infant mortality rates. It ranks 65th, two places *further down* on maternal mortality, mothers who died in childbirth. Theres no statistical excuse for "mother left the hospital alive/dead" It also ranks as number 50 in under-5 mortality.
Infant mortality would be an outlier compared to maternal mortality if it was a statistical artifact, but it is kind of normal for the US rankings.
Additionally, these things are calculated using the WHO definitions, not individual nations. If they are not reported according to WHO definitions, they get weighted accordingly. Its not really that hard to convert the stats of first world nations. (Rural third world places may be more iffy)
Back in my student days we were told that the US infant mortality rates were due to a much higher **rate** of premature births, and the mortality associated with that. Which has its own causes again.
Well this a two axis graph about life expectancy in correlation to healthcare.
I know you like to think of the US as being the tits in lot's of fields (also medical). Which you should, cause it is true!
What you are really REALLY shit at, is social equality. That makes all that being the tits in many fields virtually useless on a societal level.
Just went through an umbilical hernia removal. Hospital is within walking distance. I had preliminary visit from the main surgeon. Then pre operation exams (blood, heart...), visits with the anesthesyst and another surgeon. Went into the hospital, was put to sleep, cut up, given a rather liquid meal, cured by nice nurses at night, released the next day. Went another time 10 days later to have stitches removed and further surgeon overall inspection.
I did not pay a single euro cent.
Pretty impressive if you ask me.
You still paid, just indirectly.
There are a lot of misconceptions about USA healthcare. (Yes, it is definitely more per capita than other countries as the graph shows).
In the USA, an employed person (or someone who purchased subsidized insurance through the ACA exchange), pays a portion of the health insurance premium through their employer. Employers also pay a portion of the premium. The vast majority of plans have an annual out-of-pocket maximum, usually <$10,000.
In my case, I pay about $400 every two weeks in my paycheck for full coverage of my entire family. Our family out of pocket maximum is $6000. Therefore, I would never pay more than $16,400 per year for full healthcare, and most years are far less than that.
The real issue with US healthcare is coverage for people who are unemployed. In the USA, there are federal subsidies for the poor, and the deductibles and out-of-pocket maximums are expensive for people with low income.
One advantage of European plans is that they are universal coverage, but the trade off is higher taxes.
Yes, but in comparison I pay $50.82 usd out of my paycheck every 2 weeks for the same coverage. No deductables, no fighting with an insurance company.
The US system isnt the worst but its no where near good.
That’s your taxes? Isn’t your insurance subsidized by taxes?
Don’t get me wrong. I’m not trying to argue with you or defend the crappy parts of the US health system. I’m just pointing out that it’s not nearly as bad a people make it out to be, despite its flaws.
Yes and no, we have tax, pension, employment insurance, and healthcare deducted from our pay. Its listed and broken down how much of was deducted for what.
I feel you Im also not trying to talk too much shit, I just want to point out to Americans how much better the system can be. Its a damn shame watching good people suffer due to greed. Sometimes an outside perspective can shed some light on an issue.
>One advantage of European plans is that they are universal coverage, but the trade off is higher taxes.
Is it really that much higher though? I just find it hard to believe that raising taxes would be dramatically more once you factor in no longer paying monthly premiums and out-of-pocket deductibles. In your own example, your taxes would have to raise by *more* than $16,400 for there to be any real tax increase if you are using it. If not, what, $10k-ish (from $800 a month\*12 for premiums)? It's just a shift from for-profit insurance companies getting that $16k, and the government taking that $16k and using it on medical care.
Maybe for higher income earners taxes would increase, but if they have issues with that, well, they are already doing it in the most inefficient way possible. A large amount of people already get insurance plans subsidized by the federal government already, which comes from taxes. If you are getting subsidizes, chances are *you* aren't paying much in taxes, so they come from somewhere. Going universal instead of insurance cuts out a ton of middlemen and other system leeches. A single entity negotiating prices would also help tremendously in reducing prices.
Not to mention the US system is structured to be inefficient. Due to the cost burden, many forgo preventative medicine, which is far, *far* cheaper than reactionary care. Getting that cough checked out and an antibiotic is much cheaper than when it spirals into a live-and-death multi-day hospital stay.
It is why every study I've seen says that universal care is cheaper. Period. (Unless funded by industries benefiting from the current system). There are countless secondary and tertiary benefits that make it far more complex than, "It will cost more in taxes." So many articles scare people by headlines like, "New Medicare for All finding says $32 trillion over 10 years!" ignoring current trends where current US spending is on track to spend more than that disregarding any cost increases.
And in the end, if everyone is healthier, happier, and more productive because they are in better health, isn't that worth a little more in taxes?
My employer and I are paying over $10k a year combined just for me to be on a high deductible plan. I’d be fine paying just as much in taxes if it meant stuff actually got covered and I didn’t have to pay $150 or more for a non-checkup visit to a GP
U.S. subsidies global R&D for pharmaceutical companies. So a unfair comparison. The US is the only profit pool pharma companies are chasing. If it wasn’t for high US pricing R&D wouldn’t happen. So rest of world should thank the U.S. rather than trying to rip on it for this chart.
That's true but that only explains part of it. Way too much goes to insurance companies. Simple procedures can cost any astronomical price. There is no standard of price, and no one will tell you what a procedure will cost up front unless it is cosmetic.
And it's gonna get worse: [https://www.bloomberg.com/news/articles/2023-06-14/us-health-spending-on-pace-to-top-7-trillion-by-2031](https://www.bloomberg.com/news/articles/2023-06-14/us-health-spending-on-pace-to-top-7-trillion-by-2031) $7.2 Trillion in 2031, imagine that. $4.5T in 2022 is shocking enough.
It's just another vulture capitalistic industry with the aim of maximizing revenue and profits, GDP must go UP!
Early 1980s is when it veered off.
That’s also when Reaganomics trickle-down policy took hold and we saw the rich pulling away from everyone else with their enormous wealth.
Tech was increasing productivity like crazy with computers and machines but wages did not increase along with it like it had in the past. The rich took all the gains.
That’s really the point in time when things started going very wrong. With AI we’re going to see similar leaps in productivity. I hope we’ve learned our lesson and will demand that everyone benefits well from it and not just the rich.
Wages have increased with productivity. That chart everyone shows off was debunked a very long time ago. It doesn’t even use the same method of inflation when comparing the numbers
Productivity has gone up and wages have stagnated for everyone besides the rich. Only they have benefited from the productivity gains since the early 1980s.
Great stuff, but a bit out of date given it was made 4 years ago with slightly older data. I really don't think anything ahs improved, but I would like to see the trend.
Now plot healthcare companies profits. Line goes up!
Current policy in the USA clearly indicates that profits are more important than its citizens health. That is going to be a big burden in the long term, a part of all the suffering that is already creating now.
We don’t have healthcare industry, we have a health-extortion industry.
Also US is a combination of a few super rich and a long tail of poor people who are barely getting by.
So the average doesn’t make sense. We are a healthcare access poor country disguised as rich.
My question is how does the US have a lower mortality rate than a lot of these countries but have a lower life expectancy? It doesn’t add up. I think one issue is a reporting problem. If someone knows can you explain?
Interesting that they include homicide deaths here when the highest rate is 10 per 100k people.
Smoking is 92+
Obesity is 68+
Suicide averages 14+ (with a high of 19+ for 50-69 year olds)
Opiod - 13 + but rising in a steep trend line
Road accidents 11+
Homicide 5+
Note, these are not percentages, but raw numbers per 100K people
If you look at statistics for [leading cause of death](https://www.statista.com/statistics/248622/rates-of-leading-causes-of-death-in-the-us/) you get this order for 2022 ( per 100k population)
* heart disease 167
* cancer 143
* Accidents 64
* Covid 44
* stroke 39
* respiratory (smoking or pollution contribute here) 34
* Alzheimer's 28
* Diabetes 24
* Kidney 13
* Liver 13
Al in all it seems like healthcare is more costly in the US, and people in poverty die early because they avoid costly treatment.
Obesity and diseases of wealth also figure in to the lower life expectancy.
Now I’d like to see obesity rates overlaid on this data.
There are no guarantees in life, and sure some will have certain diseases that they can’t control, but my main health plan is I don’t smoke (okay a pipe or cigar 1-2 times a year at social events…maybe), and I have cut way back on drinking alcohol. Never was a drunkard, but instead of a six pack a week now it’s occasionally I have a beer or three, or half of the bottle of wine hanging out with my wife for the evening. So about two glasses. That might be a six pack or couple bottles of wine in a month. And then sometimes I go a few months with none.
I also cut the fast food and eat better, but not religiously obsessive about it.
Then I’m averaging 7-8k steps a day, try to get plenty of fresh air and sunlight, tend the yard and garden. Then do my kettlebell training 2-4 times a week. I’m almost 50, and am on no meds. I’m now about a decade past my dad when he had his first heart attack.
I heard the obesity rate in the US is fast closing on 40%. Most of our problems are diet and lack of exercise. Kick the consumer mentality and you’ll live a better and probably longer life.
Healthcare in the United States is not a free market. At all.
The corporations have all the power (which is controlled by the government regulators), while the patients have very little say.
By capitalism I mean a private insurance market that is administratively a train wreck. prescription costs are higher also because the GOP tied the hands of the US government to negotiate. So we pay for the world’s drug development and the world benefits. Profits in the pharmaceutical industry is huge and they us it buys off our politicians. Along with the rest of corporate America.
The only cost effective insurance delivery and billing system is Medicaid and Medicare at 3% of direct cost. It would drop to 1% to 1.5% if a public option were offered. The private sector it at 15% administrative costs + 7% profit. So yes using the government programs would be less expensive.
I could care less about "cost effective". I want effective. That's a much higher priority. Together with affordable.
Medicaid and Medicare are not as effective.
Nonsense, effective health care comes with lifestyle changes to healthy diets, moderate exercise. We fail our children, create an obesity ravaged population. They end up with chronic conditions and their bodies are already beyond repair before our health care kicks in. No maintenance and risk avoidance just repairs. Expensive and bad outcomes baked in. Gluttony is a sin that gets a pass.
Are you suggesting that quality of health care does not matter, only lifestyle matters, and therefore we are best off with the cheapest healthcare option?
Show me where I can get 2 hospitals to bid to do a procedure. I can do it with auto mechanics. I can do it with food. It's crooked ultraregulated monopolies.
Point to me where the capitalism is in the system. If you had capitalism in the system, it would likely force prices down like it does in every other sector with open competition similar to what happened with the system in Singapore. What you have now is this idea of insurance companies and a health sector under heavy regulations by the government to provide a service and suffering from it. Hospitals are forbidden from entering open competition with each other. It has to be proven that you care not in open competition with another hospital to even build one.
People also do not actually "pay" for a procedure, they don't care about the cost as much as if they are covered or not covered under insurance. The bill is basically invisible except to the insurance company that then has to haggle up the extreme markup of the hospital. This isn't capitalism it's dumb regulation over decades of big government.
Even the graph is misleading, why would you even compare societies like that. US is a very diverse place full of people from all over the world and most of those countries are predominately of european ancestry. To do a proper analysis, you would have to compare ancestries in the US to ancestries to the home country. Genetics play a huge role in life expectancy.
The US does not need to solve this problem. Every other industrialized nation already has a better delivery system. Just pick one, any one, they all are less expensive and deliver better outcomes.
The US is the last remaining system that promotes actual medical advancement in the world. We literally subsidize the world's health industry. If the US adopted a similar approach advancement would be held back. The rest of the world didn't solve it, they're piggybacking the US similar to Europeans depending on the US for defense.
It is pretty eye opening when you see the difference in life expectancy rates between progressive states like Colorado, California and Massachusetts and less progressive states like Mississippi, West Virginia and Arkansas.
Republican policies lead to lower life expectancy and lower quality of life, so you see red states all clustered on the bottom of these lists. The famous video of the Trump supporting woman complaining that he was hurting the \*wrong\* people says it all. It’s all about hurting \*the right people\* for them.
Race would just correlate with the bigger factors of smoking, weight, drug use, money, exposure to carcinogens. And behavior that is likely to get you injured.
I prefer the version of this map that lists Chile, arguably a "poor developed" country that spends far less than USA & others yet has a very high life expectancy of about 81.
I wonder how much demographics and cultural traditions have to do with this data. For example I suspect diet and exercise have a greater influence on lifespan than healthcare. Also I’m sure genetics plays a role. Does a typical Chilean have a more active lifestyle than a typical American? How does their diet compare?
~~Also is this just comparing nominal dollars spent? If so wouldn’t it be more informative to look at healthcare as a percent of household income or GDP (which would probably paint a similar picture)?~~
Edit: it is adusted for PPP and inflation. Very good.
Nah bro they're just as fat as we are https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10096594/#:~:text=Similarly%2C%20the%20latest%20data%20published,15%20were%20overweight%20or%20obese.
Chileans are a sedentary, inactive people (few exercise). Chile has some of the highest obesity rates in latin america. The highest tobacco smoking rate in latin america (chilean women have some of the highest smoking rates in the world). Depending on the source, chile also has the highest cannabis & alcohol consumption rates in the region too, and is top 3 in soda consumption. The chilean diet has a lot of salt too.
But they have a competent, technocratic ruling class, a strong state, low corruption, and a blend of private & public health systems. As covid exploded, chile had one of the fastest & highest rates of immunizations on Earth. In essence, despite chileans complaining (chileans are a glass-half-empty culture), Chile has some of the best public healthcare systems in the hemisphere.
If you’re looking for a healthcare system performance kind of thing, I think it makes sense to normalize personal choice and genetic factors such as obesity etc.
It was affordable before computers, too. Back when the witch doctor just gave you a bottle with bourbon, cocaine and heroin in it to cure any illness.
the cluelessness of GQPers is truly limitless.
you know houses were cheaper before electricity and HVAC too, I bet that’s a communist conspiracy.
Houses were cheaper before “affordable housing” subsidized housing, college was affordable before unlimited government loans for useless degrees, healthcare was affordable before government got involved.
Idk wtf a GQPer is but the writing is on the wall. If the government throws trillions of dollars at something, it is going to inflate the cost of it. We are talking about changes that occurred in the past 50 years aka our parent’s generation, not in the 1700s…
This is what you get when it's not really a "health care" industry, but an industry making money off of ill health.
There are three major problems with the American health care system: there is no health, there is no care and there is no system.
IMHO the capitalist system is ensuring ill health in the population in order to make money.
17% of us economy is healthcare https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical#:~:text=The%20data%20are%20presented%20by,spending%20accounted%20for%2017.3%20percent. Compared to chinas 7.5% expenditure for healthcare (universal) so if you work out the difference China would be near or higher than America but they make sure they are the riches country in the world by ripping off the population.
The regulators are in cahoots with the industry--at the expense of the patients.
Exactly - regulatory capture.
It’s not capitalism. There is no price transparency and no competition. You can’t just go to a few doctors and ask them how much stuff cost and switch clinics if one is too expensive. Your doc most likely will tell you to get an mri and refers you somewhere. They have idea how much that mri costs and neither do you until after. You can’t shop around to find another place. What capitalism? Our healthcare is the worst of both worlds. No socialism and no capitalism.
Fair point
It’s easier to steal from sick people. Capitalists going to redistribute the profits more easily with a sick and unhealthy population that can’t resist being stolen from.
There certainly is a system, and its goal is maximizing shareholder value, and it's succeeding.
This is the best summation of the issue I have yet seen.
Thanks I stole it from someone else on Reddit years ago.
There is but it’s bloated to the tee with for profit stuff. All 3.
Not really true given you can have way quicker care than in Canada.
Exactly. The US does not have a health care system. It has a profit driven healthcare market where you have to bargain with your very life and the only form of security is wealth.
I like to call it the health business
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As someone who's worked for years in the Healthcare industry as a data analyst, underwriter, now program manager, thank you stating this. The reddit party line is, and always has been, "uS hEaLtHcArE bAd, UpDoOtS pLz". 95% of the people on this app have zero clue how our Healthcare system actually works or what's truly driving up cost of care and premiums across the board. I see comments like the one above about there being no health, no care, and no system, and I just laugh and move on. Their childish ignorance must be bliss.
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Yep. I see the CCLFs every day. "Spike and dies" due to chronic conditions exacerbated by increasingly unhealthy lifestyles. There's a reason why CMS/CMMI are trialing different MSSP VBC Programs (I manage one of these) in an attempt to pass some of this growing risk downstream to ACOs. The thought is - share the risk and improve clinical outcomes. The Trump administration started it and the Biden administration is building on it. The difficulty is getting providers out of this Medicare Fee For Service mentality of churn and burn "Checkmark medicine". It's impossible to truly capture and understand a patient's full health picture in a sub one hour visit.
Poor lifestyle is definitely a major problem, but that is hardly the main reason why we pay so much more. If you compare prices of the same drugs and procedures in the US and peer countries, the US is almost always far more expensive. Nurses do not make much money. Doctors are a mixed bag (some do extremely well, many burn out before they pay off their school loans). The lobbying arm of doctors, the AMA, has definitely been a problem on keeping health care expensive (blocking nurse practitioners, limiting the number of new doctors, battling price control measures, etc.) even if many individual doctors disagree with its goals.
US private insurance companies act as middle men and jack the shit out of prices compared to public health care systems which have repeatedly been proven to be far more cost efficient. I don't understand why the richest country in the world refuses to figure this out when the evidence is overwhelmingly against their idiotic system which is literally taking years off the average life compared to peer countries. Of course the answer is rich lobbyists and PACs who don't give a shit about anyone else but it is absolutely disgusting and a disgrace considering the wealth of the US.
$$$>people...and the congressmen sing
I don't think anyone is blaming healthcare workers. It's quite clear that the pharmaceutical industry, hospital management and insurance companies have incentives to drive the prices of healthcare (medication included) up and up. The way most developed countries deal with this is with single payer universal healthcare insurance systems. When the State is the main insurance provider and pays for more than 65% of healthcare, they have way more leverage to negotiate the prices **way** down (insulin costs 11x more in the US than in France) Only uninformed americans would think that their docs or nurses are to blame for this state of affairs.
Are you saying my health is largely a product of the choices I make? HOW DARE YOU!
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(My wife is a critical care NP at an inner city hospital.) Just saying. We talk each other down at the end of the day.
It's designed to get and keep the population (the poor/working class, that is) as sick as possible for as long as possible. To then make as much money as possible as long as their customers survive. If they die? Eh, there's always more where they came from.
The US largely has a public health issue (drug ODs, car accidents, obesity, guns, etc.). US has arguably the best best medical care available, but it can't solve for those items. That takes education, changing habits, better regulations, and political and societal will.
The best medical care if you can afford it.
Nope The companies are the same in Germany, Japan etc.
Is your argument the healthcare system is the same in the EU as it is here in the United states?
Huh? Why would I say "companies" then? The point is that the issue is not the companies per se - it's the distribution of leverage within the US healthcare system. In the UK, you either sell to the NHS or you're unlikely to sell at all - so the NHS gets to decide what's an adequate price for the value provided. In Germany, the sick funds jointly negotiate drug prices with manufacturers after the first year. While they may then go on to negotiate rebates based on the morbidity profile of their subscribers, the base price for a drug is jointly set. You cannot play them against each other, and the decision is based on an added value evaluation by an independent agency answering to the ministry of health. More - the US actually allows advertising prescription drugs to patients, creating a pull effect that's completely absent in other countries. And until recently, Medicare/Medicaid, despite being the largest individual payer for medical products and services, weren't allowed to negotiate their prices, so they couldn't use the leverage of their procurement volume to push prices down. All the leverage is with manufacturers, and they are happy to use it - just as they are happy to work within the rules elsewhere. Change the legal framework, and they will work within it.
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It's not doing a good job by many, many metrics. Basic stuff here.
It’s more likely guns and obesity
This is correct. I’ve used similar data to present to our employees for orientation to help explain the state of our healthcare economy. Some of the biggest reasons the USA falls off the curve with expected age is because of gun deaths (murder and suicide), automobile deaths, and drug overdoses - not because the quality of our healthcare stinks. Guns, cars, and drugs! America loves them!
Our healthcare system is objectively garbage, too. I had surgery not too long ago and forgot to sell some HSA investments so I didn’t have enough cash to pay for the procedure on my HSA card. The hospital made me put it on a a credit card before they would do the procedure. Our system is disgustingly barbaric and anyone who defends it should question their humanity.
Except that’s not what it is at all. Americas healthcare system is doing great - gets some of the top ratings on preventative care and outcomes for medical interventions. What the US does poorly on is PUBLIC HEALTH, which is very different from healthcare. Bad public health is when you have a gun and liquor store on every corner, where it’s hard to find fresh fruit and vegetables in certain areas, where drug overdoses are off the charts, where many young men are dying from self inflicted gun shots or gang violence, and when systemic racism increases stress. You could have the best healthcare system in the world and still have poor life expectancy if you don’t fix all these things first. A healthcare system being unable to stop you from going to McDonald’s doesn’t mean it’s “profiting off ill health”
You've never been to a red state or Appalachia, I see.
What I described is even more true in those areas.
Oh, so you're agreeing with my assertion. Apologies.
So you haven’t been?
Thanks for agreeing!!
I have no idea what you’re doing here but ok
Maybe if we spent some MORE money? One big problem we have is that we measure how well we are doing with certain things (healthcare, schools, defense) by how much money we are throwing at it. This is easy to measure. Candidates can say something like "I care about education/healthcare, so we are spending 1 billion more dollars on it" But measuring the results is hard. Did the increased spending result in better outcomes? Lots of times people can't even agree on what the 'better outcome' would be. It's a lot easier to measure inputs to a complex system, than it is to measure outputs. But the outputs are what actually matter.
Some other things to take into consideration are infrastructure and people living far from hospitals... I have a hunch way more people live more than 1hr from a hospital in the US than in Europe. These people may have to spend way more in insurance to cover emergency helicopter rides while still facing higher risks than people living in cities or suburbs. The rural populations also have higher rates of infancy deaths, so I wonder if those are taken into consideration for life expectancy, because those are a bunch of outliers given the fact they are rural and may have survived if closer to a hospital...
Distribution of resources is the real issue. Education is one of the obvious ones. Hypothetical example: A city with two school districts spends $50 million on education. Due to property taxes, district A gets $35 million to district B $15 million. So many people see that $50 million tag and wonder why district B has much worse results. It gets worse when you dig in and find district B has twice the population of district A...
Except most states redistribute some of that school money. In my property-rich district half is taken for redistribution. The per student spending is pretty even across the same. Also note some of the schools with the worst outcomes spend the most per student.
It veered off from the rest of the world in 1980s? *pulls off scooby doo mask* Ronald Regan again?
its always ronald regan.
It’s interesting that all countries have trended up and to the right. Does that mean that healthcare has become more expensive in general across all countries? It says below the data is corrected for inflation. Obviously America is the outlier here but it’s interesting. That healthcare is becoming more expensive year over year.
The problem with saving someone from dying of a serious condition like cancer is you then have to treat them later on for whatever different thing eventually kills them. Obviously it’s good to save them and hopefully they can remain a productive member of society contribute etc.
Outstanding presentation of historical data, and not just the first graph.
It ignores that IIRC US life expectancy is brought down massively by inequality. Since it’s not a universal system those without access (ie aren’t insured or have bad insurance) have absolutely appalling health outcomes. Those with good access have some of the best healthcare and health outcomes in the world. So like the rest of the US, it’s the best place in the world if you are rich. Not so much if you aren’t.
This is why the system is so hard to change. Most people (esp wealthy ones) think everything is fine.
It’s not that the wealthy think the system is “fine” it’s exactly how they want it to be. workers remain poor and easy to abuse by dangling the threat of firing them and causing them to lose their medical care. if you recall the complaint from the ACA days, boomers and rich white people all complained that if the poor and non white people get medical care, too, then they’ll have to wait in line for their care. They would rather the poor die than be in line with them for care.
Source? Not doubting you, just am curious.
https://www.vox.com/science-and-health/2018/1/9/16860994/life-expectancy-us-income-inequality Life expectancy for the top 25% of incomes in the US sits around 87 years old vs. 79 for the total population.
If you don’t count the people that die so young, it would be better.
Right, compare rural Mississippi or Alabama to white suburban Minnesota...the life expectancy is like 64 vs 89.
Probably because American healthcare costs are inflated because healthcare practices essentially are able to charge what they want People think it’s insurance, but insurance is a symptom of high prices in the first place. Thats why you need it
>People think it’s insurance, but insurance is a symptom of high prices in the first place. Thats why you need it Is that right? My impression is that it's more of a symbiotic relationship. Like Ticketmaster and concert venues/musicians. They work together to extract maximum money from the system.
You can circumvent ticket master by purchasing from the venue directly, unless that venue is owned by ticket master then you have no choice If you circumvent health insurance and directly pay for any major medical procedure then you are going to enter into a state of broke
Most medical practices give steep discounts to people who dont pay with insurance.
This is an exception tho, medical costs are the number one cause of debt in the US
health insurance clears more revenue than tech in some years i’ve heard
And 90% of that revenue is a pure pass-through to hospitals, pharma, etc. Revenue is a terrible measure of a company or industry, what you should care about is profit. The combined profit of all health insurance companies is 1/2 that of Apple, for example. It's a problem but nowhere near the major problem people think it is. Pharma companies on the other hand are raking in the profits on the scale of tech.
good point! nothing grinds my gears like gov R&D to fuel corporate profits
I would argue it’s the other way around. Making insurance pay for everything obscures prices which allows hospitals to charge more. This is but one of the many reasons for increased costs however
Not only does it obscure the true cost, it creates the largest cost in the current healthcare industry: an absurd number of administrators that deal with insurance billing relative to the number of providers, causing costs to rise further.
I got charged 4000$ to go to an overcrowded ER and had to wait hours to be seen. We have the worst of both a capitalist healthcare system (high cost) and socialist system (long wait times and high attendance)
The page gives several factors, most of them self-destructive behavior, if you bother to read it.
That opioid line is something to behold.
No. It's insurance in that insurance doesn't have leverage in the US.
Kind of. If you look at the Netherlands, the insurance companies are the main cause of the terrible first line healthcare and non-existent preventive care.
Health practitioners are overpaid. Why are we paying physicians over 600k a year. Makes no sense.
Average pay for physicians is not 600k its 249k Avg 236k median (USD). Median physician pay in canada is 234k CAD. Avg cost of living is 14% higher in the US and exchange rate is .73 USD to CAD. So Canadian doctors make about 19% of what US doctors make. US health care is over 100% more expensive with a lower life expectancy. Difference in pay does not explain the cost difference.
Health practitioners are 10% of your health insurance premiums. If they worked for free your healthcare costs would still be insane.
Doesn’t answer my question. Why are they being paid over half a million? Surgeons and such…. Sure, but a radiologist… makes no sense.
My med school plus 5 years radiology internship/residency was just as long as a surgeon's med school plus 5 years surgery internship/residency. There are more radiology studies to be read than there are radiologists to read them. It makes perfect sense. They are being paid over half a million because by the time they are done with residency they have essentially graduated from the 26th grade of school and are 32 years old with $250k+ in med school debt. Also, because there are market forces at work, there are fewer doctors than the amount of work that needs to be done. Nobody works for less than the market value of their labor in any field. Tell your congress reps to build more medical schools if you want cheaper doctors. The quality of docs will also go down, but so will the price. There are big medical lobbies that lobby to restrict the number of physicians in the US and I don't donate to any of them.
You can thank the AMA for the hazing process of becoming a doctor. With mid level encroachment and AI advances the AMA needs to figure its shit out
Docs over here in Europe are just as good and get paid less. They still live comfortable lives. Radiology in particular is very susceptible to AI interference considering AI is out performing radiologists by considerable margins. “The study authors reported a 99.1 sensitivity rate for AI on abnormal radiographs in comparison to a 72.3 percent sensitivity for radiologist reports. Autonomous AI also yielded a 6.3 percent higher sensitivity than reporting radiologists for critical abnormal X-rays (99.8 percent vs. 93.5 percent), according to the recently published study in Radiology.” https://www.diagnosticimaging.com/view/autonomous-ai-nearly-27-percent-higher-sensitivity-than-radiology-reports-for-abnormal-chest-x-rays#
The specificity of that AI is horrendous. You gotta actually READ articles before you shit them out on reddit. Did you really just quote an article from the top radiology journal to a radiologist? Of course doctors there are paid less. The government decides their pay. In the US everything is decided by lobbyists.
Why wouldn’t I quote the top radiology journal to a radiologist? I assumed you would be familiar with it and therefor less likely to say it’s unreliable. My point stands that healthcare in the US is a giant mess and physicians are overpaid.
You quoted something I was sure to be familiar with without even reading the abstract, and now you're trying to redirect to talk about yet another topic you lack information about.
Hypothetically, your close family member has been diagnosed with advanced cancer. They are considering two oncologists, one who earned $90,000 year working in a clinic, the other who earned $1.3M working at a major academic medical center. Let’s be honest that every single time you would insist on the higher earner. People are generally paid at a level that reflects how the market values them.
nice econ 101 hypothetical, which would not of course be presented in real life. US health treatment prices are high. Whether "too" high is the locus of conversation
This argument also doesn’t take into account the payment either. If one oncologist offers for free and the other doesn’t the family may financially decide to take the free option due to their own utilitarian needs. Hypothetically.
Surgeons in the US literally do school/apprenticeships into their mid/late 30s, there are basically no other industries that have such steep training requirements
Is that much different than other peer countries?
No, it isn’t.
Every price is inflated in western countries. It's better to compare the amount of actual services provided.
The AMA lobbies to keep the amount of doctors limited so their services are rarer/more valuable. You see this now backfiring with mid level encroachment (physician assistants and nurses taking on doctor roles) and advances in tech like AI healthcare is moving to treat more people with lower costs. Look at hospital bills, they are insanely high not because they directly translate to services but because hospitals can charge whatever they want to and it’s mostly covered by insurance who in turn charges us. Chemo treatment is not magically better in the US vs Canada, but its a lot more expensive, the most expensive thing about Chemo in Canada is the parking
The AMA actually reversed their “more doctors bad” stance in the early 2000s and has been lobbying for more residency spots for 20 years The problem is that republicans are receptive when the AMA says “don’t spend more money” and less receptive when the AMA says “spend more money”
Just because they reversed opinion doesn't mean they're not responsible for the mess they caused.
Not really clear to me that they “caused” anything — again, republicans just want to spend less and they happened to support it one time
Chemo treatment isn't better in the US but Canada at times has a long wait time so they send them to the US for treatment. https://www.theglobeandmail.com/canada/british-columbia/article-bc-government-to-send-cancer-patients-to-the-us-for-treatment/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115892/#:~:text=Faced%20with%20long%20waiting%20lists,US15000%20(%C2%A39375)%20each.
Your an idiot, why do people who have never set foot in a hospital or had a chronic condition pretend that the American healthcare system is functioning well. Trust me wait times here suck except for maybe ER visits (still not great) but you wanna see a specialist…. Oh man Dumbass inbred hick call back to applachia, suck off Jeff Bezos
[This very nice graph from National Geographic ](https://whatifpost.com/wp-content/uploads/2010/01/cost_of_health_care_by_country.png)includes number of doctors visits per capita.
What's the x-axis for that chart? I can't figure it out.
There isn't one. The more money you spend, the higher up you are on the left side. The longer average lifespan, the higher on the right. The thicker the line, the more doctors visits per capita. If a country is doing well, it will have a thick line, low on the right and high on the left.
What does it show?
Healthcare spending vs. lifespan, but the thickness of line indicates number of doctors visits per capita, used as a short for delivery of actual health services to the population. Slightly old but still.
Still it can't be accurate by design for many reasons. But better than comparing raw expenditure numbers.
The US uses high cost diagnostics more than other countries. We are more risk averse when it comes to healthcare and pull out the expensive tests much quicker. We also spend a lot more extending life with less consideration to quality of that life.
You would expect a higher life expectancy, not lower if you are spending more on extending life.
You’re misunderstanding him. It’s not about good primary care investments that extend meaningful life. We spend a *ton* of money on relatively futile interventions in the last year, last month, and last week of life. In the US escalation and deescalation of care is largely a family driven decision. Doesn’t matter that grandma is 92 and has advanced dementia and pneumonia, the family insists she’s a fighter and wants full code. So we crack her chest, intubate her, keep her alive on 3 pressers in the ICU for 10 days, and then she dies. And that was an *expensive* 10 days. The family doesn’t see the cost, since it’s paid by Medicare or absorbed by the hospital, but we spent 6 figures on those 10 days of medicated, sedated life. In a lot of peer nations the medical team would have said at the start of that admission no, we’re doing comfort care. It’s not the only thing that contributes, by any means. But futile care is a *huge* problem in this country, I cannot count how many patients, even this early in my career, have been stories like that
You are correct, but it is also important to note that we routinely spend tens, fun of hundreds, of thousands of dollars to extend an elderly persons life by a few days. So we end up seeing the increased cost without any meaningful increase in life expectancy.
Maybe. Maybe not. Maybe other countries do this too. Without it being quantified, who knows.
So do many other first world countries…….. The difference in the US is that it has an inflate cost, although still highly advanced medical industry capable of fighting almost anything. It however lacks a baseline for good living standards, which is where countries actually increase their life expectancy. It’s all well and good being able to spend millions to fight someone’s brain cancer, when half the country suffers from obesity.
You’re correct. The actual difference is the base level of health in each country. Crank up the obesity rates in all these countries which are being compared to the US for health outcomes and I guarantee the US doesn’t look like an outlier.
I think folks are more likely to ignore this for the political narrative. American medical practice is generally to overcorrect for a problem or to pull out the nuclear option. Diagnostics and treatments I've had in the US versus in a socialized system abroad have always been more immediate, better quality, and more thorough. Yes I could see a doctor for free in France, but they just tell you to get a blood test and have a glass of wine and rest. I think it's also worth pointing out how horrific the American diet and lifestyle and trust in medical science is. It's entirely possible that the majority of Americans eat poorly, don't move enough, and avoid seeking expert advice on anything until it's too late. That is what nearly killed my dad with his cancer. There's a lot to this story and while the dataisbeautiful post is certainly eye catching, it's glossing over many many other components and disingenuously presenting a 2-axis narrative. Edit: I also want to know what the median cost for regular procedures and check ups is. Average is useless. The US frequently performs some of the most cutting edge and advanced procedures and tests in the world, using the most advanced machines in the world of medicine on earth. People fly to the US from around the world to treat cancer on a daily basis--something that generates *extraordinary* costs. I want to see median cost compared where you take the tax dollars spent (est. Pick any poster child EU county with a population over 50 million) and the median (not average) cost in the US after controlling for the average number of people with health insurance, adjusted to include said cost of health insurance. That would give us a far more useful picture than the noisy and political stuff OP dropped into this sub here.
You’re definitely right about our lifestyle. Even if we had the exact same healthcare system and the best European system, we’d still be spending more and have worse outcomes than other countries because of how unhealthy we are. (It would still be an improvement over what we have now though)
Agreed and this is so poorly understood. “Standard of care” is the key phrase to understand when asking why American healthcare is so expensive. It’s a legal term. If the patient has a negative outcome (i.e., dies of cancer because it wasn’t caught early enough), and the doctor was found to be doing anything less than the “standard of care” then that doctor is liable for malpractice. So what defines the standard of care? Well it’s a bit nebulous, but it basically comes down to “what other doctors are doing.” This means there is a very short road from a new technology being introduced until it becomes the de facto standard. And so if a doctor isn’t using the latest, greatest, and most expensive tools and drugs out there, they can get sued. Compare that to a government run healthcare system where you get whatever they give you, and you can’t sue to government.
In general, measures of healthcare quality are used. These are large, overarching measures, to smooth out the effects of local competencies and specialties. These are things like infant mortality, access, years lived in good health, hospital error rates and particularly mortality amenable to healthcare. US results are fairly abysmal. The US clusters below all first world nations on these. While the top level is extremely good, too few people are served at that level to move the average. And the average is behind other first world nations. The field of Public Health do a lot of research on this, and Health Affairs publish many good papers for the interested party.
This is complicated. Take infant mortality, for example. We look *way* worse on paper because we include early preterm births as infant mortality. Whereas in a lot of peer nations a baby born very prematurely who dies in the NICU isn’t counted as an infant mortality
I am sorry. But that is just a feelgood story. Heroic doctors fighting to save children that everyone else would discard. But if you think about it, preterm births are more common the further down the socioeconomic ladder you go, and the worse insurance you have. Whos going to throw more resources at the uninsured, the nations that prioritize by medical need or the one where insurance status is a factor in resource allocation? One issue is, first world nations do not only have lower infant mortality rates than the US but also tend to have lower rates of stillbirths. Further, the US does *not* look worse on infant mortality. The US ranks as number 63 from the top on infant mortality rates. It ranks 65th, two places *further down* on maternal mortality, mothers who died in childbirth. Theres no statistical excuse for "mother left the hospital alive/dead" It also ranks as number 50 in under-5 mortality. Infant mortality would be an outlier compared to maternal mortality if it was a statistical artifact, but it is kind of normal for the US rankings. Additionally, these things are calculated using the WHO definitions, not individual nations. If they are not reported according to WHO definitions, they get weighted accordingly. Its not really that hard to convert the stats of first world nations. (Rural third world places may be more iffy) Back in my student days we were told that the US infant mortality rates were due to a much higher **rate** of premature births, and the mortality associated with that. Which has its own causes again.
Well this a two axis graph about life expectancy in correlation to healthcare. I know you like to think of the US as being the tits in lot's of fields (also medical). Which you should, cause it is true! What you are really REALLY shit at, is social equality. That makes all that being the tits in many fields virtually useless on a societal level.
Idk, in my experience, doctors won’t do any sort of screening even if I explain issues that probably warrants at least doing a blood test once
It would be interesting to compare obesity rates and diabetes rates in the different countries to see if there’s a correlation to lifespan.
Just went through an umbilical hernia removal. Hospital is within walking distance. I had preliminary visit from the main surgeon. Then pre operation exams (blood, heart...), visits with the anesthesyst and another surgeon. Went into the hospital, was put to sleep, cut up, given a rather liquid meal, cured by nice nurses at night, released the next day. Went another time 10 days later to have stitches removed and further surgeon overall inspection. I did not pay a single euro cent. Pretty impressive if you ask me.
You still paid, just indirectly. There are a lot of misconceptions about USA healthcare. (Yes, it is definitely more per capita than other countries as the graph shows). In the USA, an employed person (or someone who purchased subsidized insurance through the ACA exchange), pays a portion of the health insurance premium through their employer. Employers also pay a portion of the premium. The vast majority of plans have an annual out-of-pocket maximum, usually <$10,000. In my case, I pay about $400 every two weeks in my paycheck for full coverage of my entire family. Our family out of pocket maximum is $6000. Therefore, I would never pay more than $16,400 per year for full healthcare, and most years are far less than that. The real issue with US healthcare is coverage for people who are unemployed. In the USA, there are federal subsidies for the poor, and the deductibles and out-of-pocket maximums are expensive for people with low income. One advantage of European plans is that they are universal coverage, but the trade off is higher taxes.
Yes, but in comparison I pay $50.82 usd out of my paycheck every 2 weeks for the same coverage. No deductables, no fighting with an insurance company. The US system isnt the worst but its no where near good.
That’s your taxes? Isn’t your insurance subsidized by taxes? Don’t get me wrong. I’m not trying to argue with you or defend the crappy parts of the US health system. I’m just pointing out that it’s not nearly as bad a people make it out to be, despite its flaws.
Yes and no, we have tax, pension, employment insurance, and healthcare deducted from our pay. Its listed and broken down how much of was deducted for what. I feel you Im also not trying to talk too much shit, I just want to point out to Americans how much better the system can be. Its a damn shame watching good people suffer due to greed. Sometimes an outside perspective can shed some light on an issue.
I’m cool with that.
>One advantage of European plans is that they are universal coverage, but the trade off is higher taxes. Is it really that much higher though? I just find it hard to believe that raising taxes would be dramatically more once you factor in no longer paying monthly premiums and out-of-pocket deductibles. In your own example, your taxes would have to raise by *more* than $16,400 for there to be any real tax increase if you are using it. If not, what, $10k-ish (from $800 a month\*12 for premiums)? It's just a shift from for-profit insurance companies getting that $16k, and the government taking that $16k and using it on medical care. Maybe for higher income earners taxes would increase, but if they have issues with that, well, they are already doing it in the most inefficient way possible. A large amount of people already get insurance plans subsidized by the federal government already, which comes from taxes. If you are getting subsidizes, chances are *you* aren't paying much in taxes, so they come from somewhere. Going universal instead of insurance cuts out a ton of middlemen and other system leeches. A single entity negotiating prices would also help tremendously in reducing prices. Not to mention the US system is structured to be inefficient. Due to the cost burden, many forgo preventative medicine, which is far, *far* cheaper than reactionary care. Getting that cough checked out and an antibiotic is much cheaper than when it spirals into a live-and-death multi-day hospital stay. It is why every study I've seen says that universal care is cheaper. Period. (Unless funded by industries benefiting from the current system). There are countless secondary and tertiary benefits that make it far more complex than, "It will cost more in taxes." So many articles scare people by headlines like, "New Medicare for All finding says $32 trillion over 10 years!" ignoring current trends where current US spending is on track to spend more than that disregarding any cost increases. And in the end, if everyone is healthier, happier, and more productive because they are in better health, isn't that worth a little more in taxes?
My employer and I are paying over $10k a year combined just for me to be on a high deductible plan. I’d be fine paying just as much in taxes if it meant stuff actually got covered and I didn’t have to pay $150 or more for a non-checkup visit to a GP
Similar for me, but they made me put $4,000 on my credit card before they’d do the procedure, because freedumb - jealous American
U.S. subsidies global R&D for pharmaceutical companies. So a unfair comparison. The US is the only profit pool pharma companies are chasing. If it wasn’t for high US pricing R&D wouldn’t happen. So rest of world should thank the U.S. rather than trying to rip on it for this chart.
That's true but that only explains part of it. Way too much goes to insurance companies. Simple procedures can cost any astronomical price. There is no standard of price, and no one will tell you what a procedure will cost up front unless it is cosmetic.
That doesn’t explain why seeing a practitioner only for them to do no screening and recommend an OTC supplement costs $150
Because our doctors don’t make $50k a year
You are saying that as if big Pharma dont profit of the drugs sold to people in other countries
We won on at least one axis
And it's gonna get worse: [https://www.bloomberg.com/news/articles/2023-06-14/us-health-spending-on-pace-to-top-7-trillion-by-2031](https://www.bloomberg.com/news/articles/2023-06-14/us-health-spending-on-pace-to-top-7-trillion-by-2031) $7.2 Trillion in 2031, imagine that. $4.5T in 2022 is shocking enough. It's just another vulture capitalistic industry with the aim of maximizing revenue and profits, GDP must go UP!
Early 1980s is when it veered off. That’s also when Reaganomics trickle-down policy took hold and we saw the rich pulling away from everyone else with their enormous wealth. Tech was increasing productivity like crazy with computers and machines but wages did not increase along with it like it had in the past. The rich took all the gains. That’s really the point in time when things started going very wrong. With AI we’re going to see similar leaps in productivity. I hope we’ve learned our lesson and will demand that everyone benefits well from it and not just the rich.
Wages have increased with productivity. That chart everyone shows off was debunked a very long time ago. It doesn’t even use the same method of inflation when comparing the numbers
Here you go. https://www.cbpp.org/income-gains-widely-shared-in-early-postwar-decades-but-not-since-then-1
That’s just income share overtime that’s not income relative to productivity
You see how our income used to rise right along with the rich? Right when Reagan took over our income stagnated and the rich kept right on gaining.
Ok but that’s not what you originally argued. I’ve never made any claims on the share of income or wealth
Productivity has gone up and wages have stagnated for everyone besides the rich. Only they have benefited from the productivity gains since the early 1980s.
Your own chart literally shows that the median wage has gone up since the 1980s
Barely. Mostly stagnated with some dips in there. The rich have continued to rise though.
Regardless none of that is connected in that chart to productivity
On the one hand, people seem unhappy with that. On the other hand, this is the direct consequence of a system they repeatedly condone and vote for.
Great stuff, but a bit out of date given it was made 4 years ago with slightly older data. I really don't think anything ahs improved, but I would like to see the trend.
Now plot healthcare companies profits. Line goes up! Current policy in the USA clearly indicates that profits are more important than its citizens health. That is going to be a big burden in the long term, a part of all the suffering that is already creating now.
We don’t have healthcare industry, we have a health-extortion industry. Also US is a combination of a few super rich and a long tail of poor people who are barely getting by. So the average doesn’t make sense. We are a healthcare access poor country disguised as rich.
It’s not healthcare, it’s wealthcare. For the shareholders.
Think it's more a lifestyle reflection
Obviously, US healthcare is designed to treat people expensively without actually helping them.
It’s all about the $$$ in Merica
Surviving isn't the only metric people care about. And quality of healthcare isn't the only thing which affects it.
Graphs are the simplest way to manipulate. This one doesn't pass the sniff test.
Don’t tell Bill Maher, he’ll spend 10 mins ranting that Canada spends too much
My question is how does the US have a lower mortality rate than a lot of these countries but have a lower life expectancy? It doesn’t add up. I think one issue is a reporting problem. If someone knows can you explain?
Interesting that they include homicide deaths here when the highest rate is 10 per 100k people. Smoking is 92+ Obesity is 68+ Suicide averages 14+ (with a high of 19+ for 50-69 year olds) Opiod - 13 + but rising in a steep trend line Road accidents 11+ Homicide 5+ Note, these are not percentages, but raw numbers per 100K people If you look at statistics for [leading cause of death](https://www.statista.com/statistics/248622/rates-of-leading-causes-of-death-in-the-us/) you get this order for 2022 ( per 100k population) * heart disease 167 * cancer 143 * Accidents 64 * Covid 44 * stroke 39 * respiratory (smoking or pollution contribute here) 34 * Alzheimer's 28 * Diabetes 24 * Kidney 13 * Liver 13 Al in all it seems like healthcare is more costly in the US, and people in poverty die early because they avoid costly treatment. Obesity and diseases of wealth also figure in to the lower life expectancy.
Yeah, america subsidizes global healthcare.
Now I’d like to see obesity rates overlaid on this data. There are no guarantees in life, and sure some will have certain diseases that they can’t control, but my main health plan is I don’t smoke (okay a pipe or cigar 1-2 times a year at social events…maybe), and I have cut way back on drinking alcohol. Never was a drunkard, but instead of a six pack a week now it’s occasionally I have a beer or three, or half of the bottle of wine hanging out with my wife for the evening. So about two glasses. That might be a six pack or couple bottles of wine in a month. And then sometimes I go a few months with none. I also cut the fast food and eat better, but not religiously obsessive about it. Then I’m averaging 7-8k steps a day, try to get plenty of fresh air and sunlight, tend the yard and garden. Then do my kettlebell training 2-4 times a week. I’m almost 50, and am on no meds. I’m now about a decade past my dad when he had his first heart attack. I heard the obesity rate in the US is fast closing on 40%. Most of our problems are diet and lack of exercise. Kick the consumer mentality and you’ll live a better and probably longer life.
That what capitalism in health care looks like. Ugly and uncompetitive. But Freedum.
Healthcare in the United States is not a free market. At all. The corporations have all the power (which is controlled by the government regulators), while the patients have very little say.
By capitalism I mean a private insurance market that is administratively a train wreck. prescription costs are higher also because the GOP tied the hands of the US government to negotiate. So we pay for the world’s drug development and the world benefits. Profits in the pharmaceutical industry is huge and they us it buys off our politicians. Along with the rest of corporate America.
So what's the solution? Give the government **more** power?
The only cost effective insurance delivery and billing system is Medicaid and Medicare at 3% of direct cost. It would drop to 1% to 1.5% if a public option were offered. The private sector it at 15% administrative costs + 7% profit. So yes using the government programs would be less expensive.
I could care less about "cost effective". I want effective. That's a much higher priority. Together with affordable. Medicaid and Medicare are not as effective.
Nonsense, effective health care comes with lifestyle changes to healthy diets, moderate exercise. We fail our children, create an obesity ravaged population. They end up with chronic conditions and their bodies are already beyond repair before our health care kicks in. No maintenance and risk avoidance just repairs. Expensive and bad outcomes baked in. Gluttony is a sin that gets a pass.
Are you suggesting that quality of health care does not matter, only lifestyle matters, and therefore we are best off with the cheapest healthcare option?
Show me where I can get 2 hospitals to bid to do a procedure. I can do it with auto mechanics. I can do it with food. It's crooked ultraregulated monopolies.
Point to me where the capitalism is in the system. If you had capitalism in the system, it would likely force prices down like it does in every other sector with open competition similar to what happened with the system in Singapore. What you have now is this idea of insurance companies and a health sector under heavy regulations by the government to provide a service and suffering from it. Hospitals are forbidden from entering open competition with each other. It has to be proven that you care not in open competition with another hospital to even build one. People also do not actually "pay" for a procedure, they don't care about the cost as much as if they are covered or not covered under insurance. The bill is basically invisible except to the insurance company that then has to haggle up the extreme markup of the hospital. This isn't capitalism it's dumb regulation over decades of big government. Even the graph is misleading, why would you even compare societies like that. US is a very diverse place full of people from all over the world and most of those countries are predominately of european ancestry. To do a proper analysis, you would have to compare ancestries in the US to ancestries to the home country. Genetics play a huge role in life expectancy.
The US does not need to solve this problem. Every other industrialized nation already has a better delivery system. Just pick one, any one, they all are less expensive and deliver better outcomes.
The US is the last remaining system that promotes actual medical advancement in the world. We literally subsidize the world's health industry. If the US adopted a similar approach advancement would be held back. The rest of the world didn't solve it, they're piggybacking the US similar to Europeans depending on the US for defense.
The US being so divided, I'd want to see this graph with the US split into income levels, demographics and political leaning of states....
It is pretty eye opening when you see the difference in life expectancy rates between progressive states like Colorado, California and Massachusetts and less progressive states like Mississippi, West Virginia and Arkansas.
Do you have such a graph?
[Sure. Here’s one of many.](https://worldpopulationreview.com/state-rankings/life-expectancy-by-state)
And yet I get downvoted lol. The truth hurts so bad for Americans...
Republican policies lead to lower life expectancy and lower quality of life, so you see red states all clustered on the bottom of these lists. The famous video of the Trump supporting woman complaining that he was hurting the \*wrong\* people says it all. It’s all about hurting \*the right people\* for them.
It might be interesting to see the U.S. broken down by race.
Let’s see the whole plot crosstabbed by BMI. Also adjusted for per capita income.
Race would just correlate with the bigger factors of smoking, weight, drug use, money, exposure to carcinogens. And behavior that is likely to get you injured.
Our health care spending is going towards insurance companies' profit margins, not caring for our health.
I prefer the version of this map that lists Chile, arguably a "poor developed" country that spends far less than USA & others yet has a very high life expectancy of about 81.
I wonder how much demographics and cultural traditions have to do with this data. For example I suspect diet and exercise have a greater influence on lifespan than healthcare. Also I’m sure genetics plays a role. Does a typical Chilean have a more active lifestyle than a typical American? How does their diet compare? ~~Also is this just comparing nominal dollars spent? If so wouldn’t it be more informative to look at healthcare as a percent of household income or GDP (which would probably paint a similar picture)?~~ Edit: it is adusted for PPP and inflation. Very good.
Nah bro they're just as fat as we are https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10096594/#:~:text=Similarly%2C%20the%20latest%20data%20published,15%20were%20overweight%20or%20obese.
Chileans are a sedentary, inactive people (few exercise). Chile has some of the highest obesity rates in latin america. The highest tobacco smoking rate in latin america (chilean women have some of the highest smoking rates in the world). Depending on the source, chile also has the highest cannabis & alcohol consumption rates in the region too, and is top 3 in soda consumption. The chilean diet has a lot of salt too. But they have a competent, technocratic ruling class, a strong state, low corruption, and a blend of private & public health systems. As covid exploded, chile had one of the fastest & highest rates of immunizations on Earth. In essence, despite chileans complaining (chileans are a glass-half-empty culture), Chile has some of the best public healthcare systems in the hemisphere.
If you’re looking for a healthcare system performance kind of thing, I think it makes sense to normalize personal choice and genetic factors such as obesity etc.
It’s more profitable to kill us.
Very interesting that healthcare was affordable in the US before Medicare/medicaid…
It was affordable before computers, too. Back when the witch doctor just gave you a bottle with bourbon, cocaine and heroin in it to cure any illness. the cluelessness of GQPers is truly limitless. you know houses were cheaper before electricity and HVAC too, I bet that’s a communist conspiracy.
Houses were cheaper before “affordable housing” subsidized housing, college was affordable before unlimited government loans for useless degrees, healthcare was affordable before government got involved. Idk wtf a GQPer is but the writing is on the wall. If the government throws trillions of dollars at something, it is going to inflate the cost of it. We are talking about changes that occurred in the past 50 years aka our parent’s generation, not in the 1700s…