U.S. Spends 141% More on Health Care

[haha]

However after the initial dressing there was no after care treatment and I had to care for a significant wound on my own. The US does the difficult stuff well but too often ignores basic care that ensures good outcomes.

I had a similar situation recently. Cyst removed from the middle of my back, and one from my butt. Neither exactly easy for me to see. And if you are going to ask friends, have to have pretty good friends to change the dressings on your butt.

Ha

 

[NW-Bound]

Good observation. It is a hodge-podge. The system is more of less inconsistent which opens it up to being gamed by certain participants (suppliers and consumers) as well at excluding some consumers.

A close friend of mine recently told me a story about a cousin of his. This guy is in his early 50s, never could hold a job in his life, as he was and still is a drug addict. He lived with a relative. My friend said this guy often complained of chest pain, and got transported to the ER on an ambulance. The objective was to get some pain killers that he used as a narcotic.

Recently, he applied for SSI, claiming disability, got declined, kept applying until he got it. The monthly payment was higher than what I know some workers I know get for SS. How could that be true, that a drug addict non-worker get more than workers? Did my friend lie to me?

Anyway, when this guy was accepted, they made the payment retroactive back to when he first applied. So, he got a nice lump sum. And he got subsidized housing or whatever have you.

My friend said his cousin came to see him recently. The reason? To ask to "borrow" some money. I guess the only way to satisfy this guy is to give him all the drugs he needed. An overdose would be nice, I believe.

Anyway, my friend is an ardent libertarian. In the universal health care debate, I tried to tell him that not all people in the lower echelon are like that, and there are honest low-wage workers who deserve to get some health care. Still, there is no way he would soften his stance. From his experience, can you blame him?

 

[Martha]

A close friend of mine recently told me a story about a cousin of his. This guy is in his early 50s, never could hold a job in his life, as he was and still is a drug addict. He lived with a relative. My friend said this guy often complained of chest pain, and got transported to the ER on an ambulance. The objective was to get some pain killers that he used as a narcotic.

Recently, he applied for SSI, claiming disability, got declined, kept applying until he got it. The monthly payment was higher than what I know some workers I know get for SS. How could that be true, that a drug addict non-worker get more than workers? Did my friend lie to me?

Anyway, when this guy was accepted, they made the payment retroactive back to when he first applied. So, he got a nice lump sum. And he got subsidized housing or whatever have you.

My friend said his cousin came to see him recently. The reason? To ask to "borrow" some money. I guess the only way to satisfy this guy is to give him all the drugs he needed. An overdose would be nice, I believe.

Anyway, my friend is an ardent libertarian. In the universal health care debate, I tried to tell him that not all people in the lower echelon are like that, and there are honest low-wage workers who deserve to get some health care. Still, there is no way he would soften his stance. From his experience, can you blame him?

The average SSI payment for February 2011 was $497.60. SSI Monthly Statistics, February 2011 - Table 1

If a person is eligible for SSI should government be rewarded for improper denials or delay in payment? Of course the recipient should get back pay. I helped someone with a SSI appeal. The hearing was September 12 of 2010. The judge said he would issue an order giving her SSI retroactive to her application date, two years before. The delays were all the government's fault. It took more than a year to even get a hearing date. The worst? No checks have come yet and no back pay. The SSA is way behind in processing. They should have to pay interest and a penalty for the delays that in her case are now approaching three years.

 

[lets-retire]

They should have to pay interest and a penalty for the delays that in her case are now approaching three years.

Can't argue with this. If the people are doing everything they are supposed to do and the government for whatever reason drags it's feet or delays the process there should be some form of repayment for the people.

 

[Midpack]

Obesity overall has to be a negative in health. But blaming everything on the sick people is just reaching to blame people, rather than look at a flawed system.

Who did? It's simply being considered among several reasons costs are higher in the US. Would you not agree it may be a significant reason (not saying #1 by any means)?


IMO the reasons US costs are higher without providing better results, in no particular order are:

• lifestyle (obesity, smoking, drugs)
• high cost and profit for intermediaries (insurance)
• excessive profit for some product and service providers
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• plus significantly/ironically, excessive usage

 

[samclem]

If I might: Comments in bold:

IMO the reasons US costs are higher without providing better results, in no particular order are:

• lifestyle (obesity, smoking, drugs): Yes, this is a reason.
  
• high cost and profit for intermediaries (insurance) Symptom, not a reason. All others below are symptoms, not root causes.
  
• excessive profit for some product and service providers
  
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• plus significantly/ironically, excessive usage

All but the lifestyle factors are symptoms of a bigger problem, and can best be addressed through systemic reform. Without at least a pseudo-market in health care (informed consumers making choices with assets they control, companies benefitting when they reduce costs and provide better service), it's unlikely things will improve.

We have single-payer now (Medicare) with all it's top-down driven controls and government oversight. That system is a mess. We can do better. And we can certainly do better than the "private but not a true market" system we have throughout the rest of our health economy.

 

[haha]

Without at least a pseudo-market in health care (informed consumers making choices with assets they control, companies benefitting when they reduce costs and provide better service), it's unlikely things will improve.

I would say that the entire rest of the western world is a counter argument to this. The whole UK runs on a system very similar to Medicare, except without Medicare's copays and patient cost sharing, and is the most cost effective of all the national systems including ours.

Ha

 

[NW-Bound]

I would say that the entire rest of the western world is a counter argument to this. The whole UK runs on a system very similar to Medicare, except without Medicare's copays and patient cost sharing, and is the most cost effective of all the national systems including ours.
Ha

If that is true, then either citizens of other developed countries are a lot more enlightened than US citizens, which I doubt, or they have developed a check-and-balance system that has been more effective than ours in controlling abuses and wastes.

 

[haha]

If that is true,

I do not understand this statement. The simplest, most straightforward data, including the charts that started this thread show this incontrovertibly.

Ha

 

[lets-retire]

I do not understand this statement. The simplest, most straightforward data, including the charts that started this thread show this incontrovertibly.

Ha

No all the charts show is they spend less per capita. They do not, have not, and never will, get to the root cause of why. Which really is the more important answer. I can buy a top of the line Mercedes and you can buy an entry level Kia and both are cars. You can call me a fool because I spent so much more. Until you look at WHY I my car costs more all you would know is I spent more. They also never compare costs with average income or control for the many variables between countries. If they did then we would see that the costs are not that different from country to country. I did the research on health care costs in relation to average income and found the percentages were much closer than I was expecting. Canada's costs and our costs were only a few hundred dollars off per year.

 

[huusom]

No all the charts show is they spend less per capita. They do not, have not, and never will, get to the root cause of why. Which really is the more important answer. I can buy a top of the line Mercedes and you can buy an entry level Kia and both are cars. You can call me a fool because I spent so much more. Until you look at WHY I my car costs more all you would know is I spent more. They also never compare costs with average income or control for the many variables between countries. If they did then we would see that the costs are not that different from country to country. I did the research on health care costs in relation to average income and found the percentages were much closer than I was expecting. Canada's costs and our costs were only a few hundred dollars off per year.

Actually, the outcome is better in the UK than the US and Canada has all of its citizen covered. The US has 45 millions uninsured.

 

[NW-Bound]

I do not understand this statement. The simplest, most straightforward data, including the charts that started this thread show this incontrovertibly.

It is well known that the US spends more on health care, yet our life expectancy is less. I was not questioning that fact, but was asking about the lack of copays or a similar mechanism to keep down abuses that would come with an "all you can eat" system.

Here in the US, it used to be that even insured people did not have to make any copay. The copay was said to be necessary for people to "have some skin in the game". Else, they would go to a doctor for any simple headache.

I was still thinking about the drug addict cousin of my friend who abused the ER to get some pain killers, and stories in the news of how some doctors overcharged Medicare for non-treatments, when I read samclem's post about our current Medicare not being able to control costs. If we could not afford Medicare as it is, then how are we going to pay when it is opened to more than the elderly people? I was wondering what they do differently in the UK vs our Medicare.

 

[lets-retire]

Actually, the outcome is better in the UK than the US and Canada has all of its citizen covered. The US has 45 millions uninsured.

And why are the outcomes better? Could it be due to lifestyle choices? Could it be due to diet? Where is that in the charts? As for Canada we provide a lot of their emergency care on the border. So much it is included in the training for Immigrations.

 

[haha]

I give up. It's like one of the posters said on another thread, there is nothing that can be said that someone can't say something to counter it, and it would take a judge to ajudicate it all.

To me it is as clear as the nose on my face, and that is good enough for me.

I will only hassle like this for money, I got over the thrill of arguing for its own sake about 3 decades ago.


Ha

 

[samclem]

I would say that the entire rest of the western world is a counter argument to this. The whole UK runs on a system very similar to Medicare, except without Medicare's copays and patient cost sharing, and is the most cost effective of all the national systems including ours.

Ha

A lot of us who oppose government run health care would probably welcome it with open arms if the US government proved capable of running Medicare (or if states could run Medicaid) in a way that produces happy, healthy patients at low cost. As long as these programs remain money-hemorrhaging examples of inefficiency (at least compared to the programs in other nations) I doubt Americans will want to turn more of their health care over to government control. Government healthcare--heal thyself.

 

[haha]

A lot of us who oppose government run health care would probably welcome it with open arms if the US government proved capable of running Medicare (or if states could run Medicaid) in a way that produces happy, healthy patients at low cost. As long as these programs remain money-hemorrhaging examples of inefficiency (at least compared to the programs in other nations) I doubt Americans will want to turn more of their health care over to government control. Government healthcare--heal thyself.

It may that America is the world's best example of why "diversity" is a losing idea. Cohesiveness helps social programs to be accepted and to function smoothy. And homogeneity contributes mightily to cohesiveness.

Other than that, you tell me. Is it as some have said that we Americans are all fat? But we took a poll, and this group at least is far from fat. I am not so sure that Americans are fatter than any other industrial populations. Where are all these fat people? How do the experts know that Americans are all fat? I have never seen anyone come around with the census takers and a scale. My doctor does not send my height and weight to the fat police in Olympia, or in Washington DC.

Others have said that we smoke and drink too much. But this crap too, as many nations healthier and more frugal with their healthcare systems than we smoke and/or drink quite a bit more.

Ha

 

[NW-Bound]

I am not so sure that Americans are fatter than any other industrial populations.

Oh, but yes, we are!

I still remember the time we were in Sorrento, Italy, walking up a long sloped street leading from the pier back into town. In front of us was a group of children in elementary school. They were on a school outing, and all of them had walked briskly up the steep street, except for just one girl. She could not keep up, and one look would tell you why. She was a bit pudgy, not fat at all by American standard, but that was enough for her to be left behind. She was crying, and two school teachers were with her, trying to console her. I remember telling my wife that I felt for that poor girl.

Later on the same trip, we were huffing when climbing up and down the stairs that were between the cliff-hugging road on the Amalfi coast down to the beach of Positano, an old little Italian woman of 70+ watched us and was smiling at our effort.

My BMI has always been 25 and that of my wife less than 24. However, we did not exercise much and were a bit out-of-shape. We have been trying to do better.

Others have said that we smoke and drink too much. But this crap too, as many nations healthier and more frugal with their healthcare systems than we smoke and/or drink quite a bit more.

Yes, up until recently, they smoke and drink more than we do. I am envious. How do they do that?

 

[haha]

Oh, but yes, we are!

I still remember the time we were in Sorrento, Italy, walking up a long sloped street leading from the pier back into town. In front of us was a group of children in elementary schools. They were on a school outing, and all of them had walked briskly up the steep street, except for just one girl. She could not keep up, and one look would tell you why. She was a bit pudgy, not fat at all by American standard, but that was enough for her to be left behind. She was crying, and two school teachers were with her, trying to console her. I remember telling my wife that I felt for that poor girl.

Later on the same trip, we were huffing when climbing the stairs up and down that were between the cliff-hugging road on the Amalfi coast down to the beach of Positano, an old little Italian woman of 70+ watched us and was smiling at our effort.


Yes, up until recently, they smoke and drink more than we do. I am envious. How do they do that?

Stunningly cogent train of thought!

Ha

 

[NW-Bound]

By the way, my theory is that it is not really obesity or high BMI that does us in. It's the lack of physical exercise, the driving everywhere instead of walking, the couch potato lifestyle that shortens our lives.

A neighbor of mine is a short and slightly heavy woman, also in her 50s. However, it is just her built and I will readily concede that she has more physical exercise than I have, is more fit in the cardiovascular sense, can outrun me, and outwork me in physical labor. But generally speaking, if one has to walk a few miles to catch a bus, or walk those stairs through the London Underground, plus as expensive as their food is, one has no choice but to have a low BMI and be fairly fit. It's by necessity more than personal resolute, I firmly believe.

 

[Alan]

By the way, my theory is that it is not really obesity or high BMI that does us in. It's the lack of physical exercise, the driving everywhere instead of walking, the couch potato lifestyle that shortens our lives.

A neighbor of mine is a short and slightly heavy woman, also in her 50s. However, it is just her built and I will readily concede that she has more physical exercise than I have, is more fit in the cardiovascular sense, can outrun me, and outwork me in physical labor. But generally speaking, if one has to walk a few miles to catch a bus, or walk those stairs through the London Underground, plus as expensive as their food is, one has no choice but to have a low BMI and be fairly fit. It's by necessity more than personal resolute, I firmly believe.

I've been living in the UK for 5 weeks now, feeding ourselves, no car, hills everywhere, lots of hikes as well as having to walk everywhere and I'm putting on weight

While food, I'm sure, is more expensive than in the USA it is not overly so. Quality cheeses and "artisan" breads that we love and eat in USA are actually much cheaper here. e.g. a large whole grain extremely tasty fresh baked, still warm loaf from our local supermarkets costs £1 ($1.60) and we pay well over $3 for that in the USA.

We usually put down our incresed weight when we visit here to eating out, drinking beer and using a car. But we are having difficulty controlling our weight even when fully in control. It is quite frustrating, but still have a few more months to change things.

btw, my brother and 2 sisters are obese, as are DW's younger sister and brother. Both our mothers were obese, and my parents never had a car so being forced to walk and catch the bus certainly didn't help.

The local gym we attend here has a time every day where the NHS sponsored obese members come to work out on the treadmills and bikes etc. I've seen this before with one of my sisters and also with her neighbor where NHS prevention programs worked well. With my sister it was was to quit smoking, about 7 years ago. To ensure she was sticking to the program she had to go in each week and have a CO test to be sure she wasn't cheating, and they provided the nicotine patches she needed to kick the habit.

I commented on how much weight her long time neigbor had lost and how great she looked. Sis told me that the NHS paid her Weight Watcher fees as long as she continued to lose weight. She lost a LOT of weight, and kept it off for 12 months and was provided a free tummy tuck paid for by the NHS.

Not saying that prevention programs are the answer to lower long term costs but it must help. Many companies in the USA have fitness programs and incentives to keep their health costs down, and I assume they continue to do so because they believe it works somewhat. (could just be a gimmick of course).

 

[BigNick]

IMO the reasons US costs are higher without providing better results, in no particular order are:

• lifestyle (obesity, smoking, drugs)
• high cost and profit for intermediaries (insurance)
• excessive profit for some product and service providers
• administrative burden (millions of microplans)
• high charges for specialized services
• forced use of expensive specialized facilities for routine medical needs (emergency room)
• multiple regulations around the country
• punitive legal awards
• diagnostic overuse (expensive tests even for routine matters)
• treatment overuse (especially end of life)
• excessive unproductive labor vs technology
• plus significantly/ironically, excessive usage

Something you didn't include on that list (unless you meant it as part of "service providers") is the income earned by medical practitioners. A colleague's husband is an anaesthetist with 15 years experience, and he makes a bit less than $100,000 a year (this is in a large city in France).

 

[donheff]

I'm not so sure about this skin-in-the-game argument. Maybe with elective surgery - cosmetic, hip replacement and the like. And maybe if the copay is substantial enough to make you really think twice about it. But do we really want to encourage people to hobble around all their life rather than get a knee replaced? And does any system under consideration pay for elective cosmetic surgery anyway? The idea that no copays for routine stuff would have average people running into the doctor all the time doesn't ring true to me at all. Until I was 50 or so, almost nothing would get me into the doctor. If I was sick I stayed home - cost wasn't keeping me from running in. I often skipped my annual physical and only DW's hectoring got me in on off years. As I got older I began self starting to the annual physicals but only because I need my Allopurinol prescription renewed (gout is a much better motivator than a copay). The bottom line is that it is a PITA to go to the doctor's office and a bigger PITA to go to an emergency room. I just don't buy that the problem is out of control demand for procedures we don't need. I know, anecdotes are not evidence but still....

 

[Alan]

I'm not so sure about this skin-in-the-game argument. Maybe with elective surgery - cosmetic, hip replacement and the like. And maybe if the copay is substantial enough to make you really think twice about it. But do we really want to encourage people to hobble around all their life rather than get a knee replaced? And does any system under consideration pay for elective cosmetic surgery anyway? The idea that no copays for routine stuff would have average people running into the doctor all the time doesn't ring true to me at all. Until I was 50 or so, almost nothing would get me into the doctor. If I was sick I stayed home - cost wasn't keeping me from running in. I often skipped my annual physical and only DW's hectoring got me in on off years. As I got older I began self starting to the annual physicals but only because I need my Allopurinol prescription renewed (gout is a much better motivator than a copay). The bottom line is that it is a PITA to go to the doctor's office and a bigger PITA to go to an emergency room. I just don't buy that the problem is out of control demand for procedures we don't need. I know, anecdotes are not evidence but still....

+1

I see it all the time in the UK where you can't persuade friends and family to visit a Doc when they are feeling ill. Just yesterday we were out for the day with some good friends and they are concerned about their SIL who is 53, feeling tired a lot, urinates very often but refuses to go to the doctor despite his wife's efforts to persuade him, including her telling him, "If you die I'll be left by myself with 3 boys under age 12".

The frequent urination is almost certainly BPH but he won't know unless he makes an appointment.

PS - there are no co-pays in the UK

 

[nun]

Not saying that prevention programs are the answer to lower long term costs but it must help. Many companies in the USA have fitness programs and incentives to keep their health costs down, and I assume they continue to do so because they believe it works somewhat. (could just be a gimmick of course).

Ease of access to healthcare, early diagnosis and preventative care are big factors in the better cost and outcome performance of the NHS vs US healthcare. The UK population has just as bad a lifestyle as the US, heavy alcohol consumption and lots of bad food. But nobody in the UK ever has to worry about paying for a visit to the doctor so if they feel ill they go to see their GP and may conditions are caught early when treatment is easier and inexpensive.

My mother is a good example, she's 87. About 5 years ago she had a small stroke. Since then she goes to a clinic for high blood pressure where she does some exercise and gets lifestyle advice and they monitor her BP and cholesterol. She also visits the doctor for regular checkups and he caught that her glucose levels were starting to jump up and down so she's now on a drug for early diabeties. After that diagnosis she had eye tests and those showed some bad vessels in her retina, due to the diabeties, which have been treated by laser oblation and a small cataract that has been removed. All these are small outpatient and management procedures because the conditions were all caught early.

Doctors decide on how to treat patients, but here is a national panel that decides on whether the NHS will pay for a treatment. Recently there have been some cases where an experimental cancer drug was not available on the NHS and this gets headlines. That's the deal you make for overall care for everyone. The UK populace likes that deal and the NHS is UK's political "third rail". I don't think such as system would be appropriate for the US because of it's emphasis on individualism rather than the collective good.

 

[Alan]

Ease of access to healthcare, early diagnosis and preventative care are big factors in the better cost and outcome performance of the NHS vs US healthcare.

An interesting fact in Japan, which has universal private healthcare regulated by the government, is that the average person in Japan visits a doctor 4 times more often than someone in the US and has 5 times more MRI's. Most of the doctor visits are routine, and preventative, so that could also be a factor in their longer livespans.