Per Capita Public* Health Care Spending...

Submitted by vinteuil on Fri, 07/24/2009 - 6:09pm

Social Issues

...in OECD countries, as of 2004 (the latest stats I can find for free), according to the Congressional Research Service:

Luxembourg: $4600
Norway: $3312
Iceland: $2778
United States: $2728
France: $2477
Sweden: $2398
Denmark: $2388
Switzerland: $2381
Germany: $2340
Canada: $2209
Belgium: $2164
United Kingdom: $2164
Australia: $2106
Ireland: $2064
Netherlands: $1895
Italy: $1853
Japan: $1833
Finland: $1712
New Zealand: $1612
Spain: $1485
Portugal: $1335
Czech Republic: $1214
Greece: $1142
Hungary: $917
Korea: $591
Poland: $552
Slovak Republic: $686
Mexico: $307
Turkey: $418

Got that? The good old U.S. of A. is already the worlds fourth biggest public-spender on health-care - trailing only a handful of European countries with a combined population well under that of greater Chicago.

Of course, our measly $2728 per capita per year covers less than half of our population. While, from what I hear, France's munificent $2477 per capita per year covers pretty much everybody.

* * * * *

So what's up with our existing public health-care system? Why hasn't it, through its delightful combination of public-spiritedness and administrative savings, long ago consigned all private competition to the dustbin of history?

And just exactly how much more (?!) money does it need, to provide Americans with European-style coverage at European-style prices?

Just wondering...

* * * * *

*This is PUBLIC health care spending only. For some strange reason that...ummm...entirely escapes me...ummm...

...where was I?

...the Congressional Research Service does not report these figures directly. You have to work them out for yourself. But it's easy enough: just go to Table 1 and multiply "Health care spending per capita" by "Percentage of health care publicly financed."
--

God help the while, a bad world I say.

I'll add to the point you are making, vint.

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Submitted by mmghosh on Sat, 07/25/2009 - 7:42pm.

Lets look at the average health care spend in the private sector.

WHO statistics are more recent. Actually, in 2006, the public sector spend in the USA is higher than France US $3074, France $2833.

OTOH, total (private + public) expenditure on health for the population - USA $6714, France $3554, i.e. in France the private health care costs (20% of total) parallel the public health care costs. Whereas in the USA, private healthcare costs (54% of total) are considerably more expensive than public healthcare (daV makes a similar point below).

The important point is that just higher spending in either public or private healthcare will not necessarily improve healthcare metrics - i.e. if the healthcare spend moved to 80% private or 80% public care, the metrics would remain approximately the same.

MMghosh has it right... It could be private or public but you

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Submitted by Davinci on Tue, 07/28/2009 - 10:11am.

really need a some type of Walmart type of entity that can drive costs down(The US Government) .... At the moment we have little fiefdoms of power who own the insurance market, bought the private practices to hold the market and run the hospitals. Teaching hosptitals did the same thing in some cases by buying practices or sign exclusivity with some of the large medical groups etc. KC for instance has one large Orthopedic surgery group that does most of the surgery in the city. Their are two Cardiology groups that have 70% of the market etc...

This is going to be hard and not fully develped for years.. We are likley to get a system that is imperfect waiting to be perfected....

Ask courageous questions. Do not be satisfied with superficial answers. Be open to wonder and at the same time subject all claims to knowledge, without exception, to intense skeptical scrutiny. Be aware of human fallibility. Cherish your species and your

It all comes back to rationing, sir, and....

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Submitted by Bernard Guerrero on Tue, 07/28/2009 - 10:16am.

....labor costs. Without imposing more of the former and controlling the latter, no degree of preventive care is going to bring down or even stabilize costs, regardless of whether the payer is formally public or private.

If you want one reason I actually buy to do this, it's that the government is (post the defanging of the HMOs) the only entity I can think of that can do anything that will be that wildly unpopular. And the fact that it would be a Democrat doing it is gravy. :^) Either that or the plan will fail to control costs at all and the GOP will be handed a stick to beat the Dems with. Win-win either way.

-“It is unwise for the government to tell people how they can spend their money” - Barney Frank, Chairman House Financial Services Committee, on on-line gambling, 2009

Salaries and dividends need rationing.

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Submitted by Jordan on Tue, 07/28/2009 - 10:20am.

Actual care, not so much.

Thank you! Vote Republican!

In fact providers could make more if the system didn't deem the

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Submitted by Davinci on Tue, 07/28/2009 - 10:32am.

need to do fifty things that provide no benifit to end user care...

I meant payer and provider salaries, of course. -nt-

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Submitted by Jordan on Tue, 07/28/2009 - 10:44am.

Thank you! Vote Republican!

Doctors' salaries need rationing?

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Submitted by tomsyl on Wed, 07/29/2009 - 5:51pm.

I don't have the numbers, but I thought that elective surgeons may still be making huge bucks but GPs and people working in systems like Kaiser were actually seeing decreases in income adjusted for inflation. And I saw the billings and reimbursements from the HMO when I had an eye operation recently - the eye surgeon got his bill discounted by at least 50% by the carrier before it was paid. And he was one of the top guys in town.

I certainly don't know any very wealthy doctors. Maybe the ones I know weren't smart enough to specialize in diseases of the rich when they went to med school.

Politicians spend our money like a pimp with only a week to live. CJ Boxx

Doctors, yes, but med school tuitions need to come down

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Submitted by Jordan on Wed, 07/29/2009 - 6:44pm.

as well.

Thank you! Vote Republican!

It's simple

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Submitted by HankP on Sat, 07/25/2009 - 11:44am.

we have a system where the young and healthy, if they get coverage at all, pay private insurers who make a profit and extract that money from the system. The old, poor, sick, etc. are shifted to a public system when they are no longer profitable. Therefore we have the worst of both worlds, and my guess is that our costs will continue to increase faster and the gap between the US and the other industrialized systems will continue to grow.

I blame it all on the Internet

What is the problem in making a profit? -nt-

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Submitted by mmghosh on Sat, 07/25/2009 - 7:41pm.

In this case, profit comes at the direct expense of

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Submitted by Jordan on Sun, 07/26/2009 - 10:12pm.

public health. Every dollar that is spent in the US *not* providing care is a dollar that contributes to the alarmingly bad medical outcomes.

Look at medical care ratios in US care providers for one eye-opening way to examine the figures.

A more interesting ratio would be that between medical expenses on one hand, and medical outcomes on the other. For no particularly good reason, Americans spend more money getting less effective care than most of the other industrialized nations. The difference goes into the pockets of groups like Cigna, BC/BS, Glaxo, Novartis, AstraZeneca, etc.

Thank you! Vote Republican!

"Americans spend more money getting less effective care"

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Submitted by mmghosh on Sun, 07/26/2009 - 11:21pm.

I think you're missing the big picture here. Sure, your straightforward point is undeniable. But the same thing is true of so many other situations - from food procurement to space travel - you are probably paying much more than other equivalent economies.

The point is that the greater profits from Glaxo, Novartis etc is a component of why you guys get to stay on the top, since it is the corporate and military big guns that help you get there and stay there.

My point, which I was making to Hank below, is that big spending and the perception of unfairness to the uninsured etc is part of the whole deal. That sort of societal mix and jumble is what is real about the US, and you mess with that mix (in an attempt to be fairer and more even-handed) at your peril.

You think Americans are going to keep subsidizing

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Submitted by Jordan on Mon, 07/27/2009 - 8:59am.

America's greatness out of their own pockets and by sacrificing the health & well-being of their families? Honestly, they may well do that, knowingly or not, but I can't see anyone actually making that argument to the public with a straight face.

You see, you need more heart attacks, your kids need untreated asthma. If we spend money on those things, that's less money for Wall Street to slosh around, which means America won't be the greatest anymore.

Oh, ok then.

Thank you! Vote Republican!

The poor and exploited have always underwritten "greatness"

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Submitted by mmghosh on Mon, 07/27/2009 - 7:09pm.

out of their own pockets and by sacrificing the health & well-being of their families

in every age, so I'm not sure why you think this will change.

Well, that's what they said about

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Submitted by Jordan on Mon, 07/27/2009 - 7:17pm.

hereditary monarchs, so....

Thank you! Vote Republican!

Because

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Submitted by HankP on Mon, 07/27/2009 - 7:17pm.

until the last couple of hundred years they couldn't vote on it.

I blame it all on the Internet

Voting as an agent of change is greatly overrated.

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Submitted by mmghosh on Mon, 07/27/2009 - 7:24pm.

The oligarchy of the rich and powerful of the top 5-10% of a successful nation tends to win, whatever the political system.

Which is not necessarily a bad thing. And modern oligarchies often have some component of "regular" folk.

I see you must not have covered

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Submitted by HankP on Mon, 07/27/2009 - 7:51pm.

the American and French revolutions in your studies. Not to mention de-colonisation, which is really unforgivable of the Indian educational system.

I blame it all on the Internet

Nascar drivers

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Submitted by Spartacvs on Mon, 07/27/2009 - 7:47pm.

and plumbers?

"Something I think most liberals don't understand is exactly how stupid many conservative leaders are." - Matt Yglesias

I don't think so

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Submitted by HankP on Mon, 07/27/2009 - 12:12am.

while the US may have a slightly higher gini coefficient that most other developed countries, the trend is definitely not higher gini = more powerful and influential country. You seem to think that Americans will accept a lower and continually declining standard of living as long as their corporations are profitable and their nation is regarded as powerful - I assure you this is not the case.

I blame it all on the Internet

This, in a nutshell, is the perception of the US

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Submitted by mmghosh on Mon, 07/27/2009 - 1:00am.

(from the outside, naturally).

their corporations are profitable and their nation is regarded as powerful

But really, have standards of living declined (I'm not talking about decrease in house prices, income disparity etc) - in real terms? Any data to back this up?

It has declined as a direct result of health care too

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Submitted by Blue Neponset on Mon, 07/27/2009 - 9:50am.

LINK

The United States now devotes one-sixth of its economy to medicine. Divvy that up, and health care will cost the typical household roughly $15,000 this year, including the often-invisible contributions by employers. That is almost twice as much as two decades ago (adjusting for inflation). It’s about $6,500 more than in other rich countries, on average.

We may not be aware of this stealth $6,500 health care tax, but if you take a moment to think, it makes sense. Over the last 20 years, health costs have soared, and incomes have grown painfully slowly. The two trends are directly connected: employers had to spend more money on benefits, leaving less for raises.

In exchange for the $6,500 tax, we receive many things. We get cutting-edge research and heroic surgeries. But we also get fabulous amounts of waste — bureaucratic and medical.

"And now you run in search of the Jedi. They are all dead, save one. And one broken Jedi cannot stop the darkness that is to come." -Darth Sion

Yup

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Submitted by HankP on Mon, 07/27/2009 - 3:25am.

Working people in the United States are currently experiencing the most severe blows to their living standard since the 1930s. Amid the bank bailouts, home foreclosures and auto industry collapse, the official unemployment rate for April rose to 8.9 percent, the highest monthly level since 1983. The figure rises to 15.8 percent if we use the Labor Department’s broad measure of unemployment and underemployment.

Given the immediate calamity, it is easy to neglect that the crisis for U.S. workers began long before the recession. As of 2007 — prior to the recession — the average nonsupervisory worker in the U.S. earned $17.42 an hour. This figure is 11 percent below the 1972 peak of $19.34 per hour (in 2007 dollars). And this is only half the story.

The other half is that average labor productivity in the United States rose by more than 90 percent over this 34-year period of declining wages. That is, the total basket of goods and services that average U.S. workers produced in 2007 is 90 percent larger than what they could manage in 1972. The workers’ reward for producing 90 percent more goods and services in 2007 than 1973 is an 11 percent pay cut.

link here shows the change over time - pay attention to the 50% line.

I blame it all on the Internet

How can you compare services available in the 1970s to 2000s?

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Submitted by mmghosh on Mon, 07/27/2009 - 7:18pm.

The product purchased in the 1970s was far inferior - to take just motor cars and healthcare as examples. You are not buying the same product, although the name of the product might be the same. The motor car you are buying today has levels of comfort, safety and engine quality available only in the top range models of the past (or even non-existent in those days). Similarly with healthcare. The fact of the matter is that the average quality of products today is so much higher (in part, no doubt, to the increased productivity) that direct comparisons of the sort you are making are not appropriate.

Nice head fake

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Submitted by HankP on Mon, 07/27/2009 - 7:47pm.

I'll take it that you agree that real wages have declined as productivity has increased. As for automobiles - yes, they're better, but they should be since the average real price of a new car has risen ~30% since 1970.

Face it, Manish, outside of the top 5 - 10% of the population the last several decades have not been good ones.

I blame it all on the Internet

That's pretty good I think

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Submitted by Micky Love on Mon, 07/27/2009 - 2:46am.

http://harvardmagazine.com/2006/01/the-middle-class-on-the.html

That's pretty good I think. There's a one hour lecture on youtube by the writer that covers the same ground.

The data can be summarized in a financial snapshot of two families, a typical one-earner family from the early 1970s compared with a typical two-earner family from the early 2000s. With an income of $42,450, the average family from the early 1970s covered their basic mortgage expenses of $5,820, health-insurance costs of $1,130 and car payments, maintenance, gas, and repairs of $5,640. Taxes claimed about 24 percent of their income, leaving them with $19,560 in discretionary funds. That means they had about $1,500 a month to cover food, clothing, utilities, and anything else they might need—just about half of their income.

By 2004, the family budget looks very different. As noted earlier, although a man is making nearly $800 less than his counterpart a generation ago, his wife’s paycheck brings the family to a combined income that is $73,770—a 75 percent increase. But higher expenses have more than eroded that apparent financial advantage. Their annual mortgage payments are more than $10,500. If they have a child in elementary school who goes to daycare after school and in the summers, the family will spend $5,660. If their second child is a pre-schooler, the cost is even higher—$6,920 a year. With both people in the workforce, the family spends more than $8,000 a year on its two vehicles. Health insurance costs the family $1,970, and taxes now take 30 percent of its money. The bottom line: today’s median-earning, median-spending middle-class family sends two people into the workforce, but at the end of the day they have about $1,500 less for discretionary spending than their one-income counterparts of a generation ago.

Nothing resembles virtue more than a great crime. Saint-Just

In general, nothing

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Submitted by HankP on Sat, 07/25/2009 - 8:04pm.

but when you make profits off one part of the life cycle and push the costs off on the public when it starts getting expensive, I don't think there's a problem in wondering exactly why their corporate charter was granted.

I blame it all on the Internet

but when you make profits

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Submitted by Timmy on Sun, 07/26/2009 - 9:33pm.

if you take a look at some of the European healthcare systems, profit, per se, isn't a dirty word.

““I am sick and tired of people who say that if you debate and disagree with this administration, somehow you’re not patriotic. We need to stand up and say we’re Americans, and we have the right to debate and disagree with any administration!”” –H

Come on, Hank. That's the way profits are made in any industry.

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Submitted by mmghosh on Sun, 07/26/2009 - 12:28am.

What is unique about healthcare? Its not a moral duty for a society to provide healthcare for all its constituents, just as it is not a moral duty to provide education, or jobs.

The reason is pragmatic, entirely, - an educated, healthy workforce will presumably have less social conflict, or be able to innovate better or whatever. This, though, has not been proven. The access to, or lack of healthcare or educational provision for the American people in the past 60 years has not perceptibly altered the capacity of Americans to hold on to a very high GDP, or military ability to intervene in any country's internal affairs as it suits Americans, or any other general metric.

Some threads ago, you mentioned social pathology, high divorce rates etc. In other places you poked fun at some people for being Young Earth Creationists, or believing in exorcism. Well, what of it? Does it affect the overall situation of cultural, technological, economic, military dominance? Does it even matter, how many people believe nonsense, if they are efficient and effective at doing their jobs in society?

Uh, no

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Submitted by HankP on Sun, 07/26/2009 - 2:43pm.

not every industry or business makes profits by pushing off its externalities onto the public. Many large ones do (or try to) when they get big enough to spend enough lobbying dollars to get the laws changed in ways that favor them, but there are plenty of businesses that don't.

I'm not even talking about moral duty, I'm not talking about education, I'm talking about the way this one industry operates.

As to the society as a whole, yes I do see things like the way health care is financed and the way that Wall Street is manipulated are corroding the society from within. When most people start believing that the game is rigged and there's no way around it you'll see behaviors and beliefs that start damaging the strength of what could otherwise be a happy, healthy well-educated society.

I blame it all on the Internet

I would disagree that it is not a moral duty....

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Submitted by Davinci on Sun, 07/26/2009 - 3:47am.

IMHO it is a moral duty to provide healthcare and Education... Jobs are much tougher... If you keep people healthy and give them an education then jobs will come.... But what is and is not a moral duty might be a whole other thread mmghosh.....

27.8% of the population is covered by that amount...

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Submitted by Davinci on Sat, 07/25/2009 - 4:52am.

In most cases not real well at that....Of course the question is can our infrastructure handle covering the other fifty million at the same cost? Will that coverage produce lower costs with future generations? How do we fund it? Do we put greater taxes on bad food etc.... Do we mandate spending on healthcare?

It seems we need to rethink everything from budgeting to tax structure etc... We need to make all parts of government more transparent and efficient... In order to lower this cost over time.. In part we need to be able to look at hard data sets that are standard from place to place..... Doing nothing is really not an option as is doing it stupidly... Still we are going to get an imperfect bill that should only be seen as phase one...IMHO...

The one thing we will need to do in the future is mandate a health advisory panel with real power to budgeting.... We should take this out of the Congress and presidents hands at least to a degree.... Maybe they can mandate increases.. but they need to at least be indexed to inflation and region.... If not we will get years without increases to medical professionals etc...

One question I do have is how to drive innovation without waste etc... A real fear that I have and many conservatives view.... In a capitalist system how do you not stand still without the ability to recoup or profit... Now maybe it is only the degree we are talking about etc... Maybe we will have to change the laws on generic drugs etc to keep the pipeline open... Still if you have four drugs that work well for most people and two are way less how do you determine what is waste and what is necessary?

Total Health Care spending per Capitais a better view

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Submitted by Davinci on Sat, 07/25/2009 - 4:32am.

IMHO... Below is the total from your link.... Lets look at what doing nothing costs...

http://www.billlucey.com/2009/07/how-the-uss-health-care-compares-with-other-countries.html
"The Robert Jones Wood Foundation projects the cost of health care for businesses could double, while the number of uninsured balloon to 65.7 million over the next 10 years if legislation isn’t passed soon, with the middle-class being the hardest hit.
In 2008, according to RJWF, the U.S. spent more than two trillion on health care—nearly 17 percent of our economy-yet nearly 50 million Americans and nine million children are without health insurance, a problem that is growing more alarming the longer health care reform remains dormant.
What’s worse, the U.S. is lagging behind other industrialized countries in the cost and quality of health care it provides to his citizens. According to statistics from the Organization for Economic Co-Operation and Development, (OECD), total health spending accounted for 16.0 percent of GDP in the United States in 2007, more than most other OECD countries, including France (11 percent); Switzerland (10.8 percent); and Germany (10.4 percent).
Oddly enough, despite its massive health expenditures, the United States ranks 20th in life expectancy and 27th in infant mortality compared with other industrialized countries, while having fewer physicians per capita. In 2007, for example, the United States had 2.4 practicing physicians per 1,000 population. The average for OECD countries is 3.1.
Not even the insured in the United States, it seems, may be getting the proper medical attention they require. Studies from the Commonwealth Fund report more than 54 percent of U.S. patients do not seek recommended care, fill prescriptions, or visit a doctor because of high costs compared with seven to 36 percent in other countries.
It’s simply unfathomable the United States is the only developed country without a comprehensive national health care plan for its society.
How, then, are other countries able to finance their health care systems while providing basic medical necessities without increasing costs?
For comparison sake, what follows is a brief outline of health care systems in France, Germany, the United Kingdom and the Netherlands; based on a December, 2008 report from the Commonwealth Fund."
Bill Lucey (Direct link above to Bills break Down) I found his Breakdown on how France Germany UK and the Neitherlands pays for their system and how they work interesting...

Lets put a bit of humanity to the health debate...
http://www.dailykos.com/story/2009/7/24/757552/-A-different-perspective-on-the-health-care-debate

Health Care Spending per Capita, 2004(Public and Private)
Turkey $580
Mexico $662
Slovak Republic $778
Poland $805
Korea $1,149
Hungary $1,281
Czech Republic $1,362
Portugal $1,823
New Zealand $2,083
Spain $2,094
Greece $2,162
Finland $2,235
Japan $2,249
Italy $2,467
United Kingdom $2,508
AVERAGE $2,552
Ireland $2,596
Denmark $2,656
Sweden $2,825
Belgium $3,023
Netherlands $3,038
Germany $3,043
Australia $3,121
Austria $3,123
France $3,158
Canada $3,165
Iceland $3,331
Norway $3,966
Switzerland $4,077
Luxembourg $5,090
United States $6,102

Netherlands just changed in 06 and rank the highest in EU

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Submitted by Davinci on Sat, 07/25/2009 - 5:43am.

They moved from a US type system to insurance base mandated system
They rate highest by the Healthpowerhouse system.. A pretty tough test....
http://www.healthpowerhouse.com/files/2008-EHCI/EHCI-2008-report.pdf

How it is payed for....
" Beginning in 2006, residents of the Netherlands paying income taxes were required to pay for health insurance as mandated under the Health Insurance Act (Zorgverzekeringswet; ZVW), but coverage is provided by private health insurers and regulated under private law.
By law, insurers are required to provide medical care, including care by general practitioners (GPs), hospitalization; dental care; all citizens are additionally covered by the statutory Exceptional Medical Expenses Act (AWBZ) scheme for a variety of chronic and mental health care services, including home care and care in nursing homes.
The insured pay a flat-rate premium (set by insurers) to their private health insurer. Those insured in 2006 were eligible for a refund of €255 ($367) if they made it through the year without requiring any medical attention. If they incurred costs of less than €255, residents were eligible for the difference at the end of the year
The insured are required to pay the first €150 ($216) of any health care costs in a given year (with some services excluded from this general rule).
In addition, the government provides health care allowances for low income citizens if the average flat-rate premium exceeds five percent of their household income.

So as the United States continues to struggle, mightily, in reforming a health care system that in the president’s own words is broken, other industrialized countries, although not perfect by any means, seem to be able to offer its citizens, especially the unemployed and disadvantaged, basic health services unconscionably lacking in one of the richest countries in the world."

You asked...

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Submitted by JKC on Fri, 07/24/2009 - 6:48pm.

So what's up with our existing public health-care system? Why hasn't it, through its delightful combination of public-spiritedness and administrative savings, long ago consigned all private competition to the dustbin of history?

I assume you know that the public insurance options available in the
US have specific elegibility requirements that exclude most people...