
Why Americans Spend So Much on Health Care–In 12 Charts - jedwhite
https://www.wsj.com/articles/why-americans-spend-so-much-on-health-carein-12-charts-1533047243
======
howard941
> Consumers, meanwhile, buoyed by insurance and tax breaks, have little idea
> how much they are really spending and little incentive to know underlying
> costs.

Almost weekly there's another post showing that consumers literally cannot
find out costs usually because the provider cannot supply it. It's time to put
a stake in the heart of the recurring blame-the-consumer trope.

~~~
JimboOmega
I don't read it as "blame the consumer" but "the system is opaque".

The consumer doesn't know _and_ can't find out. Articles have been written
for, I don't know, a decade or more decrying the opacity of the
"Chargemaster", etc, and how if you call a hospital to ask the charge for a
procedure, they probably can't give you a quote.

If you have certain kinds of insurance, you're not even incentivized to care -
you tolerate the opacity. But I don't think it's really blaming the consumer
so much as blaming a system way off the rails.

~~~
mfringel
The problem I have with the "blame the consumer" trope is that there's the
implicit "and if consumers had full pricing knowledge, The Market(tm) would
correct all of the other issues, and healthcare in the US would be fixed." I
assert this mostly through anecdotal evidence based on where these
conversations tend to go.

I also find it to be some of the most disingenuous handwaving I've seen in
recent memory. No one is going to comparison-shop when they have a ruptured
appendix. Worse, if they think they can just "tough out" the abdominal pain
because they can't afford the doctor visit _or the treatment that might result
from it_, they'll just die.

Just to head something off... if your answer to "What if people still can't
afford healthcare?" is "If you can't afford healthcare, then you're not
contributing enough to society to receive healthcare.", then I thank you for
your candor and your ideological consistency, and have you considered that you
might be a sociopath?

~~~
dsfyu404ed
>The problem I have with the "blame the consumer" trope is that there's the
implicit "and if consumers had full pricing knowledge, The Market(tm) would
correct all of the other issues, and healthcare in the US would be fixed." I
assert this mostly through anecdotal evidence based on where these
conversations tend to go.

If the consumer had full pricing knowledge beforehand then the market would
certainly correct some of the other issues, probably not all but certainly
some. Take a look at dental for example.

>I also find it to be some of the most disingenuous handwaving I've seen in
recent memory. No one is going to comparison-shop when they have a ruptured
appendix. Worse, if they think they can just "tough out" the abdominal pain
because they can't afford the doctor visit _or the treatment that might result
from it_, they'll just die.

Getting ripped of because you couldn't afford the time to shop around is par
for the course in many industries. Yes, some peoples' appendices will rupture
without warning but many more people will have conditions that give ample
warning and allow comparison shopping. I think this there is a very good
comparison to automotive repair in these scenarios (albeit higher dollar
amounts and consumers being more willing to have work done up front to avoid
more later).

> a system way off the rails.

I agree.

------
y-c-o-m-b
Healthcare costs are by far the #1 reason why I want to move out of the U.S.
as soon as possible.

I am well off, but due to recent experience I have a major anxiety about going
bankrupt from another unexpected health issue. I had emergency spine surgery
last year and despite coordinating everything I could to stay in network prior
to entering the hospital - surgeon was in network, hospital in network, etc...
- the monitoring group that was in the surgery room was NOT in network and
neither was the assisting physician. Their fees were so high, that insurance
refused to negotiate with them and so I was responsible for the charges
despite meeting my out of pocket maximum for out of network charges.

Basically out of network maximums are worthless! If it's set at 10k and the
bill comes back 100k, insurance can pay up to the 10k (if even that) and you
will be responsible for 90k afterwards. It's a mess. I did some reading on
this and it turns out to be a huge problem across the US, especially in states
like Texas where finding in-network providers and facilities is less likely.

I remember when I started working in the early 2000s at a gas station. I was
getting 100% paid medical benefits through Aetna and coverage was 90% through
the insurance. As time went on and I got better jobs (in IT), that turned into
a small monthly premium. Then the premiums just kept growing every year until
it became a significant chunk of my monthly take-home check. Starting a few
years ago, they've introduced reduced coverage all the way down to 70% as
premiums continue to climb and with huge deductibles and higher out of pocket
maximums. How long can they continue doing this before the whole system
collapses?

~~~
jcadam
> Healthcare costs are by far the #1 reason why I want to move out of the U.S.
> as soon as possible.

Hope you and your family are in perfect health if you plan to immigrate to a
country with socialized healthcare. Most such countries will reject families
with an autistic child, for example, based on the notion that said child will
be heavily dependent on govt/health services.

~~~
gremlinsinc
What is your source for this? I know people in Canada and France with autistic
kids who have never had any such issues.

~~~
improbable22
Did they move there with an already-diagnosed kid?

There was a professor in the news for leaving New Zealand (I think) recently
for exactly this reason. Because his kid was autistic (or something) the
authorities were highly reluctant to grant him residency & hence lifelong
care.

Edit: here's the story, 13-year-old stepson in fact:
[https://www.theguardian.com/world/2016/feb/16/prestigious-
ac...](https://www.theguardian.com/world/2016/feb/16/prestigious-academic-to-
quit-new-zealand-after-autistic-son-refused-residency)

------
komali2
Do republican politicians, and others in charge of maintaining this healthcare
farce we have, have some sort of training in "convince the downtrodden to vote
for things that make their lives harder" or is it just something natural?

I say this as a Wisconsin emigrant that watched my home state shoot itself in
the face time and time and time again.

~~~
rayiner
Do democratic politicians have some sort of training in maintaining the farce
that more things should be handled by government, when governments in
Illinois, California, New York, etc.--democratic strongholds where Republicans
cannot be pointed to as the scapegoats--are on the verge of bankruptcy?

I don't think, deep down, republicans think the current system is better. They
just don't trust whatever replaces it won't be much worse. It's easy to say
"if we were just like <X European country> we could offer universal healthcare
and also save money!" But <X European country> probably has trains that are
vastly better than ours despite costing less to operate. They have schools
vastly better than ours that they spend less money on. Clearly there is more
to the equation.

~~~
intended
It doesnt matter. These are just the general American talking points.

Fortunately since this is a global forum, people can point out that the
situation in AMerica is farce.

The basic stats are just solid - every first world country does better.

You guys have the worst of all worlds, and because of America's prediliction
for everything market oriented, and the absurd partisanship - you have no
solutions, and are ok with people getting cured in the ER.

~~~
richmarr
Not to mention the fact that companies can write off insurance contributions
against tax, and individuals can recieve that benefit without paying income or
payroll tax on it. In effect that's a subsidy in favour of the middle classes
and 1% to the tune of "between $174 billion and $429 billion over a six-year
period".

[https://www.nytimes.com/2017/07/07/health/health-
insurance-t...](https://www.nytimes.com/2017/07/07/health/health-insurance-
tax-deduction.html)

(Edited to include the missing point about income/payroll)

~~~
harryh
You say this like it's some special provision in the tax code, but it's not.
Companies pay taxes on profits, not revenue. And insurance contributions (like
many many other things) are an expense that reduces profits.

~~~
richmarr
Yep... thanks, wrote that too quickly, I'll update

~~~
harryh
Ah, I was wondering if you meant to mention that health care benefits are (in
most cases) not taxable and I see with your edit that you did. I agree with
you on that point. It's a big problem.

Interestingly, McCain proposed fixing this during the 2008 election and was
slammed for it by Obama.

------
burlesona
> The health-care industry overtook the retail sector as the nation’s largest
> employer in December, giving local economies and their workers a stake in
> the industry’s growth. Health jobs surpassed manufacturing jobs in 2008.

This seems to me the biggest source of the problem. As the saying goes it’s
hard to get someone to understand something when their salary depends on them
not understanding it.

These days healthcare jobs - technicians and clerks and so on - are the new
factory line work. Ie readily available good paying jobs that you can get (in
many cases) without a college degree. These personal care jobs are also hard
to replace with automation since the entire point is to deal with other
humans.

Thus most people agree “the system” is broken but any specific proposal made
to change it meets a big backlash of people who imagine - perhaps rightly so -
“that could cost my job!”

------
ElmntOfSurprise
The charts are not really " _Why_ Americans Spend Much on Health Care", just
"Americans Spend Much on Health Care (or More than Others and More than They
Used To, Anyway)". Believable causes that I have read being suggested are
"demographics", "lack of single payer health care", "unhealthy lifestyle",
"inefficient allocation of resources towards terminally ill patients",
"Americans pay for drug research that inhabitants of other countries get for
free", "expensive safeguards against malpractice lawsuits". Lobbying, taxation
and opacity to consumers seems like a poor explanation of why healthcare in
the US is so much more expensive than in other countries, and more expensive
than in the past.

------
tzs
I wish we didn't overpay compared to other first world countries, but although
that is very annoying it is probably sustainable. Furthermore, we have several
examples of other first world countries paying much less, using systems
ranging from full socialized medicine (the UK) to almost fully private systems
with some government regulation (Switzerland), so that fixing this is not a
matter of figuring out something that works. It is a matter of getting enough
people to agree on the same fix.

What worries me more is how the costs keep going up, and that's when measured
as a percentage of GDP, so you can't just hand wave it away as part of
everything going up over time due to inflation.

That's not sustainable.

Worse, the same thing is happening in other first world countries, with the
costs going up at similar rates as they are here, so unlike the overspending
problem this is not just a matter of getting the will to adopt one of the
known solutions.

There's a great interactive view of the data at the OECD health spending page:
[https://data.oecd.org/healthres/health-
spending.htm](https://data.oecd.org/healthres/health-spending.htm)

Uncheck the "latest data available" box, and that will enable the year range
sliders. Set them to 1970-2017 and the graph will show the growth over time
for several countries. Mouse over the lines on the graph and it will give you
number.

------
esturk
Alternative link.
[https://t.co/qiNptlTJ9b?amp=1](https://t.co/qiNptlTJ9b?amp=1)

------
pettersolberg
They spend so much, because it's basically Health Business not Care.

~~~
WillPostForFood
I'd go with MoneyCaid. Health run care by big bureaucratic business deeply
intertwined with big bureaucratic government. So there's lots of money
flowing, but not as much care.

~~~
opportune
As someone who got a peak into some of the intimate details of a large Hospice
services provider, I have to agree. The fact that there are, no matter what
they call themselves, salesmen who wine and dine hospital and senior home
officials so that their employer can be made a part of their hospice pipeline
is sickening. What’s worse is when you discover how many “palliative” patients
will routinely temporarily leave care for surgeries, then cycle back on, for
years.

Not to mention that many of my relatives, and myself, have been egregiously
misbilled or convinced to purchase very expensive, extremely unnecessary
devices/treatment. I’m sure a lot of people in healthcare are good, but the
people calling the shots - including even some doctors - don’t give a shit

------
t1lthesky
Americans spend too much on nearly all government provided services. Anyone
who thinks that more government spending is the solution really doesn’t
understand the underlying issues at all.

When it costs 5x as much to build a new subway line in NYC compared to Paris
[1], spending 20% more on infrastructure isn’t going to do anything. Arguably
it will make things worse, allowing the existing inefficiencies to continue.

This problem occurs in all the areas where America lags behind other first
world countries. Education, healthcare, infrastructure - spending is equal or
greater than comparable nations, but the returns on each dollar spent is much
smaller.

People try to simplify this issue in a partisan manner to having bigger
government (Democrats) vs having more free markets (Republicans), but when you
look at each of these areas in greater depth you realize that it’s not that
simple. There are a multitude of causes unique to America that contributes to
costs being so high, as exemplified in this thread’s article. In the case of
health care, elsewhere in the world there exist both free market and
government provided solutions that deliver better outcomes than the American
system.

For a more in depth coverage on this topic, I highly recommend:
[http://slatestarcodex.com/2017/02/09/considerations-on-
cost-...](http://slatestarcodex.com/2017/02/09/considerations-on-cost-
disease/)

[1] [https://www.nytimes.com/2017/12/28/nyregion/new-york-
subway-...](https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-
construction-costs.html)

------
triangleman
Is there a printable view of this? Not that it's multiple pages but if you try
to print it, you lose all the charts after the first!

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neonate
[http://archive.is/u9WHs](http://archive.is/u9WHs)

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jpmonette
You can skip the paywall here (if you have a Facebook account, of course):

[http://facebook.com/l.php?u=https://www.wsj.com/articles/why...](http://facebook.com/l.php?u=https://www.wsj.com/articles/why-
americans-spend-so-much-on-health-carein-12-charts-1533047243)

~~~
esturk
You can avoid having a FB account if you just use the twitter link I posted.

------
gdaxthrowaway
I spend 0$ on healthcare in US. Government pays for everything. That's easy.
Hide your income and get a Medicaid.

------
alphabettsy
The common refrain that we will improve healthcare by keeping the government
away and relying on the free market ignores the fact that most people are
unable to shop for healthcare. Consolidation, price obscurity and immediate
need makes that impossible. Even if it were possible, will there be uniform
methods for describing the services and total price of services so that people
can shop around?

------
swarnie_
Please can someone explain the USA's lack of free healthcare to me? Every time
i see it suggested or attempted its immediately sabotaged by just about
everyone.

The NHS is one of the greatest things to come out the UK but you guys seem so
opposed to the notion.

~~~
koolba
The abridged version is that they were working on it but the head of Kaiser
convinced Nixon that private health insurance was a better option. Fast
forward a few decades and there is too much at stake for the companies
providing the care^insurance for a graceful change. Large companies also don't
give a hoot because they're able to offer corporate self-insured plans which
constitutes a competitive advantage against smaller employers.

My personal opinion is that the ACA was also complete garbage. Either go
single payer (or at least an option to _buy into_ a single payer) or don't go
at all. The half assed approach we've ended up with is the worst combination
as the individual is forced to purchase insurance in a market with perverse
incentives on all sides and no real competition.

~~~
improbable22
There are lots of other systems besides single-payer (like the NHS grandparent
mentions liking) or the US. It isn't some law of nature that anything "in-
between" is doomed to failure.

For example, read a bit about the Swiss system:

[https://en.wikipedia.org/wiki/Healthcare_in_Switzerland](https://en.wikipedia.org/wiki/Healthcare_in_Switzerland)

