
The US spends more on healthcare for no gain says new report from Johns Hopkins - grecy
https://www.jhsph.edu/news/news-releases/2018/us-health-care-spending-highest-among-developed-countries.html
======
mikeg8
The book _The Healing of America_ by T.R. Reid, 2010 was a phenomenal look at
this subject and the conclusion was this: we are the only developed nation
whose government allows for-profit health insurance companies to exist with
ZERO regulation to cap healthcare prices. Because of this, we spend 20% of
every dollar on "administrative" costs compared to 3%-7% in the European and
Asian countries. The goal for American healthcare companies is increasing
shareholder value, not reducing costs. IMO healthcare is an obvious example of
where a "free market" approach has failed and government oversight is
critical.

[https://www.amazon.com/Healing-America-Global-Better-
Cheaper...](https://www.amazon.com/Healing-America-Global-Better-
Cheaper/dp/0143118218)

~~~
DennisP
I read that book too, and agree it's phenomenal. It's not just about capping
insurance profits. The countries doing the best also have price controls on
the healthcare providers. Doctors make a lot less money. On the other hand
they generally don't have to pay for medical school.

France, Germany, and Japan all have similar systems, according to the book.
They have private nonprofit insurance, some kind of mandate to purchase it, a
government price list on services, guaranteed coverage of anything on the
list, and digital medical records.

A lot of German primary care doctors don't even hire office staff. They
prescribe whatever they want, swipe your medical card, and they're guaranteed
to be paid in a week, no questions asked.

Japan has a clever way to handle the mandate. If you don't pay your premiums,
nothing happens, but if you need healthcare you're not covered until you pay
your back premiums.

I wish all the Americans who think the rest of the developed world runs on
single payer would read this book. None of the three countries I just
mentioned use single payer. The book also covers Canada and the UK, both of
which are single payer (and single provider in the UK), and while their
results are pretty good, they're not as good as the other three.

~~~
euske
One of the main reasons why I gave up career in the States and came back to my
home country (Japan) was healthcare. I had a day surgery in the US and the
whole experience (i.e. bills) just scared heck out of me. I am very happy with
the system here. Everything is extremely efficient compared to the US. A
little while ago, I had this mysterious headache and went to an orthopedist,
dentist, psychiatrist, neurosurgeon then took an MRI. All within one week. My
Canadian friend told me that it would be a half-year ordeal in Canada. By the
way, I'm not rich.

~~~
joering2
Just got hemoroids frozen and cut with laser. Cost here in USA under premium
insurance was $12,000. Went to Germany got it done on the same equipment in
luxury stay for 14 days at $870. Plus $800 plane tickets. Meanwhile a friend
of mine had a heart attack. As a Bank of America emplyee he had somewhat goog
insurance that paid some. He was left with $180,000 bill.

~~~
arcticfox
> As a Bank of America emplyee he had somewhat goog insurance that paid some.
> He was left with $180,000 bill.

Forgive my ignorance but how is that possible? The highest out of pocket
maximums for Marketplace plans is $15700 for an entire family.

~~~
JAlexoid
There are interesting cases, where doctors prescribe stuff they get no
valuable information from.

I had this in US. Shoulder pain, that was diagnosed via an XRay... But the
doctor decided he wanted an MRI. That's no unusual, but unnecessary in my
case. Got charged extra $500 for the pleasure. Thankfully I was on an HDHP, so
the HSA savings got hit.

~~~
lostlogin
That’s not an unreasonable charge for an MRI and I’d argue that you got off
quite lightly. You can’t diagnose many of the potential problems shoulders
have from an x-ray but a good clinical examination will catch many of them,
with an MRI for confirmation. Labral tears would be an example of this.

~~~
patient_zero
For a second I read your comment as liberal tears, and had to do a double-
take. :)

Speaking to the 500$ charge, are you saying that is a typical cost around the
world for a MRI? Is there something about the machine's cost that justifies
this or are you just saying that a 500$ charge is typical in the american
system?

~~~
Fiahil
And here I thought my last 120 EUR MRI was very expensive... (in France, of
course)

~~~
lostlogin
That’s impressive. The purchase price and running cost are high. Then there
are expensive labour costs (doctor, probably 2x techs and admin/reception
staff. Often a nurse is around for more complex procedure too). Peripheral
equipment isn’t cheap, with defib, contract injectors, RIS/PACS, reporting
stations etc. Scans are slow relative to CT and x-ray so I have no idea how
they make that work. Did you pay the whole bill? I am an MR tech.

------
airstrike
It's worth noting that the U.S. market does pay for the lion's share of
patented drugs, effectively funding a significant portion of R&D that benefits
the whole world years later when generics come into market (at least for those
drugs which are not costly to manufacture, which happen to be the majority).

I'm not saying this model is right. I'm just saying that doing away with it
will have fundamental consequences to healthcare R&D

EDIT: To be clear, a minority of drugs are either very hard to manufacture
(It's been a while for me so I don't recall their exact name, but I think they
may be called "biosynthetics" – please correct me if I'm wrong) or researched
for a very small number of patients (so-called "orphan drugs"), which confers
them additional protection from generics and competitors. These generally have
much higher prices than the "standard" drug.

~~~
cameronh90
It does appear to be the case that the US funds most pharma R&D due to
Americans overpaying relative to the rest of the word. In some cases (China,
India) this is due to weak IP protection, but in other cases (Canada, UK,
Europe) it's more to do with our governments having a stronger negotiating
position and setting hard limits on what they'll spend for a given benefit to
patients.

Some characterise this as freeloading, but looking at the NHS for example,
they set relatively clear limits for how much they will pay per quality-
adjusted life year that a drug provides. If a drug costs more than this limit,
financially more people will lose out if our healthcare system purchases this
drug over something else (more doctors, hospital beds, etc.).

Does this make us immoral for "freeloading", because we prefer putting our
limited money into cost effective treatments?

Also, is it not worth looking at why pharma R&D costs so much? The pharma
industry seems to run at a very healthy profit margin compared to most other
industries. Maybe the lack of market pressure is allowing the pharma industry
to remain fatty? Obviously there's a fear that cutting US pharma revenue would
hurt global medical R&D, but I don't see this as being a foregone conclusion.
It could just as possibly be market failure and regulatory capture keeping
pharma R&D expensive.

~~~
darawk
> Does this make us immoral for "freeloading", because we prefer putting our
> limited money into cost effective treatments?

It doesn't make you immoral, but it is important in understanding the
tradeoffs of suggesting that the US switch to an NHS-style system.

> Also, is it not worth looking at why pharma R&D costs so much? The pharma
> industry seems to run at a very healthy profit margin compared to most other
> industries. Maybe the lack of market pressure is allowing the pharma
> industry to remain fatty? Obviously there's a fear that cutting US pharma
> revenue would hurt global medical R&D, but I don't see this as being a
> foregone conclusion. It could just as possibly be market failure and
> regulatory capture keeping pharma R&D expensive.

They may be doing well, but you may not be seeing all the little pharma
companies that die trying. At the end of the day, investors are allocating
capital where they think they can get returns. If you reduce the returns of
pharma, you reduce the attractiveness of investing there.

~~~
JAlexoid
I try investing a lot in smaller pharma companies... and they are hammered by
the big ones. Not on innovation, but on marketing.

I disagree about NHS type system, that reduces access. A healthy mix is
required, though.

A lot of upfront costs are also footed by users and government/non-government
funds. And a lot more of those costs are due to government regulation and
essential insurance at development.

Pharmaceutics researchers aren't exactly rich, btw. Your dentist probably
makes more than many researchers of life saving drugs.

~~~
laurencerowe
How does an NHS type system reduce access? Everyone is covered and can go to
the doctor without worrying about paying thousands in copays.

~~~
DanBC
And also if people wish to pay for private care (whether out of pocket or
using insurance) they're free to do that too.

------
rohanshah
It's worth noting that a recent analysis of S.1804, the Medicare for All Act,
"could reduce total health care spending in the U.S. by nearly 10 percent"
[1]. Even conservative analysis [2] has the program project to save in the
trillions over a decade.

All while providing comprehensive, universal healthcare, free at the point-of-
service.

Also, Medicare For All would theoretically be able to command substantially
lower drug prices by nearly monopolizing demand.

Notably, given the study's analysis focus on OECD countries, the United States
is (said to be [3]) the only of the top 25 wealthiest countries and one of two
total member countries to not provide universal healthcare coverage.

[1] [https://www.peri.umass.edu/publication/item/1127-economic-
an...](https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-
medicare-for-all) [2] [https://www.mercatus.org/system/files/blahous-costs-
medicare...](https://www.mercatus.org/system/files/blahous-costs-medicare-
mercatus-working-paper-v1_1.pdf) [3]
[https://www.politifact.com/virginia/statements/2015/sep/01/d...](https://www.politifact.com/virginia/statements/2015/sep/01/dan-
gecker/dan-gecker-says-us-only-wealth-nation-without-univ/)

~~~
tptacek
Why would I be excited about a proposal to totally restructure an industry
that every American comes into contact with and that represents something
approaching 20% of our economy just for the prospect of a _ten percent
savings_? Take any family complaining today about the cost of a Silver plan on
an ACA exchange, offer them a 10% savings, and see if they're OK with what
they're paying.

~~~
bshoemaker
Because it covers millions more, while spending less. Is this difficult to
understand?

~~~
tptacek
It leaves us overspending on health care by a huge amount, raises everyone's
insurance, and ultimately takes away everyone's employer-provided care, which
the majority of Americans who have it like. If it was cutting our expenses in
half, the cost savings might sell it. But 10%?

~~~
pjc50
> ultimately takes away everyone's employer-provided care

Really? Even the NHS system allows a parallel employer provided system to run
alongside it, it's just only common for higher-paying jobs and those with US
parent companies.

~~~
tptacek
Right, the rich will retain private care no matter what. The challenge is what
happens to the middle class, the majority of whom have employer-provided care
that they _actually like_ (this is a major challenge with any health reform in
the US: the status quo has powerful support). There's a near-consensus that
the impact to the market for these insurance products will, within a few
years, be eliminated by M4A.

------
sdrinf
PSA: As of 2019, federal law requires all hospital & doctors to post prices in
a machine-readable format.

The results are pretty striking, esp here in the Bay: eg UCSF (
[https://www.ucsfhealth.org/about/pricing-
transparency/](https://www.ucsfhealth.org/about/pricing-transparency/) )
charges $2600 for 1-way and 2-way chest X-rays, but charges $220 (that’s two
_hundred_) for 3-way chest X-ray. The difference? How many angles they take of
your body -ie, a 3-way includes the 2 & 1-way; and, more notably, the 3-way
was used as a chargemaster item used in pricing estimators. So eg when I went
in for a routine chest x-ray, I've expected a $300-ish bill, and got charged
with a $2600 one. Knowing these prices now allows me to ask specifically from
my doctor to select the diagnosis&intervention with the highest benefit/cost
ratio.

I’m really curious seeing consumer reactions to this, because current medical
billing practices must die.

~~~
taormina
This is astounding. It used to be that doctors were not allowed to post their
prices! Openness is needed to fix medical billing.

~~~
JAlexoid
Why would you care, when your copay is $30 flat?

~~~
dougmwne
Every time I use my health insurance in the USA I peel back another layer of
this onion of a scam. I've started doing most of my health care abroad even
though I'm insured just so I don't have to deal with this industry. I doubt
posting prices online will do much because it seems like a quick fix to a
systemic issue.

1\. Go for a 3 minute, 30 second ENT appointment about earwax. Think I'm just
paying a co-pay. Receive an extra bill for "Charges in excess of negotiated
amount"

2\. Go for appointment and be told: "If you just pay us now and bypass your
insurance it will be cheaper than your copays." This happened twice without
any prompting.

3\. Be told by another office that my insurance doesn't cover a service and
that it would be better if I paid out of pocket. Learn later that that service
should have been covered 100%. Struggle for months to get insurance to pay
instead all the while being told by the office "we can't guarantee you won't
end up paying more in the end, even if it does say 100%"

~~~
tapland
It surprises me that that behavior is even legal. It shouldn't be in a modern
democracy.

------
slx26
I speak for myself, but I'm pretty sure many people would share the thought:
healthcare is the number one reason for which I'd never move to America.

And there are a billion things for which you might want/not want to move to
another country. And I'm healthy, and there are many other things that might
seem crazy about America. I don't know, maybe I'm just paranoid, but I do
seriously hope for the sake of everyone (and I don't mean to be meddlesome),
that US citizens stop accepting this as normal and the situation changes soon.

~~~
bitxbit
This is odd. If you have a decent job and health insurance coverage, there’s
nothing better in terms of healthcare than living in cities such as Boston. I
can’t think of another city where you have access to multiple world-class
hospital systems. Quality of care is simply unmatched.

~~~
AndrewDucker
Have you see the discussions above where people talk about being hit with
bills for hundreds of thousands because of Out Of Network charges?

------
elipsey
I think it would be worthwhile to discuss more than just per capita cost. The
way that these costs are distributed is important and, I believe, problematic.
The problem here is not just that per capita cost is high, it’s that for
reasons that are partly structural, and partly demographic, healthy young
payers with lower incomes can be burdened with the full, un-subsidised, costs
of insurance, while others consume services without seeing the price. Some
people have tax subsidized employer sponsored health care, some people have
socialized health care, some people pay for insurance out of pocket with post-
tax income, and some people have nothing and have to negotiate costs under
duress after they have already consumed services. Doctors will not commit to a
price in writing in advance. If you think will, try it sometime ;)

I’m currently paying more then %100 of my annual income into an insurance
pool, because I need insurance to protect my assets. (It’s complicated...)
Moreover, the cost is not tax exempt because it is not employer sponsored. I’m
healthy and don’t really consume much in the way of services. Meanwhile,
others in the same insurance pool I’m paying into never see the price of their
premiums, and don’t pay taxes on them. I understand that the point of
insurance is to pool risk for insurable events, but how can we ever have an
efficient market without price information?

As Milton Friedman put it “No one is as careful with other people’s money, as
he is with his own.”

~~~
beatgammit
I'm confused, do you have low income and a fairly large amount of assets? I
can see this if you retired early or something, and in this case the
comparison with your income really isn't particularly interesting.

------
bluetwo
Like the article says, previous research has come to the same conclusion.

We pay much more, and are ranked nowhere near the top for lifespan, childhood
mortality, and other measures.

Obamacare was a great first step. Define what basic healthcare is and form
markets that encourage apples-to-apples comparison. Let the free market work.

Sucks that one party used this as a weapon to wrestle power.

Oh well.

Not going to argue here about healthcare reform, though. So if you disagree,
don't expect a response.

~~~
MichaelApproved
> Let the free market work

Respectfully, enough with this free market garbage. The healthcare industry is
not a free market, it can never be. It's not possible for the consumer to be
educated.

Even if you put emergencies aside, when an unconscious person can't start
price shopping emergency rooms, you still have regular office visits that are
impossible to price shop.

Ask yourself when the last time you asked your physician how much a service
cost. I asked my physician and they had no clue. They finally gave me an
estimate of "it'll be nominal", so I accepted the procedure. Turned out to be
~$200. I'm currently disputing it and refuse to pay based on their original
quote of "nominal".

Imagine your at the doctor and need to get a blood test. What do you do? Start
calling around local labs to ask which one has the best price? Maybe check
Groupon for a discount? All this while your doctor waits to see if the price
is within your budget, so they could continue the test.

Pricing in the medical industry is not even opaque. It's solid black.

~~~
ModernMech
> They finally gave me an estimate of "it'll be nominal", so I accepted the
> procedure. Turned out to be ~$200. I'm currently disputing it and refuse to
> pay based on their original quote of "nominal".

This is a case of expectations. $200 is nominal as far as medical procedures
go. Based on my last couple encounters with healthcare, $200 barely gets you
in the door. I paid $2000 on my last ambulance ride. My last stay was $14,000
for a couple days. That's _with_ insurance.

~~~
MichaelApproved
I was having an office visit getting tested for the flu, not on my way to the
emergency room.

The person who gave me the "nominal" quote also said my insurance would likely
even cover the test. She was wrong.

I spoke to the office manager and she seems to agree with my take on the
situation.

If you give a vague subjective word like "nominal" for a service, it's on you
to hope the consumer agrees.

------
gerbilly
It seems to me the US never outgrew it's frontier mentality.

Before, if you felt too hemmed in you could always move west and get free
land, get together with other locals and form a small town.

Better to be the founder of your town than a random nobody in your previous
town.

Back in the 18th-19th centuries, medical care was primitive and sometimes
dispensed by the barber.

For toothaches and broken limbs, you might see a dentist or a doctor, for
anything life threatening you toughed it out and died at home.

We don't do that anymore of course, but it's almost as if attitudes about self
sufficiency have lagged behind.

------
harimau777
Are there any measures of how America does compared to Europe if you only
count Americans that have good health insurance?

It seems to me that many people who are opposed to socialized medicine don't
necessarily disagree that it would give the poor better care; rather they fear
that it will result in them receiving worse care.

~~~
grecy
> _Are there any measures of how America does compared to Europe if you only
> count Americans that have good health insurance?_

Anecdotally, I'd say they do crap.

Friends outside LA are upper-middle class. Extremely good health insurance for
the last 20+ years. Had a baby, emergency C-section. Less than 12 hours later
they were told they must move hospital or else pay the $60,000 per day out of
pocket because their insurance wouldn't cover it anymore. They had to drive
themselves, in their own car, less than 12 hours after an emergency C-Section,
with the infant.

Of of this after paying through the nose for 20+ years for excellent health
insurance.

As an Australia/Canadian this is barbaric, and utterly unacceptable.

~~~
kodablah
I think the commenter was asking about quality regardless of cost, especially
for the upper tier.

~~~
grecy
Yes, and I was saying the quality is very low.

------
halfjoking
The title is inaccurate.

It shouldn't be "spends more for no gain"... it should be "spends more for
worse healthcare."

"No gain" implies that we are getting the same level of healthcare as other
countries, when in fact we have worse outcomes, less nurses/doctors, worse
wait times, and always get stuck with the bill. Only in America do people
regularly end up in bankruptcy for medical expenses.

------
topkai22
I saw an interesting article a while back. It looked at the benefits adjusted
income of workers in the US since 1980 or so. Basically, the “disappearing
wage growth” at of the last part of the 20th and early 21st century fir the
bottom of the income curve is largely (although entirely) explained by the
increasing cost of health care as a component of compensation.

~~~
int_19h
Is this averaged across all industries and income levels?

------
nickhalfasleep
I wonder how long other industries will let the healthcare companies get away
with this.

The first Fortune 500 company to give it's employees free travel to Mexico,
Canada, or Cuba for affordable care will cause quite a few waves.

Or a smart country could open up "embassy clinics" throughout America,
offering affordable healthcare and taking the profits back home.

~~~
tptacek
Fortune 500 companies already frequently self-insure their employees.

------
bedhead
Where does the money go? Aside from the waste and fraud, two places. First, we
pay for convenience. We want to see a doctor _now_. We want immediate access
to all the best equipment, and specialists, and drugs, and we don't want to
wait around or travel far. And we increasingly want it for every citizen.
Second, over treatment of the dying - no subject is more uncomfortable. When
asked what the biggest problem Kaiser Permanente faced, Charlie Munger, board
member, responded over treatment of the dying. Various estimates are half of
all healthcare spending takes place in the final two years of peoples' lives.
In both cases, we've essentially deemed care as "cost no object", and when
that happens, things get sideways fast.

I'm not saying what is right or wrong, just what the problem is. Fast, cheap,
good - you can always only pick two.

~~~
6nf
> We want to see a doctor now. We want immediate access to all the best
> equipment, and specialists, and drugs, and we don't want to wait around or
> travel far. And we increasingly want it for every citizen.

Australians can get these at a fraction of US prices though

~~~
refurb
Can they?

 _Mr Meschemberg’s cancer is HER 2-positive (HER 2 is a protein found on the
surface of some cancer cells). HER 2-positive cancer cells tend to be far more
aggressive, as they divide and grow faster than normal. “That makes [my
cancer] a bit different,” he said. “There are drugs that are available to help
but they’re not on the PBS.”_

[https://www.news.com.au/lifestyle/health/health-
problems/mee...](https://www.news.com.au/lifestyle/health/health-
problems/meet-the-aussies-whose-cancer-treatment-isnt-covered-by-the-
pharmaceutical-benefits-scheme/news-story/d264fe3c6510bbed33d3e84bc8f351e2)

~~~
6nf
It takes a few extra years for new drugs to get added to the PBS, but even if
they are not, there's a cap on how much 'out of pocket' you'll pay for
treating serious medical conditions. It's maybe $3000 per year depending on
your situation. Medicare will cover the bulk of it even if it's not on the
PBS.

------
WhompingWindows
Reading through this thread is proof enough that the system is relentlessly
complex. Medicine itself is incredibly complex, payment is complex, the system
is nearly 20% of the economy, and not even 100 world-class experts could
provide us with a fool-proof plan to solve this mess. Whatever the solution is
to our healthcare systems' problems, it is not going to be simple, easy,
quick, or cheap.

------
tboyd47
Here's a simple, free-market solution that no one seems to have thought of:
start a health insurance company that pays for medical tourism. That would
provide consumers a cost-effective alternative and put pressure on the
American hospital systems to bring down costs. Why wouldn't this work?

~~~
dandare
Even better: a billionaire philanthropist to start a non-profit health
insurance company that only works with its own chain of evidence-based
providers and hospitals, combined with medical tourism. That would provide
consumers with a cost-effective alternative and put pressure on the American
hospital systems to bring down costs. Why wouldn't this work?

------
EGreg
It’s a simple economic argument:

In a single payer system, providers compete but buyers don’t, so prices are
kept low.

Prioritization is based on need.

------
jasonlotito
These studies never seem to differentiate between different types of care. We
left Canada for the US because of the healthcare. Autism care and support is
far better in the US then Canada. Even if this is costing us more as a whole
(it's far cheaper in my out of pocket costs), there are gains. So in general,
we might be doing worse in general, but that doesn't mean we aren't doing
amazingly betting in certain areas. I realize I'm talking about one specific
area, but knowing how much was spent in the US vs Canada in terms of care,
yes, more was spent on my child in the US instead of Canada, but the results
were so much better.

Basically, it's easier to spend less when you just don't do certain things
that are much more expensive.

------
pytyper2
They spend more on healthcare because a corporation presented a bill with a
larger total at the bottom. NO human goes to the hospital and says, "...please
charge me 37 dollars more than last visit for that generic aspirin..." All you
international geniuses, help us out, stop investing in the for profit US
healthcare system. Sell your holdings today, don't invest your retirement in
funds that invest in for profit healthcare companies. That would get the ball
rolling. Same goes for for profit prison management.

Trivia: What percentage of for profit healthcare corporations are directly or
beneficially controlled by foreign investors who reside in countries that do
not have our healthcare cost problems?

~~~
JAlexoid
We will not. USA is the global piggy bank.

Honestly - it is.

------
tabtab
Many are not going to trust such studies any more than they trust climate-
change research, and would rather the market "fix" the problems than a
gov't-centric approach.

------
anovikov
Why do people keep thinking about this in the terms "who should pay for that"
while in the market economy, it won't change anything? It's about supply and
demand, just force medical schools prepare more doctors, for example
threatening them with automatic diploma recognitions and green cards on
arrival, for medical professionals from every first world country who could
speak decent English.

------
dhruvp
If you want to read more on this topic, I highly recommend An American
Sickness ([https://www.goodreads.com/book/show/31253737-an-american-
sic...](https://www.goodreads.com/book/show/31253737-an-american-sickness)).
It's written by the current Editor in Chief of Kaiser Health News.

------
vmsp
Interestingly, I just read this last night on Factfulness by Hans Rosling so
it's certainly not a new finding. I highly recommend the book.

------
geggam
I was in a cancer center picking someone up and overheard the staff ordering a
dose of medicine.

A single dose was billed at $100k US

------
whiddershins
I believe there is an economic analysis I saw mentioned by Scott Alexander
that basically the cost of healthcare can be predicted as a function of the
quality of care and the wealth of the country.

Allegedly healthcare in the United States costs exactly as much as that
formula would predict.

I don’t have a citation here, and if anyone has one that would be great.

But if it is true, we might be trying to fix something that isn’t broken in
any of the ways people intuitively conclude.

~~~
InclinedPlane
I don't give a shit even if we ultimately have to pay more than we are now on
healthcare (spoilers, we won't) as long as we can have universal coverage.

------
sbt
It's always for someone's gain but as with other things in the US it's the
shareholders who gain.

------
vasilipupkin
I think it’s hard to compare these numbers across countries. For example, a
richer country could choose to spend more on stuff that ultimately makes
little difference in outcomes. For example, fewer people per hospital room or
better hospital food or shorter wait times for a non threatening disease.

~~~
nerdponx
I'm not sure this holds up to scrutiny. Why don't other rich countries (e.g.
Canada, which lets you pay for your own healthcare if you want) have this
problem?

~~~
vasilipupkin
Canada has equivalent of Medicare for all. And Canada has at least some of
these problems, for example longer wait times. These long wait times don’t
ultimately affect average outcomes.

~~~
nerdponx
I think you misread my post. By "these problems" I meant "overspending on
things that don't improve outcomes."

But if paying for extra care is illegal in Canada then my argument doesn't
work.

~~~
vasilipupkin
Being able to see my doctor for a health problem on short notice improves my
quality of life but it probably doesn’t change outcomes as there is a very low
likelihood that my problem is both life threatening and urgent. But choosing
to pay doctors more to reduce wait times is not right or wrong - it’s just a
different preference.

~~~
nerdponx
My point is that you don't see people spending extra to see private doctors in
Canada despite it being a generally wealthy nation. There is more at play than
the original suggestion that high spending is simply a function of being a
richer nation with more money to spend on "extras" like short waiting times.

~~~
vasilipupkin
You do actually - Canadians sometimes go across the border to US for
surgeries, etc.

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d--b
These studies serve no purpose. Everybody knows this.

The usual debate follows: yes but US funds research - yes but doctors,
insurance and pharmaceutical companies get paid a lot more than anywhere else
- yes but that’s the market, I want to pay more to have a top notch doctor /
insurance - blah blah blah.

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Fej
Judging by the comments, there are a lot of us here who already know this. _So
what are we going to do about it, now?_ The system is broken but there are a
number of entrenched interests who want to keep it that way and an electorate
willing to buy whatever they say.

I am short on hope.

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trophycase
Everyone wants to blame drug prices but let's not ignore the problems of
obesity, diabetes, etc. Much of which is a result of urban sprawl, poor diet
(both in food culture, and in crop subsidies), and poor work culture.

~~~
airstrike
As a U.S. immigrant who struggles to find truly healthy food choices in
Manhattan of all places, I couldn't agree more.

~~~
wil421
Most really healthy people cook for themselves.

~~~
airstrike
That's what I do too, but every once in a while you have to buy prepared food
and the portion size, calorie count and amount of sodium / sugar in American
food is simply staggering

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HillaryBriss
one of the mysteries for me is always: economists love it when the government
spends more money because of money multiplier effects (the old Keynesian idea
of burying wads of hundred dollar bills in millions of bottles and then pay
someone to dig them up and spend it).

but then, when you have this HUGE industry which literally spends hundreds and
hundreds of billions on all kinds of nonsense like wasteful billing
administration, unnecessary defensive medical tests, overpriced drugs, etc,
the same economists are unhappy.

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wwarner
The name of the school is `Johns Hopkins`. Carry on!

~~~
tlb
Fixed the title, thanks.

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skookumchuck
In the US, the most heavily regulated industries are health care and
education. They have the highest prices.

The least regulated industry is software, with the lowest prices (most
software is literally free).

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sanjiwatsuki
I see people saying that drugs in the US are twice as expensive as other
countries in the comments. I'll summarize [0] which is one of the sources for
that number.

People in the United States spend roughly 2x per capita compared to Germany,
Canada, and the UK. This does not mean that drugs in the United States are
twice as expensive.

The US tends to use newer molecules in the drugs that are purchased --
particularly ones that are still patented and more expensive. Other countries
like Germany and the UK tend to use older drugs (e.g. molecules over 30 years
old).

A naive analysis would notice that the US spends more on drugs for a lower
number of sales and would conclude it's because prices are high, but that
ignores the fact that US doctors tend to prescribe newer on-patent drugs which
are -- _drumroll_ \-- more expensive and not necessarily more effective. I'd
argue this is the fault of the doctors prescribing the drugs more than any
drug company's fault.

If you examine Exhibit 6 in the study, you'll see that, yes, the United States
does tend to have more expensive drugs than most other countries but it is NOT
an outlier. For example, Japan and Mexico pay more than the US for the same
drugs on average. Drug prices are not nearly as big of a problem as people
make it out to be.

Also, to its credit, the US also has significantly cheaper generics and over-
the-counter drugs.

[0]
[https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.1....](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.1.221)

------
interlocutor
The reason healthcare costs so much more in the US than other countries, is
health insurance. When insurance pays for everything patients don't care how
much the medical providers are charging, or whether they are providing
unnecessary services. When somebody else (i.e., insurance) is paying, the
individual consumer is encouraged to consume without any restraint. When all
consumers behave this way, healthcare providers are able to charge sky-high
prices and unnecessary services, which in turn causes insurance premiums to go
up. (Look up "tragedy of the commons").

The solution is to make the consumer participate in driving costs down. One
employer I know of has an excellent solution to the problem: Make employees
pay 100% of the bill up to a certain amount, such as $6000. That's a large
amount, but the employer then contributes a large amount to your Health
Savings Account (HSA), such as $4000. This amount is for you to keep
regardless of whether you have any health bills or not. (This money can be
used for medical expenses only, but can be used any time, including after
retirement). So the maximum you will spend out of pocket per year is $2000.
How does this encourage the consumer to scrutinize and control medical
expenditure? Because the first $6000 of medical spending in a year is "your
money". This is money you'd be able to keep in your HSA if you didn't have any
medical expenses. This gives the consumer a strong incentive to reduce costs,
question charges, avoid unnecessary services, and so on.

