The Waste of America's Health Care System in 1 Chart

[OJsDad]

Link to the video. 

http://video.cnbc.com/gallery/?video=3000222527

[Keunert]

i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.

Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance. 

in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.

:) i marked the important part for the us participants in this thread  8)

[Mr. Bigglesworth]

M. Night Shyamalan was on CNBC yesterday and was talking about education.  He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top. 

That is very interesting. If true it would explain a lot.

It's one of those things that can be bent to mean anything. The US has very good prep schools that could well be at the top of the world. What % of the population gets that education? The same for the universities, the best in the world. At least for a couple thousand students at each of the top ones. What happens to the rest?

[Mr. Bigglesworth]

i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.

Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance. 

in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.

:) i marked the important part for the us participants in this thread  8)

A mix of public and private is the best system. What needs to be shut down is the people attempting to game it, or present it as broken to game it.

[OJsDad]

i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.

Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance. 

in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.

:) i marked the important part for the us participants in this thread  8)

My teams former HR manager is a single parent and has a daughter with some health issues.  Instead of taking some time off to take her to the doctor, she would wait and take her to Urgent Care after work.  She did this until salary employees were switched from a traditional health care plan to an health savings account with a higher deductible.  Then she realized that urgent care cost about the same as an ER visit.  She started taking the time to schedule a doctors appoint after that she started to actually look at the bill and had to write the check our of her own account.

[OJsDad]

M. Night Shyamalan was on CNBC yesterday and was talking about education.  He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top. 

That is very interesting. If true it would explain a lot.

It's one of those things that can be bent to mean anything. The US has very good prep schools that could well be at the top of the world. What % of the population gets that education? The same for the universities, the best in the world. At least for a couple thousand students at each of the top ones. What happens to the rest?

Actually, everyone does get access to this level of education.  In fact, if you look at the large city schools in Ohio, they're spending a lot more money per pupil and not getting the results;

School District              Enrollment                $ per Student                       State Report Card Grade

Cleveland                       40803                       $14551                                        D
Akron                              21984                       $13627                                       C
Toledo                            21642                       $14912                                        F
Columbus                       49424                       $14614                                        D
Cincinnati                       28670                       $14720                                        C
Dayton                           13934                       $14375                                        D

Deer Park                       1255                         $10936                                        B
Arcadia                             583                           $9385                                        B
Kenton                            1876                          $9156                                        B
Delaware                        4932                          $9681                                        B
Olentangy                      16754                         $9599                                        B
Delphos                           1098                         $7673                                        B
Westerville                     14187                       $10720                                       B

[Windigo]

i am skeptical about the personal responsibility. i am currently heavily involved in building an elderly home and therefore have some interest in the topic.
costs are foremost exploding because of two facts: higher life expectancy and a ratio between old and young people that will soon make everything even worse.

Switzerland has about the second most expensive health care system in the world, just after the us. our system is a mix of a general and europe wise very basic insurance that everyone gets. and a market driven private insurance for what is above basic needs. the system sucks money wise. doctors are spending more and more time filling out forms and fighting with insurance companies about how many minutes of their service belongs to the basic insurance and how much belongs to the private insurance. 

in contrast to this France, Sweden, Denmark and Norway have non profit oriented, governmental run health care systems that achieve a lot more health per buck. i tend to think we should move in this direction, giving up on this half market - half solidarity driven system.

:) i marked the important part for the us participants in this thread  8)

A mix of public and private is the best system. What needs to be shut down is the people attempting to game it, or present it as broken to game it.

+ fucking 69!!!

[Mr. Bigglesworth]

M. Night Shyamalan was on CNBC yesterday and was talking about education.  He pointed out on those international tests that everyone points to and says that the US education system is so bad, that if you take out the inner city school districts that the US rises to the top. 

That is very interesting. If true it would explain a lot.

It's one of those things that can be bent to mean anything. The US has very good prep schools that could well be at the top of the world. What % of the population gets that education? The same for the universities, the best in the world. At least for a couple thousand students at each of the top ones. What happens to the rest?

Actually, everyone does get access to this level of education.  In fact, if you look at the large city schools in Ohio, they're spending a lot more money per pupil and not getting the results;

School District              Enrollment                $ per Student                       State Report Card Grade

Cleveland                       40803                       $14551                                        D
Akron                              21984                       $13627                                       C
Toledo                            21642                       $14912                                        F
Columbus                       49424                       $14614                                        D
Cincinnati                       28670                       $14720                                        C
Dayton                           13934                       $14375                                        D

Deer Park                       1255                         $10936                                        B
Arcadia                             583                           $9385                                        B
Kenton                            1876                          $9156                                        B
Delaware                        4932                          $9681                                        B
Olentangy                      16754                         $9599                                        B
Delphos                           1098                         $7673                                        B
Westerville                     14187                       $10720                                       B

You have to explain what you mean. I am talking about a few schools that do anything to get the Profs they want. Clearly everyone does not have access to those people.

[Jack Nastyface]

Certainly one factor that is influencing (and will continue to influence) USA medical spend is the aging baby-boomer generation.  I believe that the US is somewhat unique in that the post-war baby boom was greatest in the USA, resulting in record population growth.  That demographic is now getting old, and like most old people everywhere, their health care costs are higher.  Couple that with other problems like choices about diet and excercise and you get higher-than-average demands for healthcare.

And it's probably going to get worse.  Over the next 20 years, we are going to be experiencing the greatest "wave of death" in history as those baby-boomers approach end-of-life   Further, financial evaluations of health care service will show that about 70% of the money that will be spent on individual healthcare in a person's life occurs within the last 8 months before death.

Maybe Logan's Run got it right.  I mean about the whole "random sex-partner transporter" thing, not the "carousel of death".

[airboy]

There are several other things about the US medical system where the entire rest of the world (almost) are free riders.

1] In the USA if you develop a new drug, medical device, etc..... you can actually sell it at a price which allows you to recoup the investment costs and to make money.  You can also make enough money to cover all of the failures of drug/device trials that did not work out. 

For the rest of the world, they impose massive drug price caps or simply don't allow their citizens to purchase drugs (or use medical devices) that are considerably better until the patent protection expires.

Effectively, the USA is the only country left where the private sector does medical research.  Almost all of the drug/equipment advances in the last 15-20 over the entire world have almost all been for USA companies or international firms who are selling their drugs for a profit in the USA.  As the USA nationalizes their health care, private sector health research will drop to almost nothing.  This is a huge long run cost to humanity.

2] US Health Care spending is concentrated in the last 12 months of life.  A huge amount of spending goes to those who are dying in an effort to prolong life.  What is interesting is how many US doctors refuse treatment of dramatic end of life care.  They see first hand what the suffering is like and choose not to take part.  US end of life care is almost totally paid by the US government and many, many people will choose any hope if someone else pays the bill.  [Before anyone goes nuts about their parent/loved one at the end of life my parents died a horrible lingering death so I've experienced this first hand].

3] Another free rider problem we have is people who simply refuse to buy simple preventative care.  This floods emergency rooms.  We have the exact same problem in the USA for car insurance.  A lot of people simply will not pay if they think they can get away with it for insurance.

4] I agree with Longblade that medical malpractice & ambulance chasing lawyers are a problem - but it is only say 5-10% of the issue.

5] Last, the graph shows life expectancy vs. health care spending.  This has been examined by public health researchers.  A significant part of the problem (not all, but a large part) is due to very unhealthy lifestyles that are controllable such as obesity, smoking and lack of exercise.  The other part is lack of basic preventative care.  A huge part in the US is deaths at or close to birth by moms who are drug addled and don't take care of themselves and effectively kill their children.  Statistically, if you have a disproportionate number of people die in year 0 to year 1 it really changes the statistical distribution.  As a stats guy this is very easy to see in the data and has been written about in the literature.

6] Really last point - I'm not disagreeing with the earlier comments or the data presented.  I just think that the issue is much more complicated than "people are greedy and game the system."  Remember, people are always look out for their best interests and will try to game the system.  Even on this website we have people alerting themselves to sales, giving away games, and discussing price trends for games.  We do the exact same thing everywhere.  It is called self interest.

[Keunert]

[Mr. Bigglesworth]

There are several other things about the US medical system where the entire rest of the world (almost) are free riders.

1] In the USA if you develop a new drug, medical device, etc..... you can actually sell it at a price which allows you to recoup the investment costs and to make money.  You can also make enough money to cover all of the failures of drug/device trials that did not work out. 

For the rest of the world, they impose massive drug price caps or simply don't allow their citizens to purchase drugs (or use medical devices) that are considerably better until the patent protection expires.

Effectively, the USA is the only country left where the private sector does medical research.  Almost all of the drug/equipment advances in the last 15-20 over the entire world have almost all been for USA companies or international firms who are selling their drugs for a profit in the USA.  As the USA nationalizes their health care, private sector health research will drop to almost nothing.  This is a huge long run cost to humanity.

2] US Health Care spending is concentrated in the last 12 months of life.  A huge amount of spending goes to those who are dying in an effort to prolong life.  What is interesting is how many US doctors refuse treatment of dramatic end of life care.  They see first hand what the suffering is like and choose not to take part.  US end of life care is almost totally paid by the US government and many, many people will choose any hope if someone else pays the bill.  [Before anyone goes nuts about their parent/loved one at the end of life my parents died a horrible lingering death so I've experienced this first hand].

3] Another free rider problem we have is people who simply refuse to buy simple preventative care.  This floods emergency rooms.  We have the exact same problem in the USA for car insurance.  A lot of people simply will not pay if they think they can get away with it for insurance.

4] I agree with Longblade that medical malpractice & ambulance chasing lawyers are a problem - but it is only say 5-10% of the issue.

5] Last, the graph shows life expectancy vs. health care spending.  This has been examined by public health researchers.  A significant part of the problem (not all, but a large part) is due to very unhealthy lifestyles that are controllable such as obesity, smoking and lack of exercise.  The other part is lack of basic preventative care.  A huge part in the US is deaths at or close to birth by moms who are drug addled and don't take care of themselves and effectively kill their children.  Statistically, if you have a disproportionate number of people die in year 0 to year 1 it really changes the statistical distribution.  As a stats guy this is very easy to see in the data and has been written about in the literature.

6] Really last point - I'm not disagreeing with the earlier comments or the data presented.  I just think that the issue is much more complicated than "people are greedy and game the system."  Remember, people are always look out for their best interests and will try to game the system.  Even on this website we have people alerting themselves to sales, giving away games, and discussing price trends for games.  We do the exact same thing everywhere.  It is called self interest.

I used to work for an EU multi-national medical company. I used to get their detailed financials which showed quite a large investment in R&D. In fact most of their debt, which was significant, was for investment in R&D. I also happened to run their supply chain for our product. I know the costs to deliver world wide. I know the margins. All I can say is a large part of the world got product. There was profit in those markets. The US market is very different. Margins are huge relative to the rest of the world. Nothing is done about it.

[Mr. Bigglesworth]

BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.

[airboy]

BTW readers should not do the mental spin of trying to believe an EU company was screwing Americans. There were bigger US companies in the market with equivalent tech products. They basically had price power worldwide. Our product was actually cheaper in the US while having equivalent quality outcomes. So if anyone was screwing Americans it was the volume leading US firms.

You actually confirmed the point I was making.  In the US, the margins for successful new drugs and medical devices are huge.  Rest of the world, they are small.  This means that the USA is either the primary or the disproportionate funding mechanism for medical R&D for the world.

Also, it is true that many countries just won't use cutting edge drugs or equipment (or adopt them much later) because their government does not want to pay.

[GDS_Starfury]

considering how many drugs warn you about bleeding out of your asshole, having the possibility of limbs falling off and heart attacks or strokes I wouldnt be rushing to get the cutting edge drugs either.