Your first paragraph is a great distillation of the debate, and the post keeps climbing from there. I would add that healthcare is expensive because the healthcare workforce makes up about 14% of the total US workforce and the average wages for most occupations is significantly higher than the average. But we also gain something other systems don’t have, and that is responsiveness in many parts of the system (I know - there are horror stories aplenty, but there are also scores of stories where rapid actions through the system saved lives).'We typically are not kept waiting for critical procedures like one hears about in Canada and the UK. There is no question that the system needs improvement, but that can happen only if we are willing to allow new ideas to be tried rather than stifled by massive bureaucracy in the public and private sectors.
Gary, my husband’s experience bears out what you write. His doctor found a lump on his neck. It was speedily biopsied. The results came in on a Friday; we were sitting in the oncologist’s office on Monday morning; my husband had a ct scan Monday afternoon; and the oncologist called Monday evening while I was out to say he wanted my husband in the hospital the next morning at 8:00. A room was prepared for him, and chemotherapy would start immediately. A lymph node was impinging upon a vital part of my husband’s body. Today my husband has been cancer free for two years. I don’t see how any other country could have moved more swiftly. I’ll add that we are ordinary people with no particular status in business or political circles, so no strings were pulled.
Great piece Robert. I've always been amazed when people felt that they'd get better care in Cuba. The care here is complicated, and sometimes expensive, but remarkable.
Thanks! And yes, your observation is correct. Tourists in Cuba reportedly get perfectly fine care on that island. High party officials do fairly well. Too bad if you are an ordinary person.
Dr. Leap, I am a retired emergency physician (and familiar with your writing). You are correct, and I don't think other systems offer a place like the ER where anyone, insured or not, can walk into a place with any complaint and get evaluated by experts with an extraordinary amount of technology to help decide why you are in pain/weak/confused/acting funny/smell bad or whatever. Truly remarkable.
I don't know, but I strongly suspect that general American healthcare is expensive because it subsidizes government programs. I retired and went on Medicare almost a year ago, and subsequently had some fairly major heart surgery with assorted minor complications. It is nothing short of humiliating to see how Medicare gives my providers the shaft; I assume the shortfall is made up through private insurance plans.
Money all going to drug co's, insurance co's and electronic record developers. With the full cooperation of gov't (who sweeps up the campaign contribution money). If you want to see where the money goes, see who's buying TV ad time. As a long-time primary care doctor, I just shuffle papers for all them now.
Tricky question. Different question, though. That's more about price than it is about spending. Price can go up, and that can either mean MORE spending or LESS spending.
No, Medicare's price is what it is (and this year they charged me based on LAST year's income, before I retired). They *spent* on me substantially less than I actually cost, and the hospital didn't shut down, so I assume they cover the shortfall with those $50 Tylenol tablets.
Again, this post is about the TOTAL amount of spending, not the prices or quantities of particular medical goods and services. But since you ask about the latter, e.g. $50 Tylenol tablets, they are mostly accounting fictions. Some study years back showed that, effectively speaking, a hospital's expenditures are almost entirely fixed costs. How much the bill SAYS they charge for a bandage or a Tylenol is effectively ex post accounting sophistry. I used to explain it my students this way: Picture two pizza parlors, each of which will sell you a beer and pizza combo for $15. On one, the menu says that the beer is $3 and the pizza is $12. At the other, the menu says the pizza is $5 and the beer is $10. But at both, the only thing for sale is the $15 combo. It makes absolutely no difference what the menus say about the price of beer alone or pizza alone. Pizza isn't subsidizing beer, and beer isn't subsidizing pizza at either place. It's just just an accounting fiction. And Medicare's accounting methods have forced providers to engage in such accounting fictions. Except for those who don't take insurance--like the Surgery Center of Oklahoma. At SCO, you simply get a straight, all-in price for a knee replacement--no meaningless breakdowns.
Great insight and argument... I have had this very thing stumbling around in the more obscure recesses of my mind for some time, but have never been able to wrestle it into the open and into a coherent line of thought. So refreshing to have someone do that for me.
People really do pursue what they want, characterized by their means, and insistence upon liberty. Tell them what to buy, with what to cook, what to drive, where to live, (etc. and et al.) and increasingly bump a stump (often many different stumps), to the every lasting exasperation and frustration of the political elites who know what is best for us. Seems simple, to me. Unlike Russia, for example, we do not have a citizenry evolved over hundreds of years of centralized cultural, political and societal command and control – a DNA of equality of poverty and coherence of repression that even today leads many in Russia to look back on the Stalin years with wistful nostalgia. Although we do have a large segment of our population who might imply otherwise. I suppose every polity must include a high ratio of sheep.
I'm late reading this post, but I can't resist making some comments. You make some good points,and perhaps our spending is not as out of control as those with an agenda would have us believe. On the other hand...
(1) Big numbers hide a lot of small sins. This argument doesn't address the very poor care and limited options for those who do not have employment-based commercial insurance or Medicare. Medicaid is crap, so between uninsured and Medicaid one would hope the nation with so much wealth could do better.
(2) Why should we be satisfied with the same crappy healthcare delivery systems as other developed nations? Why aim for European mediocrity? Why not, in traditional American fashion, make healthcare something that is simultaneously improving in quality, decreasing in cost, and increasing in availability? Why not unleash market forces on healthcare? As you correctly point out, the discussion around reform in this country concerns things that won't really move the needle. Rather than constantly chasing the unintended consequences of the last government intervention, let try the only thing that has ever created value -- a free market.
Your first paragraph is a great distillation of the debate, and the post keeps climbing from there. I would add that healthcare is expensive because the healthcare workforce makes up about 14% of the total US workforce and the average wages for most occupations is significantly higher than the average. But we also gain something other systems don’t have, and that is responsiveness in many parts of the system (I know - there are horror stories aplenty, but there are also scores of stories where rapid actions through the system saved lives).'We typically are not kept waiting for critical procedures like one hears about in Canada and the UK. There is no question that the system needs improvement, but that can happen only if we are willing to allow new ideas to be tried rather than stifled by massive bureaucracy in the public and private sectors.
Glad you approve! I agree with all the parts when you're not talking about me, too. :)
Gary, my husband’s experience bears out what you write. His doctor found a lump on his neck. It was speedily biopsied. The results came in on a Friday; we were sitting in the oncologist’s office on Monday morning; my husband had a ct scan Monday afternoon; and the oncologist called Monday evening while I was out to say he wanted my husband in the hospital the next morning at 8:00. A room was prepared for him, and chemotherapy would start immediately. A lymph node was impinging upon a vital part of my husband’s body. Today my husband has been cancer free for two years. I don’t see how any other country could have moved more swiftly. I’ll add that we are ordinary people with no particular status in business or political circles, so no strings were pulled.
So glad to hear that your husband got the care he needed! Thanks for your note.
Great piece Robert. I've always been amazed when people felt that they'd get better care in Cuba. The care here is complicated, and sometimes expensive, but remarkable.
Thanks! And yes, your observation is correct. Tourists in Cuba reportedly get perfectly fine care on that island. High party officials do fairly well. Too bad if you are an ordinary person.
Dr. Leap, I am a retired emergency physician (and familiar with your writing). You are correct, and I don't think other systems offer a place like the ER where anyone, insured or not, can walk into a place with any complaint and get evaluated by experts with an extraordinary amount of technology to help decide why you are in pain/weak/confused/acting funny/smell bad or whatever. Truly remarkable.
I don't know, but I strongly suspect that general American healthcare is expensive because it subsidizes government programs. I retired and went on Medicare almost a year ago, and subsequently had some fairly major heart surgery with assorted minor complications. It is nothing short of humiliating to see how Medicare gives my providers the shaft; I assume the shortfall is made up through private insurance plans.
Money all going to drug co's, insurance co's and electronic record developers. With the full cooperation of gov't (who sweeps up the campaign contribution money). If you want to see where the money goes, see who's buying TV ad time. As a long-time primary care doctor, I just shuffle papers for all them now.
Tricky question. Different question, though. That's more about price than it is about spending. Price can go up, and that can either mean MORE spending or LESS spending.
No, Medicare's price is what it is (and this year they charged me based on LAST year's income, before I retired). They *spent* on me substantially less than I actually cost, and the hospital didn't shut down, so I assume they cover the shortfall with those $50 Tylenol tablets.
Again, this post is about the TOTAL amount of spending, not the prices or quantities of particular medical goods and services. But since you ask about the latter, e.g. $50 Tylenol tablets, they are mostly accounting fictions. Some study years back showed that, effectively speaking, a hospital's expenditures are almost entirely fixed costs. How much the bill SAYS they charge for a bandage or a Tylenol is effectively ex post accounting sophistry. I used to explain it my students this way: Picture two pizza parlors, each of which will sell you a beer and pizza combo for $15. On one, the menu says that the beer is $3 and the pizza is $12. At the other, the menu says the pizza is $5 and the beer is $10. But at both, the only thing for sale is the $15 combo. It makes absolutely no difference what the menus say about the price of beer alone or pizza alone. Pizza isn't subsidizing beer, and beer isn't subsidizing pizza at either place. It's just just an accounting fiction. And Medicare's accounting methods have forced providers to engage in such accounting fictions. Except for those who don't take insurance--like the Surgery Center of Oklahoma. At SCO, you simply get a straight, all-in price for a knee replacement--no meaningless breakdowns.
Great insight and argument... I have had this very thing stumbling around in the more obscure recesses of my mind for some time, but have never been able to wrestle it into the open and into a coherent line of thought. So refreshing to have someone do that for me.
People really do pursue what they want, characterized by their means, and insistence upon liberty. Tell them what to buy, with what to cook, what to drive, where to live, (etc. and et al.) and increasingly bump a stump (often many different stumps), to the every lasting exasperation and frustration of the political elites who know what is best for us. Seems simple, to me. Unlike Russia, for example, we do not have a citizenry evolved over hundreds of years of centralized cultural, political and societal command and control – a DNA of equality of poverty and coherence of repression that even today leads many in Russia to look back on the Stalin years with wistful nostalgia. Although we do have a large segment of our population who might imply otherwise. I suppose every polity must include a high ratio of sheep.
Glad to help! Nostalgia for Stalin is hard to imagine, isn't it?
It is hard to imagine - but it is there... even among some of our own resident socialists much less former Soviet citizens
Yup
I'm late reading this post, but I can't resist making some comments. You make some good points,and perhaps our spending is not as out of control as those with an agenda would have us believe. On the other hand...
(1) Big numbers hide a lot of small sins. This argument doesn't address the very poor care and limited options for those who do not have employment-based commercial insurance or Medicare. Medicaid is crap, so between uninsured and Medicaid one would hope the nation with so much wealth could do better.
(2) Why should we be satisfied with the same crappy healthcare delivery systems as other developed nations? Why aim for European mediocrity? Why not, in traditional American fashion, make healthcare something that is simultaneously improving in quality, decreasing in cost, and increasing in availability? Why not unleash market forces on healthcare? As you correctly point out, the discussion around reform in this country concerns things that won't really move the needle. Rather than constantly chasing the unintended consequences of the last government intervention, let try the only thing that has ever created value -- a free market.