11/09/2009

11-09-09 - Health Care 2

Some data :

nice scatterplot that shows our outlier clearly

tons of nice charts here but you have to click on them to read them.

More data here ; in particular Exhibit 6 at the bottom is the key problem. Health care spending as a percentage of GDP is growing fast in Europe. (not as fast as the US, but still bad).

Another key point I think is that the US system is horribly broken at the low level. We often focus on the problem of who's paying (insurers vs. government) and who's covered (univeral, poor, etc). But even once people get into a hospital our system is fucked. Medicare + Medicaid (+ all government spending on health care) is 7% of GDP, which is close to what the Europeans spend on all their health care. Government spending is also growing as a percent of GDP (even normalized to remove the growth of the elderly population), so it's not like that is controlling costs. I think it's easy for politicians to villify the private insurers, but they are only a small part of the problem. We need to be looking at doctors who are making poor care decisions.

ADDENDUM : This Uwe Reinhardt guy is alright. He annoyingly uses the hack's method of presenting only little snippets of data that are carefully chosen to prove his point at the time, but it's still interesting.

Uwe E. Reinhardt - Economix Blog - NYTimes.com

Why Does U.S. Health Care Cost So Much (Part I) - Economix Blog - NYTimes.com
Why Does U.S. Health Care Cost So Much (Part II Indefensible Administrative Costs) - Economix Blog - NYTimes.com
Why Does U.S. Health Care Cost So Much (Part III An Aging Population Isn�t the Reason) - Economix Blog - NYTimes.com
Why Does U.S. Health Care Cost So Much (Part IV A Primer on Medicare) - Economix Blog - NYTimes.com
U.S. Health Care Costs, Part V Can Americans Afford Medicare - Economix Blog - NYTimes.com

Who Needs the Public Option - Economix Blog - NYTimes.com
Is Medicare Raising Prices for the Privately Insured - Economix Blog - NYTimes.com
Health Reform Without a Public Plan The German Model - Economix Blog - NYTimes.com
A �Common Sense� American Health Reform Plan - Economix Blog - NYTimes.com

18 comments:

Jon Olick said...

I wonder how much obesity contributes to these.

cbloom said...

CDC in 1998 estimated $47 B :

http://www.cdc.gov/obesity/causes/economics.html

projected to the present that estimates to $147 B :

http://www.medicalnewstoday.com/articles/158948.php

cbloom said...

Also interesting :

http://papers.nber.org/papers/w15485

declining minimum wage = increasing obesity

LDO

(BTW I think these silly economics papers are more amusing parlor conversation fodder than actually informative or useful)

Jon Olick said...

so basically somewhere between 10 and 20 percent of health-care costs are related to obesity currently. Which brings us from $6700 from that first link to 5500 to 6100. We are still above the line there, but not nearly as much. I wouldn't be surprised if our diet accounts a lot too. Artificial sugars, fatty foods, etc...

Aaron said...

[Which brings us from $6700 from that first link to 5500 to 6100.] Yeah, but you also gotta subtract out the % that obesity accounts for in the countries you're comparing against.

Aaron said...

GDP per capita figures are very tricky to interpret. Wealth in america is so skewed toward the rich. It would be more accurate to skim off the wealthy from the equation, then re-compare. I bet our outlier comes out way farther out. Also, I wonder if that $/person counts people who are not insured. That makes a huge difference, since those other countries are insuring everyone for that amount and we're missing like 20% of our population.

Aaron said...

Regarding economics papers: Yeah modern econ papers are a joke.

cbloom said...

Yeah our obesity is not that much worse than the UK for example.

Profit and overhead from the insurance companies is a much easier and more obvious subtraction. However there too you have to compare to places like Germany that have semi-private insurance companies and ask why it's so much worse here.

cbloom said...

[ GDP per capita figures are very tricky to interpret. Wealth in america is so skewed toward the rich. ]

Yeah, one thing I've been thinking about is that all this use of GDP numbers is fucking things up.

For example - health care costs as a percent of GDP looks bad, but if you did it as a percent of median income, it would look much much worse, because GDP has been growing fast but median income is totally stagnant.

That Uwe doofus makes some claims that "the growth of health care costs is not such a big deal because GDP will continue to grow too". But that fails to account for the distribution of GDP. In fact, health care & rent will soon put the majority of americans into abject poverty.

[ Also, I wonder if that $/person counts people who are not insured. That makes a huge difference, since those other countries are insuring everyone for that amount and we're missing like 20% of our population. ]

They always count total health care $ spending per person. People who aren't insured still get health care in various ways.

Aaron said...

That Ewe Reinhardt economix blog has tons of interesting stuff on it. It might be a little heavy on the economist viewpoint, but economists aren't too bad when kept in the proper context.

Aaron said...

[Profit and overhead from the insurance companies is a much easier and more obvious subtraction. However there too you have to compare to places like Germany that have semi-private insurance companies and ask why it's so much worse here.]

What the what... From another one of those economix posts: "In effect, the organization tells us here that unless its member companies are allowed to burn 35 to 45 percent of premiums on marketing, broker commissions, administration, other expenses, and profits, they cannot thrive in the non-group market for health insurance." Sweet mamma-jamma that's a lot of green.

Jon Olick said...

[Yeah, but you also gotta subtract out the % that obesity accounts for in the countries you're comparing against.]
I was under the impression that obesity was primarily an american problem. Another example where conventional wisdom fails me.

cbloom said...

"Regarding economics papers: Yeah modern econ papers are a joke."

that's a decent article, but I don't think he goes nearly far enough. The Levitt style economics is not merely fluff subject matters, it's completely lacking any substance other than its own cleverness. They're so sloppy about controls and cause-effect that all conclusions they draw are highly questionable. And because the topic is such fluff nobody bothers to do serious followup analysis. It's just generally harmful to discourse.

Absalon said...

When comparing Canadian and American per capita spending you have to remember that those are averages. For that cost every Canadian has a reasonable standard of health care but in the US there are people who have no health care. The overspending in the US is worse than the article suggests.

cbloom said...

BTW sort of off topic, but I've known a lot of broke people in the US who had no health care and I wonder why. Are they just lazy or stupid, or is it really that hard to get Medicaid? I know in WA the situation is pretty dire because WA hates humanity, but in CA I know Medical was pretty good and seemed easy to sign up for.

... hmm nevermind, I found it. The income cutoffs are just absurdly low. It's around $800/month , so if you are working at all you don't qualify. That's retarded.

There are a lot of ways that US law makes it better to be completely broke than to try to get by on a low wage.

Aaron said...

In related news (ok not but I just have to link this), dick pills are up in price by 2x in 10 years. I don't actually agree that dick pills should be provided by the government. I just don't think it should be buying them. We should be jacking them from these ludicrous drug companies for a nice solid discount.

cbloom said...

I suspect that part of the US health care cost problem is people getting coverage for things they wouldn't get covered for in other countries (such as ADD , social anxiety, ED, etc.) (I dunno how common it is for this stuff to be covered, but to my knowledge no other culture has so many nonchalant pill-poppers for essentially non-medical malaise).

Certainly a big part is that we don't have good price controls on drugs because the fucking retarded voters believe the saintly capitalistic pharma companies have a right to charge as much as they please.

And another big part are the scumbag corrupt lazy doctors who take kickbacks from pharma companies in order to prescribe the latest most expensive drug when cheap older generics are just as good.

Sly said...

[I suspect that part of the US health care cost problem is people getting coverage for things they wouldn't get covered for in other countries (such as ADD , social anxiety, ED, etc.)]

French are the champions in the western world in antidepressant consumption :D

old rants