Interesting NatGeo Graphic

[Jacob]

Maybe this discussion has moved beyond the initial topic, but I agree that this chart gives us no insight into whose health care or health care spending is better, and whose is adequate.

As has been mentioned, if you look at life expectancy for those who reach 40, we are just as good as any other country. Someone mentioned homicide. I'd amend that to say that it is because of driving and guns.

As a great writer, IMO, said last summer:

Why's that? Well, first, the "health care" debate is not primarily about health, which chugs along regardless of how the debate goes: Life expectancy in the European Union, 78.7 years; life expectancy in the United States, 78.06 years; life expectancy in Albania, 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia and Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral — margin-of-error territory. Maybe we could get another six months by adopting EU-style socialized health care. Or we could get another six weeks by reducing the Lower 48 to rubble in an orgy of bloodletting, which seems to have done wonders for Bosnian longevity. Or we could lop a year off geriatric institutionalization costs by installing some kook in a pillbox hat as Islamic dictator and surrounding him with a palace guard of Austin Powers fembots. It's as likely to work as anything Congress will pass.

You will also find, as someone has noted in this thread, that when we compare our country to the best EU countries controlling for ethnicity, we are not at all behind them.

None of this is to say, as Robin so diligently tries to accuse conservatives, that the status quo in the US is hunky-dory. Quite the contrary, we spend a ridiculous amount. The problem with current proposed legislation is that it makes no serious attempt to control costs. Instituting government subsidies to cover an additional 40 million hardly seems like the place to start controlling costs. Yet it is the costs that most people are concerned about. Hence, public disapproval of the current proposal in congress.

[SloanHater]

The German system has worked well for 40 years. But it's currently collapsing under it's largess and the Germans demographic problem. It's basically free for those with low income, but it's also hugely progressive and funded by very high taxes (quaintly called "insurance premiums") on the middle class (for me to insure my family of four over there - $1600 Euros a month). Their system keeps it self afloat by paying doctor's NOTHING. They educate them, train them, and then lose them to the US, and have to import semi-skilled medical professionals from Eastern Europe and the third world.

The German system is no longer really a great example of what we want to emulate...

Collapsing? The German healthcare situation is no where near as dire as it is in the US. The point you readily glaze over is the fact that ALL Germans have had access to good healthcare for over 40 years and that they only spend around 10% GDP doing so. (Almost half what the US spends.)

As for your statement that German doctors are paid 'Nothing,' relative to doctors in the US, you're right. Their mean salary is around $125,00 compared to $225,000 in the US.

Which begs the question, why are Americans paying twice the cost for essentially the same medical care?

(Please don't include or cite specialist in your reply. We're talking primary care v. primary care.)

[Jarid in Cedar]

Collapsing? The German healthcare situation is no where near as dire as it is in the US. The point you readily glaze over is the fact that ALL Germans have had access to good healthcare for over 40 years and that they only spend around 10% GDP doing so. (Almost half what the US spends.)

As for your statement that German doctors are paid 'Nothing,' relative to doctors in the US, you're right. Their mean salary is around $125,00 compared to $225,000 in the US.

Which begs the question, why are Americans paying twice the cost for essentially the same medical care?

(Please don't include or cite specialist in your reply. We're talking primary care v. primary care.)

I don't know too many primary care docs that make $225,000, especially in our area. Probably closer to 150-175.

[Slim]

As for your statement that German doctors are paid 'Nothing,' relative to doctors in the US, you're right. Their mean salary is around $125,00 compared to $225,000 in the US.

Which begs the question, why are Americans paying twice the cost for essentially the same medical care?

(Please don't include or cite specialist in your reply. We're talking primary care v. primary care.)

Dude. This can't be right. Thousands and thousands of medical students are busting their asses studying for boards right now because they don't want to be "stuck" making less than 150k a year as a primary care doc after enduring 12+ years of post high school training and a mortgage worth of student loan debt.

[statman]

Collapsing? The German healthcare situation is no where near as dire as it is in the US. The point you readily glaze over is the fact that ALL Germans have had access to good healthcare for over 40 years and that they only spend around 10% GDP doing so. (Almost half what the US spends.)

As for your statement that German doctors are paid 'Nothing,' relative to doctors in the US, you're right. Their mean salary is around $125,00 compared to $225,000 in the US.

Which begs the question, why are Americans paying twice the cost for essentially the same medical care?

(Please don't include or cite specialist in your reply. We're talking primary care v. primary care.)

Take a gander at this:

http://www.spiegel.de/international/0,1518,grossbild-575805-399537,00.html

[ERCougar]

Collapsing? The German healthcare situation is no where near as dire as it is in the US. The point you readily glaze over is the fact that ALL Germans have had access to good healthcare for over 40 years and that they only spend around 10% GDP doing so. (Almost half what the US spends.)

As for your statement that German doctors are paid 'Nothing,' relative to doctors in the US, you're right. Their mean salary is around $125,00 compared to $225,000 in the US.

Which begs the question, why are Americans paying twice the cost for essentially the same medical care?

(Please don't include or cite specialist in your reply. We're talking primary care v. primary care.)

You complimented my post, which I appreciate, but I fear you missed the main point. European health care is a very different animal than American healthcare, and it's not at all a given that it's superior--see my list of procedures as examples of significant differences. Personally, I'd prefer the access of a European-style system to what we have, but apparently, the majority of Americans disagree with me. They really aren't at all "essentially the same medical care". In fact, if you were to replace any well-insured American's program with a European-style coverage, they'd complain to no end. See 1990's and the HMO experiment.

In the end, if we hope to give everyone basic healthcare access, we have to adjust everyone's expectations about what that means or it will be extraordinarily expensive. Educated liberals know that but aren't telling anyone. Educated conservatives know that as well, but don't consider basic healthcare access for all a priority.

[RobinFinderson]

You complimented my post, which I appreciate, but I fear you missed the main point. European health care is a very different animal than American healthcare, and it's not at all a given that it's superior--see my list of procedures as examples of significant differences. Personally, I'd prefer the access of a European-style system to what we have, but apparently, the majority of Americans disagree with me. They really aren't at all "essentially the same medical care". In fact, if you were to replace any well-insured American's program with a European-style coverage, they'd complain to no end. See 1990's and the HMO experiment.

In the end, if we hope to give everyone basic healthcare access, we have to adjust everyone's expectations about what that means or it will be extraordinarily expensive. Educated liberals know that but aren't telling anyone. Educated conservatives know that as well, but don't consider basic healthcare access for all a priority.

It will be expensive, but no one knows how expensive it will be. On the one hand, a single-payer system would have to come with things like tort reform (otherwise the government would be liable for doctor screwups) and cost controls, so it would be less. Also, universal coverage would cut out insurance overhead and all of the costs associated with inefficiencies resulting from the current system. Also, it would presumably make a fitter population, focusing on prevention and health, so we would see national improvement to worker productivity and reductions in illness due to poor diet (heck, with everyone fitting the bill, we may even find the political willpower to make damaging foods more expensive, as was done with cigarettes. That bugs my inner libertarian, but it might happen, and it might have a decent result, just like it did with tobacco).

I agree that it will probably take longer to get some procedures that are not immediately necessary to preserve one's life. There will be some waiting, which might not be such a bad thing. I'm sure the millions without insurance will be happy to wait to be seen, and for the folks that aren't used to waiting, it will be good for them.

[statman]

You complimented my post, which I appreciate, but I fear you missed the main point. European health care is a very different animal than American healthcare, and it's not at all a given that it's superior--see my list of procedures as examples of significant differences. Personally, I'd prefer the access of a European-style system to what we have, but apparently, the majority of Americans disagree with me. They really aren't at all "essentially the same medical care". In fact, if you were to replace any well-insured American's program with a European-style coverage, they'd complain to no end. See 1990's and the HMO experiment.

In the end, if we hope to give everyone basic healthcare access, we have to adjust everyone's expectations about what that means or it will be extraordinarily expensive. Educated liberals know that but aren't telling anyone. Educated conservatives know that as well, but don't consider basic healthcare access for all a priority.

What I wish is that the conversation about health care was honest. Quite simply, it's not. Obama keeps saying His was will be cheaper - which is a load of horseshit. He knows it. The media who keep parroting it know it. Everyone knows it. Why not just tell the truth?

When the Europeans installed their system, they were open about it. They knew it was going to cost money to insure everyone. They knew there were more efficient & costly ways to do it. But they, as a group, decided that insuring everyone was the RIGHT thing to do. And maybe it is.

But we've never actually had that discussion. We just have Obama telling us that His plan will be cheaper, that we won't have to wait in lines, that no one will ever be denied treatment for anything, ever, that flowers shoot out of his ass when he farts...

[cowboy]

This chart assumes that health care spending for an entire country is directly correlated to health care quality, and hence should be highly correlated to that country’s average life expectancy. Three decades ago this may have been the case, but now health care has moved beyond living, and is focuses as much on quality of life as life itself. Further, enormously expensive procedures that increase the life expectancy for a very small percentage of people will have little effect on overall life expectancy simply because of the proportion affected.

The Department of Health publishes a Medical Expenditures Panel Survey every year, and 2007 is the most recent. According to the panel, 2007 US health expenditures excluding Rx were $1.98 trillion, or $6,584 per person. The following chart breaks these charges down by quintiles:

While only 20% of the population incurred more than $4,188 in health care expenses, that same group accounted for 90.2% of all health care charges, and their average annual expenditures were $27,865 per person. The distribution of that group is skewed, however, as is shown with a comparison of the mean and median below:

I know this will make you statistics guys crazy, and I know this isn’t exactly the way to explain these statistics, but it’s an easy way to make a point. Let’s assume that 95% of the observations in this top quintile were between $11, 632 and $12,735. Now, we can assume that these observations accounted for no more than ($12,735 x 62,614,674 people x 95%) or $817 billion. We can then assume that no more than 5% of that group (1% of the total population) incurred total expenses of no less than $972 billion ($1.789 trillion - $817 billion.)

In other words, no more than 1% of the total population accounted for at least 49% of all health care expenditures in 2007. This is such a small percentage of the population that any longevity resulting from these expenses will have a very small effect on the life expectancy of the population as a whole.

What do they spend it on? Obviously, the list includes the big ticket items like transplants, joint replacements, cancer therapy, and other major surgeries. Long-term care can account for some of it, as convalescence costs at least $50,000 per year in most places. Do these items extend life? Some of them do. Do they improve life quality? Absolutely.

Now the question is whether the benefit of the big ticket items is worth the cost. That is a debate that is worth having. On one hand it seems a huge burden to double health care costs and hence insurance premiums for all Americans just to benefit such a small percentage of the population, especially since a good amount of these expenses go toward procedures that improve life quality but don’t necessarily lengthen life. On the other hand, if you are the parents of 15-year-old boy with a new heart, or you are the one who no longer has gall bladder attacks, your perspective may be different. One thing is for sure, the current proposal in Congress does very little to change this situation.