tag:blogger.com,1999:blog-3152270.post108983367218372732..comments2024-03-17T10:40:52.762-05:00Comments on The Buck Stops Here: Health Care CostsStuart Buckhttp://www.blogger.com/profile/05731724396708879386noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-3152270.post-1120453646185916762005-07-04T00:07:00.000-05:002005-07-04T00:07:00.000-05:00Health care costs in the U.S will never go down. T...Health care costs in the U.S will never go down. The incentives are all in the wrong direction. There are no standards.Cost per incremental improvement in quality of life per diagnosis. Hence MRIs and surg-centres and CT scans are sprouting on every street corner. I know. I am a retired MD.The answer is simple. Have every physician's "test ordering profile" and "cost index per diagnosis per patient" become publicly available on-line; as well as the compensation packages of all health-care company executives and promotional incentives offered by the biotech and pharmaceutical industries.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090333141252545622004-07-20T09:19:00.000-05:002004-07-20T09:19:00.000-05:00Shouldn't the costs of litigation factor in here t...Shouldn't the costs of litigation factor in here too? The malpractice insurance rates for all parties involved in health care are a bit higher in the US than most (or all) other countries.<br /><br />Dan SAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090289217484036452004-07-19T21:06:00.000-05:002004-07-19T21:06:00.000-05:00If the government gave everyone a free Hyundai, yo...If the government gave everyone a free Hyundai, you'd see the country's per capita expenditure on automobiles decline, as people who prefer, say, Audis to Hyundais when paying full cost, come to prefer free Hyundais to $30k Audis. <br /><br />That's what the countries clustered around 80% public health expenditures do - they offer free low-quality health care and make people pay full freight to go outside the socialized health system.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090075135774783202004-07-17T09:38:00.000-05:002004-07-17T09:38:00.000-05:00Stuart,
I think the team doing the best work on th...Stuart,<br />I think the team doing the best work on this issue is Uwe Reinhardt (Woodrow Wilson School) and Jerry Anderson and Peter Hussey (Johns Hopkins School of Public Health). They constantly reanalyze the latest OECD health spending data and publish on this issue all the time in Health Affairs -- most recently, "U.S. Health Care Spending in An International Context." Briefly, that article discusses the following reasons for higher U.S. health care costs:<br />1--GDP per capita -- greater ability to pay;<br />2--Much higher professional labor costs;<br />3--Much lower buying power due to the fragmented multi-payer structure of the U.S. health care system;<br />4--Lower supply of health professionals;<br />5--Somewhat lower supply of hospital beds and healthcare technology (surprising to me, but it's true when compared to, e.g., Japan);<br />6--Complexity of financing structure leading to high administrative costs;<br />7--Unwillingness to ration health care.<br /><br />On that last point, and in reference to a comment above, it's been a while since I looked at it, but I think Daniel Callahan's discussion of his term the "ragged edge of life" in his book "What Kind of Life" provides an elegant way to think about health care "needs" and rationing.<br /><br />Note also Peter H. and Jerry A. of the Johns Hopkins group have recently been publishing a lot on cross-country health care quality comparisons. Very interesting stuff, I think.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090026212586080932004-07-16T20:03:00.000-05:002004-07-16T20:03:00.000-05:001) Do "U.S. health care expenditures" include plas...1) Do "U.S. health care expenditures" include plastic surgery, fat farms, drug rehab, etc.? 2) Remember that when foreigners come to the U.S. for health care, that gets counted as a U.S. health care expenditures.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090013804551639692004-07-16T16:36:00.000-05:002004-07-16T16:36:00.000-05:00Some economist found that when public education wa...Some economist found that when public education was established in Britain and the U.S., total investment in education decreased. The model they used to explain this is that under private funding, people willingly paid for an equilibrium quality q, but when a free alternative sprang up of lower quality q* (say, q/2), they switched to that. And once you're in public education, you can't improve quality by spending an additional marginal dollar.<br /><br />Something like that is probably happening in health care. The resources that foreign governments put into health care compete with higher-quality forms of care, while in the US the govt's money supplements private high-quality care. So in the US govt funding increases the equilibrium quality of care consumed, while in socialized health-care countries it generally decreases it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090011305649666512004-07-16T15:55:00.000-05:002004-07-16T15:55:00.000-05:00You left out a huge reason-healthcare costs spent ...You left out a huge reason-healthcare costs spent in this last year of life. I remember some study somewhere that a huge percentage of healthcare costs are spent on people in their last year of life. A simple change in philosophy ("well, that third round of chemo will probably do more harm than good") would save a lot of money. The downside is a person might not squeeze out a few more months in agony.<br /><br />This would be a big change. A good friend of mine bragged about how his dad was a fighter and gave it is all- I nodded my head and wondered if I would just try to spend some quality time with my family versus medical specialists. Obviously my friend would not. A more cynical view is that doctors do the math and know that "doing their all" provides them with the Aspen lodge and the beachouse.<br /><br />When those socialist countries put people on waiting lists, I think they know damn well that a lot of people won't be around when their turn comes. That keeps the costs down.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090008063062699632004-07-16T15:01:00.000-05:002004-07-16T15:01:00.000-05:00Who knows, maybe there's some "risk homoestatis" g...Who knows, maybe there's some "risk homoestatis" going on. In a country where people think, "If something happens, the doctors will fix it," they may be more likely to ignore that advice to eat healthier and get more exercise. "I'll get a blood pressure drug and a cholesterol drug and ...."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-3152270.post-1090002372573393812004-07-16T13:26:00.000-05:002004-07-16T13:26:00.000-05:00Back on 9/30/03, a blogger posted 2 links, one to ...Back on 9/30/03, a blogger posted 2 links, one to al Guardian comparing 4 diseases and survival rates between Britain and US.<br /><br />The other link was a study, IIRC, of certain cancer survival rates between US and Western European countries broken down by country and male/female.<br /><br />Guess who had the best survival rates????<br /><br />Of course, it could be 9/30/02.<br /><br />I'm sorry I didn't save either, but for some reason, I remember that date. Maybe they want to do some research?<br /><br />Sandy P.Anonymousnoreply@blogger.com