I think scaling the average costs from other countries accounting for GDP would be a good way to set the rates.
In all OECD countries, unfortunately, healthcare spending doesn't seem to be especially correlated with increased lifespace.
Median actually does a better job of including the poor than does mean. The reason is that median counts the number of affected people, whereas mean counts the amount of spending. Clearly the latter skews more towards the rich, for whom spending may approach infinity.
Because healthcare is an ever expanding, ever innovating industry with infinite scope. For countries with universal healthcare this is painfully obvious. What once was a service in the 1950s to perform what now would be considered very rudimentary procedures and proscribe < 1% of contemporary drugs, now do space age procedures as if routine and treatment plans that took decades of international cooperation to develop.
> In all OECD countries, unfortunately, healthcare spending doesn't seem to be especially correlated with increased lifespace.
Diseases of plenty now represent greater harm in most of the developed world than do ailments of scarcity.
Second, just where is this extra income supposed to come from? More likely households bear almost all of the incidence of this spending, meaning each dollar spent on health means approximately one dollar less available to households to use elsewhere. This is certainly what the literature on employer health insurance benefits tends to suggest.
Third, the timing of this is all wrong. It’s clear the arrow of causation goes overwhelmingly from income to health spending because changes in health spending clearly follow changes in income. Over the past few decades it takes an average of about 2-3 years for changes income to be fully reflected in changes in health spending due to the large role played by 3rd party payers, employers, etc (the current year elasticity is about 0.2 whereas the long-term elasticity is north of 1.6).
~RCA
Besides, you have to factor in living costs.
I've looked into living cost a few times when considering working in the Bay Area and I realized that while my income would easily double, my living costs would increase a more than just a factor of two. I would have to accept a lower standard of living than I enjoy now.
I think the only way to really deal with healthcare cost is to look at whether or not we think it is a good idea that there is a huge profit margin. For patient outcomes and for society as a whole.
Adjusted for GDP, US spending on inpatient procedures is somewhat inline. However, spending for outpatient procedures is way higher. Americans just have a lot more outpatient stuff done than other countries.[1]
[1] McKinsey analysis of US healthcare spending; search my history for actual link or google it!
Inventing a fancy index is not a replacement for "price fixing". And price fixing does not work. You reduce supply.
Am I going to get a quad bypass just because it is cheaper?
People seek care because they need it. The kind of care that people use more because it is cheaper/available is maintenance care (which reduces overall costs because things are often treated before they become critical).
The first time I heard “I am feeling sick / cut my hand / need stitches but I cannot afford to go to the doctor” was in the US, and it left me dumbfounded - I have lived in a few places, and that’s a US only thing.
Also, I could understand some of George Carlin’s jokes (e.g. “dirty doctor” one) until I had lived in the US.
E.g., in the netherlands (and IIRC also in Germany), it is considered rude to come to work when you are sick - you expose everyone else to risk, for a work day that's likely less-than-effective (because, you are sick) -- whereas in the US, you're expected to just pop an advil and show up (and .. if you are visibly suffering, you'd be considered a hero).
IIRC, it made zero measurable difference on the number of visits, but the bureaucracy involved with charging this was costing more than than the money collected, so it was eventually scrapped.
(I might be mistaken, an Israeli versed in how the system works / worked is welcome to correct me)
In argentina I remember calling a doctor home to check up on a cold. This would be unreasonably expensive in the US for very little healthservice in exchange.
In fact, the US could improve a lot of basic services if it looked at what other developed countries (OECD) are delivering, and for how much, and made those targets for the next lets say ~10 years.
After those 10 years of bringing the US more into line with the best countries in the world, it should strive to do even better.
Or, alternatively, the US can keep falling further behind.
I can tell from first hand experience. Healthcare companies, set prices by market. Specifically, by what price that market will sustain. It just so happens that the US can sustain the highest prices. You know being unregulated and rich af and all.
This is how all industries/companies set prices btw. What you’re saying, It’s kind of like saying, I want New York City to base real estate prices off median home prices in the Midwest because as a buyer I like those prices better.
It amazes me how the US is still arguing how archaic districting laws should work, how to have elections with integrity or manage without paper checks or fax machines.
I realize there are politicsl/historical and cultural differences but there is a combination of exceptionalism (“the US is so special we can’t just look at France and imitate”) and resignation (“yeah we want that but we cant have that because it would never work because X”) surrounding each of these discussions. The US is pushing boundaries in so many areas but when it comes to evolving society in a way that requires broad agreements, there isn’t much to report on
In fact, it sounds like a great way to make things worse!
If you refer to the professionals’ compensations that’s correct, but not that useful as it applies to all of the adult working population.
If you’re referring to the capital accumulation of investments in healthcare companies, you’re off the mark, as there are several examples that falsify your statement, even in the US
This is manifestly untrue in so many domains, including medicine. Most research is heavily government funded, particularly pure research, and most academics are not interested in profit. The only orgs motivated by profit (drug companies, insurance companies) are the ones who push this misconception, because they profit from it. As one example, the UK runs large trials comstantly to improve care, without a profit motive.
Nobody has to postulate that price fixing (as you call it), or single payer healthcare without insurers works better, because the rest of the developed world outside the US uses that system and delivers very similar outcomes for radically lower cost. The facts are clear.
It’s no different in Canada - small towns don’t offer as good of care particularly when it’s something that’s not common.
Anyway, I found a reference to support your claim:
Also consistent with the conclusions of Torrey1 and Saha et al,2 our analyses shown in table 3 found a strong tendency for prevalence to increase with latitude.[1]
Vitamin D deficiency from what I've read is common everywhere. It does make sense that longer winters would impact a person such as staying inside more. Yet I doubt any evidence can confirm lack of Vitamin D is associated with the illness schizophrenia.
And there's probably at least quite a few things that aren't mental illness that benefit from mental healthcare.
If the quality of care is so amazing I'd expect Americans to have longer life expectancy, and they don't.
https://www.vox.com/science-and-health/2018/1/9/16860994/lif...
In some cases, maybe the US has better care. But the cost of that is just way too damn high.
Yes, medical research in the US is superior, but that shouldn’t be at the cost of peoples’ lives.
Reducing investment in medical research will absolutely come at the cost of people’s lives. More people’s infact, as anybody will die from a terminal illness that doesn’t have a treatment. As an example the US market constitutes something life 70% of _global_ pharmaceutical profits.
In the private sector, far larger amounts of funding are spent on marketing than research[1]. The basic maths shows: investment in research can be maintained or even increased while providing greater access to the fruits of that research.
The money is there. What we lack is the proper incentivisation.
1. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...
But as we see above, plenty are willing to carry the water of the poor, downtrodden drug companies.
The incremental cost of selling drugs you’ve already developed is quite low, so of course they can still profit from them in less profitable markets. But it’s the US that’s paying for them to be developed. This isn’t even up for debate, R&D in the US dwarfs everywhere else.
So they focus on illnesses of the rich gerontocracy while diseases of the developing world have to be addressed by public funding. Additionally, there's no real incentive to work on cost reduction.
The US was rather a shock for me. Costs were mind-boggling, and most physicians struck me as jerks. At least, the male ones did, and they predominated. Nurses, on the other hand, generally seemed OK.
Somehow the US healthcare system seems to attract jerks for physicians, and they seem to be mostly in it for the money. Not all of them, obviously. But enough to set the standard.
I have no clue how that happened. Or how to reverse it.
Edit: Some might ask why being "in it for the money" is bad. I mean, that's what "free enterprise" is about, isn't it? But think about it. Is it OK for priests/minster/rabbis to be "in it for the money"? Or politicians? I hope not. And then, why physicians?
One of the problems with care in the US are clinics that treat Drs (and NPs and PAs) essentially as billing machines, and don't allow them any time to build any rapport or relationship with patients. Depending on your insurance coverage, your location, and your needs, your experience will vary wildly.
For what it's worth, my experience teaching premeds was also not so great :) That's also anecdotal. But colleagues had similar complaints.
Also:
> And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. ... A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others.
> The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. When you compare the percentage of physicians who are generalists with those who are specialists, the United States beats only Greece among developed economies.
> Here, financial drivers play a role. Doctors who choose to specialize can make much more money, millions more dollars over a career, than primary care physicians.
https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-...
Also see https://www.politico.com/agenda/story/2017/10/25/doctors-sal...
The evidence is constantly against US healthcare except for experimental or rare treatments. The doctors aren't any worse, surely.
I 100% agree: experience is key ... but so is a clinic's/hospital's internal investment in any given speciality. And if it's a teaching/research hospital, so then is publishing by its clinical experts.