Look how much more the US spends on Health Care than anyplace else

I really love this graphic, from National Geographic. The left side of the chart is how much each country spends on health care; the right side shows the average life expectancy in each country. The thickness of the lines indicates how many doctor visits per year the average citizen gets.

We’re just not getting good value for our money. We’re spending more than anyone, by a huge margin, but getting slightly below average results and relatively little access to doctors.

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57 Responses to Look how much more the US spends on Health Care than anyplace else

  1. 1
    Anne says:

    This is an eye-catching graphic, but not necessarily the best way to show the facts. An excellent statistics blog discussed this and produced more informative graphics showing the same information: it is clear from these that there’s a pretty clear correlation between health-care spending and life expectancy for all countries except the US.

    I wonder, though, whether the problem is that the US is really two nations: the wealthy, who spend a lot(*) on health care and live a long time, and the poor, who don’t spend much and die young. Aggregating those two populations could well put the US in a weird place on the graph.

    (*) I don’t mean that individual wealthy people spend a lot of money directly on health care; I just mean that a great deal of money is spent on their health care. A different question is whether the amount of money that the wealthy feed into the health care system is more than is spent on their health care (so they are funding health care for the poor) or less (so that the poor are actually funding health care for the wealthy).

  2. 2
    djw says:

    I showed this to my students today, after spending about five minutes clumsily trying to explain this on Monday (and faring poorly). This deserves some sort of award for effective visual communication.

    As an aside, I’m kind of floored by the countries where the median doctor visits are 12+ or even 8+. Obviously, the optimal number is somewhere north of what we’ve got here, but that seems like it’s got to be well beyond the point of diminishing returns.

  3. 3
    chingona says:

    I wonder, though, whether the problem is that the US is really two nations: the wealthy, who spend a lot(*) on health care and live a long time, and the poor, who don’t spend much and die young. Aggregating those two populations could well put the US in a weird place on the graph.

    My impression is that it’s significantly more complicated than that. There was that New Yorker article that made the rounds earlier this year that looked at McAllen, Tex., which spends more per person on health care than any other part of the country. It’s not a particularly well-off community, and some communities that are well off spend a lot less per person. The reporter could not come up with any explanation that made sense other than profit motive, though of course every doctor denied it. Also worth noting is that they did not get particularly better health results for their money, either.

    It seems there are a lot more companies and individuals in this country invested in making money – and a lot of it – from health care than in other countries. I also think there’s cultural factors. Americans are very invested in the idea that you can control your life, which probably leads to more tests, etc., and American doctors are very invested in the idea that they can control outcomes and order a lot of tests, procedures, etc. And then they bill for each of those. When you have culture and profit reinforcing each other, that’s a pretty powerful driver.

  4. 4
    chingona says:

    Oh, and I agree the thing with the number of doctor visits is weird.

    I wonder if it’s all medical visits and includes people with chronic conditions being monitored by nurses, where here people with chronic conditions might get a lot less treatment/monitoring until things get really bad, then they need expensive surgeries, medicines, etc.

  5. 5
    Robert says:

    So, what we need to ask is, how can we be more like Mexico?

  6. 6
    Robert says:

    Also, I am not sure that life expectancy at birth is all that useful a metric. Does Japan have a great LEAB because of their ethnic heritage and uniformity, their awesome doctors, their diet, their unique local geography and risk profile, their absence of wars since 1946, the healthy sea air, or what? We don’t know.

    “Percentage of life expectancy increase since year [x] that can be attributed to health care spending” might be more useful, but also a cast-iron bitch to figure out.

    This chart seems like a conflation of some questionably-related numbers that make the US look bad, but without any context or data or obvious causality. How come Mexico gets the same outcome as the former Czechoslovakia for half as much money?

  7. 7
    chingona says:

    That would be a more relevant objection (and it’s probably valid up to a point) if the graph were being used to argue that we need to spend MORE money on health care. As an indication that we’re not getting very much return on our investment and something is deeply messed up in our system, I’m not sure how pointing to the healthy diet of the Japanese takes away from that point.

  8. 8
    Robert says:

    And another thing. That super-high per-capita figure represents about what, 15% of GDP. That’s not peanuts – but it’s not hysterically out of line with other countries. Canada spends 10% of GDP. We are also a lot RICHER than Canada, so our GDP % counts for more than theirs in terms of raw cash.

    I wonder what your graph would look like rescaled to show GDP% on the lefthand side.

    More philosophically – consider the extent to which all that extra spending is a good thing, rather than something to bemoan. This is a rich country. We spend a beacoup amount of money on healthcare for ourselves. Now, from the outcome side of the graph, you can make a fair point that we’re not seeming to get a whole lot for that money.

    Yet, when you ask people about their care, they generally like it. If they can’t get it, or there’s red tape, they hate that, but the part where the doctor uses the Star Trek laser to recarve their organs and magically make tumors go away, that part is pretty awesome. We have a lot of problems in our system, but when people can get the care and it’s the right care, they tend to be happy with it.

    I wonder what the right hand side of the graph would look like if it was scaled by % of people who were happy with the health care they were currently or most recently receiving.

    I really wonder what that combined graph would look like.

  9. 9
    jdalton says:

    I dispute the idea that the US is “a whole lot richer” than Canada. Surely the US is not 50% richer than Canada, as a difference of 10% GDP to 15% GDP would suggest. I’d also like to point out that all of this can be done on budget- before the recession hit, Canada had more than ten consecutive years of not just balanced federal budgets, but budget surpluses. Under three different prime ministers from two different parties.

    The best argument for public heathcare, in the end, is not moral but practical. Public healthcare saves money and cuts wasteful spending.

  10. 10
    Ampersand says:

    I wonder what the right hand side of the graph would look like if it was scaled by % of people who were happy with the health care they were currently or most recently receiving.

    That would be a biased comparison, since it would exclude people who were unhappy because they can’t afford health care — which, of the many bad things in the US system, is the worse.

    Anyhow, I don’t have the time or the graphing chops to recreate this charge plotted by happiness. But I can at least provide the data.

    (Click on it to see it bigger).

    So by and large, people are similarly satisfied with the medical care they get across the countries, although people in the Netherlands are the happiest with their health care. Americans pay more overall, pay more out of pocket, wait longer, and are more likely to put off or skip needed care because they can’t afford it.

    And for this we’re paying 2 or three times as much, per person? For that, I’d want Americans to be clearly, vastly, overwhelmingly happier with their care. And that ain’t what’s happening.

    I found that chart in a data-rich blog post written by an American surgical resident, who writes:

    So, after seeing some data on more than the few horror stories from health systems around the world, are you convinced that universal systems will mean longer wait times? Poorer care? More expensive care? I believe the data suggests more people around the world in these systems experience less of these problems than those of us in the US. We spend more, almost twice as much as any other country. Despite that, our wait times for physicians are worse, we pay far more out of pocket for prescriptions and copays than any other system, we spend more on administration of health care than any other country, we have more people who avoid seeing the doctor for fear of costs, and we are more likely to say we want our system scrapped. In an update to this analysis the Commonwealth fund found that in deaths which were amenable to health care interventions the US performed worse than the other 18 industrialized countries to which it was compared. If we performed as well as one of the top three countries, we would eliminate about 100,000 excess deaths a year.

    So even limiting the comparison to areas where health care interventions matter, the US is doing worse. And we’re paying a lot more for doing worse.

    And another thing. That super-high per-capita figure represents about what, 15% of GDP. That’s not peanuts – but it’s not hysterically out of line with other countries. Canada spends 10% of GDP.

    15% is hugely out of line with other countries; most countries are in the 7.5%-11% range. Put another way, even as a percentage of GDP, we’re spending 140-200% what other countries are spending.

    Not that GDP is the appropriate measure, by the way. Our GDP is high not only because we’re richer, but also because our population is unusually large. But an unusually large population just means we have more people’s health care to pay for. Health care per capita is a more appropriate figure for comparing bang for the buck per patient.

  11. 11
    russ says:

    Some additional factors for lower US life expectancy that are not directly related to health care costs (but are related to other dysfunctions in US society):

    1. High number of soldiers, currently fighting in several wars
    2. High number of automobiles (with large numbers of resulting accidents, injuries, and deaths) and often crappy or nonexistent public transport
    3. High rates of violent crime

  12. 12
    Robert says:

    JDalton, see http://www.nationmaster.com/graph/eco_gdp_per_cap_ppp_cur_int-per-capita-ppp-current-international

    US PPP GDP per capita is $41889; Canadian is $33375. We’re about 25% richer than them, per capita.

  13. 13
    Dianne says:

    US PPP GDP per capita is $41889; Canadian is $33375. We’re about 25% richer than them, per capita.

    Our Gini coefficient stinks, though, so less of the increased income in the US is available for the “average” person.

  14. 14
    Simple Truth says:

    As far as longevity goes, I just watched a TED talk that tied longevity mostly to your society – I think the figure was 90% society vs. 10% genetic. It’s a great talk if you want to watch it. Dan Buettner’s TED talk

  15. 15
    nobody.really says:

    THE MAIN EVENT: In this corner we have Amp, noting how terrible it is that US citizens should have to pay more than the citizens of developing nations for health care. In that corner we have Robert, arguing that there’s nothing wrong with relatively rich people paying more — not to get more, not because things cost more to provide — no, merely because we CAN pay more.

    Amp, Champion of Competitive Markets , vs. Robert, Champion of health care as Progressive Taxation — the fight of the century! The Flog in the Blog! Now, let’s have a clean fight, boys….

    Robert’s argument is not entirely specious. Arguably the US pays more than it’s fair share for all kinds of healthcare-related research and development — especially pharmaceutical R&D — and the benefits flow to the citizens of the world who are, on average, poorer than US citizens. Yes, this is rough justice for the relatively poor citizens of the US, and a windfall to relatively rich citizens of other nations. If the US starts bargaining harder with pharmaceutical companies over drug prices — or, worse still, opens its borders to re-import drugs from abroad — I would expect pharmaceutical companies to begin driving harder bargains regarding sales beyond US borders.

    In other words, part of the disparity depicted in the chart may reflect the idea that the US bears a disproportionate share of R&D costs, and our loss is their gain. If health care reform alters this dynamic, US health consumers will gain, but the gain will not come solely out of the pockets of insurers and providers.

  16. 16
    Dianne says:

    Arguably the US pays more than it’s fair share for all kinds of healthcare-related research and development — especially pharmaceutical R&D — and the benefits flow to the citizens of the world who are, on average, poorer than US citizens.

    Actually, there’s as much pharma activity in Europe as in the US. The US’s main advantage in research is the NIH, a huge funding source not matched in other countries.

  17. 17
    Veritas says:

    As a US citizen who lived for 20 years in a continental European Country:

    Doctors are too revered in the US and earn too much (“too much” with regard to their real level of education; they aren’t Gods, they are people). And, because they are revered as Gods (and they do nothing to disparage that image), they are invariably sued – big time – when family members find out that they are not Gods. And believe me, they are not Gods. In any case, that drives up malpractice insurance, and that is passed along. The doctor has to have his big house and submissive wife, so anything that cuts into the lifestyle is going to be passed along. And it is.

    Secondly: You would be absolutely amazed at the six-figure people who are wandering around the health-care peripheries as “administrators”.

    Somehow, sadly, the trend in the United States was to pay through the nose for health care. You don’t have to, and the two areas I mentioned above are ripe for reductions.

    In short: Americans are too maudlin.

  18. 18
    Charles S says:

    Norway and Luxemburg both have higher per capita GDP than the US, and both of them have negative slopes on the graph (Norway would if it were shown, $4700 per capita expense with a life expectancy of 80.6), so Rich countries do seem to spend more for less marginal benefits, but both of these very rich countries spend much much less per capita than the US. Furthermore, Norway and Luxemburg are spending about the same fraction of GDP on health care as Canada is, not 50% more like the US.

    There is no excuse for a rich country spending a disproportionately high share of GDP on end of life care and getting mediocre life expectancy and access to care. We are clearly spending our health care money on the wrong things (and more importantly, failing to spend our health care money on the right things). We clearly need far more inexpensive but effective health care like the sort of care Mexico is able to provide (walk-in free primary care clinics in every neighborhood, home visits from nurse practitioners for people with chronic health problems, etc). Whether or not we want to stop wasting money on unnecessary CT scans at for-profit scanning centers owned by the doctor who recommended that we should get a CT scan and on pushing people into million dollar heroic end of life care that prolongs suffering in a hospital rather than providing them the option of well done home hospice care is a separate question.

  19. 19
    djw says:

    How come Mexico gets the same outcome as the former Czechoslovakia for half as much money?

    Actually, in comparative health care analysis Mexico is often lauded for the bang for their buck they get. This isn’t news.

    Robert makes a number of valid points about the limitations of this data, but it’s all at the margins. There’s no way to slice the data in which are status quo isn’t remarkably inefficient.

  20. 20
    jeff says:

    I’m sorry – I missed the class where we expressed efficiency in health care as spending the least amount of money for the longest life expectancy? Is that the metric we are striving to optimize (hint: no).

    I read this chart quite differently – we pay a ton of money to avoid the doctor (but once a year). When we do go, we pay our doctors quite handsomely, get a battery of very cool, and informative tests and treatments (that overall may do nothing to improve our life expectancy, but may considerably improve our quality of life — a bit too subjective to measure). And along the way, we have to put up of with some annoyance of bureaucracies (nothing compared to a socialized system) , but overall this expensive systems has a decent amount of flexibility that American will always pay more for

  21. 21
    jdalton says:

    @Robert- How does the average American being 25% richer than the average Canadian warrant a 50% increase in healthcare costs? That’s twice the increase it should be. I think you’ll find, as well, that the median American is not in fact better off than the median Canadian. The gap between rich and poor in the US is quite noticeable whenever I visit.

    @Jeff- Public and private institutions are both quite capable of becoming mired in bureaucracy. All I can tell you is, in Canada, I have never had to phone up a call centre to ask permission to get treated, nor has any doctor I’ve ever visited. These call centres do not exist. There is no branch of Canadian health care dedicated to spending money on advertising to promote itself in competition to some other option. I don’t know how much money is spend on branding or graphic design of healthcare documents or websites, but the end results suggest “not much.” There are no investors or shareholders expecting a cut of revenue, and no group or office dedicated to deciding how best to reject potential members. There is no medical exam required to become a member, nor questionnaire to fill out nor group of people whose job it is to create or process those questionnaires. (There IS a form to determine how much I can afford to pay- right now the answer is not much!)

    Once a month I write a cheque to the appropriate government body. I have a card in my wallet I’ve been carrying around since I was a teenager with my name on it. If I find myself at a hospital or clinic, I flash my card, they make a note in the computer that someone showed up (so the doctor can get paid), and then the doctor does whatever he or she thinks I need. Then I turn around and walk out. I fail to see where this terrifying socialist bureaucracy you speak of could even find a role to play.

  22. 22
    Charles S says:

    Actually, from the perspective of a patient or any non-medical professional, a single payer system is vastly less bureaucratic than our system of insurance. In a single payer system, you make an appointment with a doctor, go in and are seen by the doctor, tests are ordered and conducted, and you pay your taxes the same whether or not you see the doctor. You don’t receive complicated and confusing bills, you don’t receive complicated and confusing statements from both the doctor and the insurance company telling you how much the doctor claims they will charge you, how much the insurance company claims the doctor will charge you, and how much the insurance company plans to pay, all of which you should cross check to make sure that the insurance company hasn’t screwed up. In a single payer system, the government will never suddenly decide to force you to pay for treatment, simply because they make more money the longer they delay payment, and because not everyone realizes that the should contest the denial (something US health insurance companies frequently do when they deny claims). Your claim that it would be worse under a socialized system is an empty lie, backed by nothing but decades of anti-communist propaganda and years of insurance company paid scare-mongering.

    And from the perspective of the medical system, our insurance bureaucracy is enormously expensive, with doctor’s offices frequently having to have a full-time staff member to deal with the complexities of the multitude of insurance companies and plans, figuring out what is covered and how much and arguing with the insurers about what they will pre-approve, in the cases where pre-approval is required.

    And yes, one very important thing we want out of a health care system is a long life.

  23. 23
    Myca says:

    I’m sorry – I missed the class where we expressed efficiency in health care as spending the least amount of money for the longest life expectancy? Is that the metric we are striving to optimize (hint: no).

    I don’t think that it is unreasonable to believe that we ought to design our health care spending so as to produce better health care outcomes, and I find it pretty amazing that anyone would think otherwise.

    For someone to think otherwise and not really make an argument for it, but instead to handwave it all away with a parenthetical ‘no’ … well, that’s safe to ignore.

    —Myca

    PS. It does occur to me though … as a special favor for me, I’d really appreciate it if all opponents of the health care bill argued loudly and frequently that they want to spend as much money as possible for as little health care as possible. That would really be great for me and my side. Please do that.

  24. 24
    GTK says:

    As a physician, I feel a single payer system is the way to go. Will it happen anytime soon? No. Insurance companies, many doctors and yes even patients will fight this tooth and nail because of greed and fear. Why would the companies let themselves be put out of business? Why would doctors accept a smaller, albeit still very good paycheck.

    The benefit as I see it is better utilization of our facilities, standardization of care across communities using evidence based medicine and improved access for patients. Looking at the chart we don’t see doctors on a regular basis despite spending $7000 . That means we wait until we are very sick to seen which translates into higher costs. Also, how much of that money is used for administration. At my hospital we have 6 case managers (former nurses) who spend all day faxing paperwork to different insurance companies to get approval for hospitalizations in order to get payment. In a single payer system, you know your getting paid and you don’t have to waste time/money jumping through hoops in order to do so.

    My final thought that no one has yet mentioned, how much of that $7000 is PROFIT?! Has anyone done that analysis?

  25. 25
    russ says:

    Jeff: have you actually USED health care in another country, or are you just reflexively praising the US as the best, and reacting automatically against anything with the word “socialized”?

    I’m an American who’s been living in Poland for 4 years (certainly not a first class country economically), yet the health care I’ve received here has been as good as in the US (actually better in that several doctors have identified and explained several health issues I’ve had my whole life which NO US doctor ever identified or even mentioned to me, despite their “cool” and “informative” tests – it seems in other countries, medical tests can be informative even if they are not cool) at a small fraction of what I paid in the US for health care… and there was NOT more bureaucracy! US insurance companies create more bureaucracy (in my experience) than what I’ve experienced from the Polish socialized health care system.

    I do agree with you that mere length of life is not the full story, and that quality of life also matters. In that regard, the US is not necessarily leading either, e.g. being one of the most obese countries in the world. On the other hand, there is less smoking in the US than some countries. Quality of life is a tougher one to define with a single statistic indeed.

  26. 26
    Dianne says:

    And along the way, we have to put up of with some annoyance of bureaucracies (nothing compared to a socialized system)

    Actually, having worked in both a “socialized system” (the US VA system) and a “free market” system (other parts of the US), I’ll take the socialized system every time. True, the VA system has a certain amount of bureaucracy and the bureaucracy can sometimes seem a bit arbitrary, but at least it’s one single system. Unlike the thousands of random bureaucracies generated by various insurance companies out there. It’s just easier to learn one arbitrary system than hundreds of them.

    Frankly, if I could find an appropriate job in Canada or western Europe, I’d go there. Sure, the net pay is a little lower, but the amount of scut work is also less and the system easier to cope with. Oddly enough, they’re not hiring for the most part.

  27. 27
    Dianne says:

    Why would doctors accept a smaller, albeit still very good paycheck.

    Less paperwork. More time to see patients. Anyone who doesn’t find that a convincing argument should get a different job.

  28. 28
    Robert says:

    Frankly, if I could find an appropriate job in Canada or western Europe, I’d go there…Oddly enough, they’re not hiring for the most part.

    Yeah, it’s a mystery.

  29. 29
    Dianne says:

    Yeah, it’s a mystery.

    Not really. Something about training and retaining enough people locally to fill the need. Something the US doesn’t do very well. OTOH, for some reason all medical systems in the western world are prone to specialty fads. Sooner or later my specialty will be the one no one wants to touch and there’ll be available jobs everywhere. Should’ve gone to Norway when I had the chance though.

  30. 30
    JudgeX says:

    Simply put, the graphic points out something that most Americans actually already know to be true.

    However, many Americans are greedy, and many more are ignorant, and will always push to be against fixing problems within our society, especially when they don’t themselves face them. This is specifically evil. Atheistically, it’s self-serving to the point of harming others, and theistically, it’s commiting serial sins of omission.

    The bottom line is, you deserve what you condone. If you truly believe that another human who simply isn’t lucky enough to find a job that offers health insurance deserves to be made poorer or even suffer and die due to a randomly obtained sickness… then you deserve to yourself be put in that situation, or worse, helplessly watch it happen to a loved one as thousands of Americans do every day.

    You deserve what you condone.

  31. 31
    Ampersand says:

    Robert, if there were lots and lots of available jobs for doctors in Canada and Western Europe , would you have taken that as evidence that Canada has a good system? Or would your reaction have been something more like “See, no doctors want to work in Canada! That’s how bad their medical system is”?

    You’re acting as if it’s a matter of faith that all medical systems other than the US’s are bad; you certainly aren’t making evidence-based arguments. Is there ANY possible evidence that you would accept as demonstrating that other countries have health systems about as good as the US’s? What facts would convince you that the US spends too much on medical care?

  32. 32
    djw says:

    I missed the class where we expressed efficiency in health care as spending the least amount of money for the longest life expectancy? Is that the metric we are striving to optimize (hint: no).

    Of course it’s not the only thing we try and optimize, but it’s certainly one of them. Indeed, it’s actually one place where the American health care system shines–no one is better at keeping 90 year olds in ill health alive longer than we are! But, life expectancy does have a moderate correlation to a variety of other goals, such as quality of health whil alive. So it works OK as a stand-in for a simple chart.

    And along the way, we have to put up of with some annoyance of bureaucracies (nothing compared to a socialized system)

    This is completely false with respect to many socialized systems. The amount of bureaucracy dealt with by health care consumers in the UK is a tiny fraction of what we put up with.

    Truly, this comment could only be written by someone who has had extremely good luck with insurance companies so far. I used to work at a pharmacy, billing prescriptions to insurance companies. Several of those companies denied claims about 2-5% of the time, seemingly at random. The sheer number of hours I spent dealing with those denials, trying to figure out why, contest them, etc. was huge. You can actually go to school to get a degree as a “medical billing specialist” in this country and make good money doing it.

  33. 33
    Robert says:

    I was referring to Europe’s generally high level of unemployment, actually. Not that we’re shining any lights in that department these days.

    I don’t think that other countries’ health systems are worse than ours; I just don’t think that ours is as bad as the cherrypicked graph shows, or that we should bankrupt ourselves for Aetna so that Obama can claim a “victory” on health care.

  34. 34
    Dianne says:

    I was referring to Europe’s generally high level of unemployment, actually.

    Unlike, say the US’s? According to the Economist, the most recently available unemployment figures are pretty similar for the US and the EU (IIRC, the US is 10%, EU is 9.8%).

    I don’t think that other countries’ health systems are worse than ours; I just don’t think that ours is as bad as the cherrypicked graph shows,

    I tend to agree that graphics like this can be deceptive: many factors influence overall survival rates, etc. However, that’s a heck of a lot of a difference to try to explain with confounders.

  35. 35
    hburg1222 says:

    So how much of the medical costs here in the US are spent on test just in case of litigation. Tort reform is what we need to bring the medical costs down.

  36. 36
    Sebastian says:

    As someone who’s used to a socialized health care system, and who has had to deal with the one here, I have to say, there is no contest. I’m very healthy (knock on wood) – in the last ten years, I’ve been in a hospital three times – and every single time it was for injuries sustained while doing something stupid (a stabbing, a broken bone and a full body bruise from being mangled in the surf for half an hour)

    In France, there is less codling, the people are less polite, but everywhere I’ve been has been clean, and somehow, efficient looking. The doctors may seem haughty and condescending, but they really make me feel that they are doing their job.

    In the US, I’ve walked out of three hospitals (two in the South, one in LA) while bleeding or holding a fractured arm, because they were FILTHY. The second time, some sawbones tried to stitch my wound on a metal table that had the previous person’s blood on it. Furthermore, you are always made to feel like a fucking supplicant. Show insurance, wait forever, waste half an hour with an uneducated moron who will weight you and take your blood pressure and then Xray you and leave you undressed so that you can wait for a doctor… but Hell yeah, they are very polite, and it is Sir this and Sir that, and thank you, and you are so pale, and would you like a wheelchair, and bleah. The wrist is fine, can you please slap some plaster on the radial, so I can get the fuck out? Five years later I am still angry.

    I am sure that my experience should be unusual, but every non-American I have spoken to expresses the same sentiment – you feel as if you are begging for something that you may or may not get, your time is being wasted by people who are clearly just going through a checklist, and at the end, every effort is made to have you out without anyone spending a second thinking about your problem.

    My girlfriend had five UTIs in as many months. Five fucking times she was ran through a series of tests, and given antibiotics. In October she went back to Colmar (little provincial town) she was diagnosed, prescribed a diet and given something that is not an antibiotic… and the UTI has not been back.

    My coworker went back to Bulgaria(!?) to have his teeth done, and came back happy. Here he has the best insurance our employer is offering, but was tired of the time he was spending and of the, quote, ‘clumsy apprentices’ who were doing the work.

    But you know… for all the anger, I am still here. It’s still better to make your money here, and as a matter of principle, I’ll spend it here. It would be great if the Health Care System is straightened out. It probably won’t be. When I just look at the way that lobbyists (who would be jailed back home) control the political process, all I feel is hopelessness. As long as I am healthy, I don’t care much. Selfish much? Probably.

  37. 37
    Myca says:

    Tort reform is what we need to bring the medical costs down.

    Ezra Klein explained pretty clearly why you’re very wrong almost four years ago.

    The money quote:

    Dr. David Studdert led a team of eight researchers from Harvard School of Public Health, Brigham and Women’s Hospital, and the Harvard Risk Management Foundation* who examined 1,452 medical malpractice lawsuits. They found that more than 90 percent of the claims showed evidence of medical injury, which means they weren’t frivolous. In 60 percent of these cases, the injury resulted from physician wrongdoing. In a quarter of the claims, the patient died.

    Also:

    The most impressive and comprehensive study is by the Harvard Medical Practice released in 1990. The Harvard researchers took a huge sample of 31,000 medical records, dating from the mid-1980s, and had them evaluated by practicing doctors and nurses, the professionals most likely to be sympathetic to the demands of the doctor’s office and operating room. The records went through multiple rounds of evaluation, and a finding of negligence was made only if two doctors, working independently, separately reached that conclusion. Even with this conservative methodology, the study found that doctors were injuring one out of every 25 patients—and that only 4 percent of these injured patients sued.

    —Myca

  38. 38
    Robert says:

    Even so, Myca, that could simply indicate that our system is finding bad doctors and making them (and thus the system) pay, whereas in other countries that doesn’t happen, or happens less.

    I’m not saying that’s the case (I don’t know) but logically, that medical malpractice cases often have merit behind them is separate from whether making it harder to recover such losses would cut our medical bills.

  39. 39
    Myca says:

    Oh, certainly.

    It would cut our law enforcement costs quite a bit if we just stopped prosecuting murder, too.

    —Myca

  40. 40
    Robert says:

    Yes, but the point is that it is entirely possible that *European* countries are not adequately paying for malpractice and so the numbers aren’t comparable. IE, it isn’t that our number is super high, it’s that theirs is super low, and they get it that low by requiring people to just eat it if they get bad medical care.

    Anybody know what the European countries do for malpractice?

  41. 41
    chingona says:

    I don’t know what European countries do, but I will point out that one thing people in European countries don’t have to worry about is paying for on-going medical costs once the physician-caused injuries make them uninsurable and unemployable. People love to go on and on about how litigious we are here, but a major reason people sue is not to get revenge on or even justice from the person who harmed them but because they have no other possible way to get money for their now much-increased costs.

    For what it’s worth, I’d be very open to creating something like the system we have with vaccines, where if you’re injured by a vaccine, you receive compensation from a fund paid for by the vaccine manufacturers and managed by (I think) the government. It would be a lot more difficult because the types of physician-caused injuries are much more variable, but it would provide a lot more certainty and fairness for everyone if it were well managed, and I suspect costs would be more predictable than what goes on in jury verdicts and with malpractice insurance.

  42. 42
    Maia says:

    Robert – Chingona’s point is a pertinent one – in countries where healthcare is covered automatically people do not need to sue doctors if they mess up in a way which demands on going medical care. That saves a lot of money because going through a legal process is a very expensive way of getting money for care.

    In New Zealand, we take it one step further and have accident coverage for everyone as well, which includes treatment injury.

  43. 43
    Myca says:

    Yes, but the point is that it is entirely possible that *European* countries are not adequately paying for malpractice and so the numbers aren’t comparable.

    Sure, or it’s possible that the outsized appeal of medical salaries in the US has lead many not-very-qualified-or-interested-but-very-very-greedy people to become doctors.

    Or it may be that the pay-per-visit structure has lead to a lot of slipshod work in an effort to get people in and out as quickly as possible.

    There’s a lot of data to examine here, including (as you suggest) what the European countries do for malpractice, but also what their rates of medical injury actually are. Maybe they’re hurting patients at the same rate we are, and paying out less, or maybe they’re hurting patients less and as a result paying out less.

    Either way, what is clear is that the problem is NOT frivolous lawsuits, and what is clear is that the solution is NOT tort reform.

    —Myca

  44. 44
    Sebastian says:

    Robert: It’s simple (for France) If there is harmful intent, it’s a criminal case. If there is negligence, it’s an administrative investigation. If it’s the coin toss coming up ‘shit outta luck’, one gets to swear a lot. In all three cases, the injuries get treated by the same socialized care system that caused them. You may believe that it is inadequate, and there’s nothing anyone can do to convince you otherwise.

    But of course, there is nothing stopping one from filing a civil suit. Check out the case of Johnny Hallyday, which is still ongoing. That was a major screw up, according to some. And if I remember correctly, it was an expensive, private clinic that screwed up. You are aware, of course, that there is nothing stopping rich people from getting expensive, private medical care even in France…

  45. 45
    Robert says:

    It isn’t a question of whether it’s inadequate, it’s a question of whether the cost is being included in the figures or not. It’s basically a question of whether the externality is included in the price or not.

    Thank you very kindly for the data point.

  46. 46
    chingona says:

    Mods, I posted a comment last night. I thought it had shown up, but now it’s gone. Any sign of it on your end?

  47. 47
    Ampersand says:

    Sorry, Chingona; I just searched our spam trap, and there are no posts from you there, nor are there any in the waiting-for-moderation area. Sorry. :-(

  48. 48
    chingona says:

    Odd.

    Anyway, what I said is that I’m not sure it’s accurate to describe medical malpractice as an externality. The costs associated with it are very tied up both in the way we practice medicine and the way we pay for medical care. I don’t you can just pull it out of the costs.

    That said, I’m also not sure that the $7,290 includes all of our medical malpractice costs (though I’ll defer to anyone who has dug down in the data and knows better). Doctors can’t just raise rates to offset the increased premiums when their malpractice insurance goes up because insurance companies and Medicare set most of the reimbursement rates. There’s not a 1-to-1 ratio of rising malpractice costs and rising medical costs.

  49. 49
    djw says:

    There’s not a 1-to-1 ratio of rising malpractice costs and rising medical costs.

    That’s an understatement. The relationship exists, but it’s quite mild. Other bizarre features of the global insurance/re-insurance market have a much greater affect on the cost of malpractice insurance.

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  52. 50
    Mad Jayhawk says:

    Whoever did this cute little analysis needs to study-up a little on cause and effect. Increased longevity could be caused by a whole host of other factors not shown on the graph. It could be related to expenditures on health care but probably isn’t. Longevity is more likely to be related to environment, diet, and heredity. Medical costs, too, are hard to pinpoint. Are what are medical costs in one country the same in another? Research? Is that a medical cost? Have you seen what they call hospitals in some countries? Are the costs related to those included? The old apples and oranges problem. All of these things vary significantly from country to another. Graphs like these are used to make a political point, not a scientific one. Be wary of reaching conclusions from propaganda like this that may have significant and long-lasting impact on us all.

  53. 51
    RobRomano says:

    The graphic includes costs like “hospital infrastrcture” in healthcare spending. this causes the graphic to be misleading to most observers, and much less useful as any sort of guide with which to base policy on, or to argue in favor of the kind of reform Obama is pushing. It is eye-catching though.

    One thing all statisticians know is that CHARTS AND GRAPHS are fabulous ways to misrepresent factual data.

  54. 52
    Ampersand says:

    Increased longevity could be caused by a whole host of other factors not shown on the graph. It could be related to expenditures on health care but probably isn’t.

    Indeed, I’d say what the graph mainly shows is the LACK of a strong relationship between expenditures and longevity, especially as regards US spending. That you seem to think it is intended to show the opposite, suggests that you have not successfully understood the graph.

    The graphic includes costs like “hospital infrastrcture” in healthcare spending. this causes the graphic to be misleading to most observers, and much less useful as any sort of guide with which to base policy on, or to argue in favor of the kind of reform Obama is pushing.

    Rob, are you saying that hospital infrastructure is NOT part of the nation’s healthcare spending? If so, then what’s your argument? Because it seems self-evident to me that hospital infrastructure is legitimately part of our health care system.

    The extent to which some people object to any acknowledgment of realty — in this case, that the US does, in fact, spend a lot more on health care per capita than any other country, which is what this graph illustrates — makes me despair of ever having a rational discussion of health care reform.

  55. 53
    Mad Jayhawk says:

    We’re just not getting good value for our money. We’re spending more than anyone, by a huge margin, but getting slightly below average results and relatively little access to doctors.

    Indeed, I’d say what the graph mainly shows is the LACK of a strong relationship between expenditures and longevity, especially as regards US spending. That you seem to think it is intended to show the opposite, suggests that you have not successfully understood the graph.

    Which is it? By ‘results’ in your first paragraph do you mean longevity since that is the only thing plotted against expenditures besides number of doctor visits? Then you seem say there is no relationship between expenditures and longevity. Do you mean there is a result, lower longevity, when it concerns the US but there is no result when it comes to other countries’ expenditures?

    I thought the rationale behind this graph is that there is a relationship between spending and longevity. If there isn’t, why publish the graph in the first place other than to weakly try to back up a contention that there is some sort of causal relationship between expenditures and longevity?

    With all due respect, the graph is a piece of garbage in my opinion.

    Help me out here. Obviously I am confused.

  56. 54
    Mad Jayhawk says:

    Ezra Klein explained pretty clearly why you’re very wrong almost four years ago.

    It is not the number of cases or their frivolous or non frivolous nature that is the problem although the number of people expecting perfect outcomes when they deal with the medical system has increased. It is the size of the awards being made to plaintiffs that is the problem. Tort reform would not end patient’s right to sue in the case of bad results but put a cap on the awards for malpractice. No one in their right mind would want doctors shielded from having to take responsibility for what they do (unless of course they blame George Bush).
    Jury awards have skyrocketed. Just Google ‘malpractice’. Tort lawyers even shop for courts most likely to award huge amounts for pain and suffering. The awards some courts have made to plaintiffs have been breathtaking. You can win the Powerball Jackpot or have a surgeon leave a sponge inside you. As a result malpractice insurance has gone through the roof. How much is that stray sponge really worth?

    Some physicians have even stopped practicing because they cannot afford the insurance any longer. The costs for malpractice insurance and for all the extra defensive tests ordered by a doctor to lower the possibility of getting sued get passed on to —– guess who?

    You do not have to be a genius to figure out why Democrats avoided addressing tort reform in their healthcare bill do you? These charts will quickly tell you why. We all pay for all these lawsuits and huge jury awards. The tort system needs reform. Do not let the lackeys for the ATLA tell you differently.

  57. 55
    Anon says:

    I just love how stupid Americans are, just you keep on dying and suffering with no healthcare. Go watch Sicko.

    Personally, I prefer to have open and free healthcare.

    *clap*