U.S. Health Care Ranked Worst in the Developed World (2 Viewers)

[Maurile Tremblay]

Yes, maybe they should include other parts to the evaluation. Perhaps outcomes or even something like efficiency. 

The OP doesn’t list all the factors taken into account, but it does explicitly say ‘quality of care.’

 

[Henry Ford]

Although the U.S. has the most expensive health care system in the world, the nation ranks lowest in terms of “efficiency, equity and outcomes,”

@Maurile Tremblay, this is why I thought my post might be funny. Thank you for showing me the error of my ways. 

 

[Terminalxylem]

I have been very healthy.  My actually medical spending is a negligible percentage of all the health insurance premiums I had paid throughout the years..  I know by the time I really need the care I would be paying 100% out of my own pocket.  This really sucks.

I have the same experience with car insurance.  In my opinion, this insurance business is a big scam.

Why will you be paying 100% out of pocket?

 

[zoonation]

...you guys can't help yourself.  My response was directly related to his response in the topic.   You guys have to make it personal.  I noticed no one answered my question, if you had a heart attack would you rather go to a US hospital or a Mexican hospital?  The same goes for cancer.   Which one you choose?   Come on, it is really easy.  I already know the answer. 

If I had a heart attack I would be happy to receive care in any of the top countries on the list.  It is a total myth that you will somehow get significantly better care for a heart attack in the US than you would in the UK, Switzerland or Canada.  

The key difference and the reason the US tanks so low is that the US is the only country in the western democratic world where having a heart attack could bankrupt you.  

Does the US have the best medical care in the world?   I would say yes.  But the fact that the care is not accessible to a significant percentage of the population is why the US scores so low.  

 

[Terminalxylem]

I do not get much benefits from health insurance now.  My employer offers the choice of 2 different kinds of high deductible insurance.  The only thing free is the annual checkup (get my temperature, heart rate and blood pressure taken) and flu shots that work 20% of the time.  I only ever get the flu once in a while, and it would be stupid to spend almost $500 out of pocket to see my primary physican for 5 minutes.  I could have gotten more rest if I did not go to the doctor in the first place.

Not sure you’ve ever been hospitalized, but it is really tough to pay out of pocket. I have good insurance, but was hospitalized out of network when I broke my leg requiring surgery. I paid nearly $11K of the bill for a single night in the hospital.

The influenza shot ain’t great, but it’s usually better than 20% efficacy. If you are relatively healthy, you probably don’t need a doctor visit for the flu. Different story if you have chronic medical problems, as your risk of flu-related complications goes up, some of which can be life threatening.

 

[Sand]

My six point plan to reduce the costs of healthcare

1) Reduce the cost of nurses, doctors and other healthcare professions by making the professions more attainable  Increased supply will decrease the demand and reduce employee costs. 

The AMA is most powerful union in the US.  Been saying that for a while.

 

[Ilov80s]

Insurance is a scam until you get cancer or are in a serious car accident. 

 

[Terminalxylem]

The AMA is most powerful union in the US.  Been saying that for a while.

It’s not a union.

 

[Sand]

It’s not a union.

The AMA controls labor in the medical industry, both from a disciplinary point of view and a labor supply point of view.  It may not be a union in name, but in power and control it is very much in that realm.

 

[timschochet]

  I know by the time I really need the care I would be paying 100% out of my own pocket.  

Unless you die very suddenly without any hospital or medical care whatsoever, or you are an 8 figure guy and much of it is easily accessible, it is guaranteed that there will come a time in your life when you will require more medical care than you can afford to pay out of your own pocket. 

 

[TripItUp]

The AMA controls labor in the medical industry, both from a disciplinary point of view and a labor supply point of view.  It may not be a union in name, but in power and control it is very much in that realm.

They are one of several roadblocks that needs to be addressed. 

I know quite a few doctors, most of them went into Medicine  for the money.  There is a fundamental problem with that.  People that get into nursing and some of the med tech areas as well...it’s all about money.  This isn’t the case in other first world nations. 

 

[Sand]

Unless you die very suddenly without any hospital or medical care whatsoever, or you are an 8 figure guy and much of it is easily accessible, it is guaranteed that there will come a time in your life when you will require more medical care than you can afford to pay out of your own pocket. 

If this was actually true then we'd have much, much higher premiums.  Fact is this isn't the case and most folks pay more into the system than they get out.  Medical expenses are dominated by the top few percent of cases.

 

[TripItUp]

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start

there is a lot to unpack here...don't even know where to start.

 

[The Commish]

there is a lot to unpack here...don't even know where to start.

Agreed....It took me a couple days to go through it.  There's a ton of other studies out there very similar.  It's pretty interesting all around.  It gets out from the "M4A is the best thing ever" and "Our system is the best in the world just like it is" nonsense and sheds light on the real status.

 

[Terminalxylem]

The AMA controls labor in the medical industry, both from a disciplinary point of view and a labor supply point of view.  It may not be a union in name, but in power and control it is very much in that realm.

Can you elaborate? 

While the AMA is an influential professional group, doctors arent obligated to join; less than 1/3 are members. They’ve campaigned to increase the number of medical school spots in recent years, but residency positions have lagged behind, largely because Medicare doesn’t have money to fund them. Physicians are being supplanted by other providers (nurse practitioners and physician assistants), which is probably a good thing. But nothing to do with the AMA, at least not directly.

 

[Terminalxylem]

They are one of several roadblocks that needs to be addressed. 

I know quite a few doctors, most of them went into Medicine  for the money.  There is a fundamental problem with that.  People that get into nursing and some of the med tech areas as well...it’s all about money.  This isn’t the case in other first world nations. 

How do you know what influenced them to go into medicine? I’ve never heard a physician admit $ was their primary reason for pursuing the job, especially considering the alternatives for intelligent, highly motivated individuals.

 

[TripItUp]

How do you know what influenced them to go into medicine? I’ve never heard a physician admit $ was their primary reason for pursuing the job, especially considering the alternatives for intelligent, highly motivated individuals.

Because I know  a lot of them.  My two best friends from college are orthopedic surgeons, for example.  They'll all tell you the same thing, most but certainly not all, doctors go into medicine at least partially for the money.

 

[Terminalxylem]

Because I know  a lot of them.  My two best friends from college are orthopedic surgeons, for example.  They'll all tell you the same thing, most but certainly not all, doctors go into medicine at least partially for the money.

So do I. It’s possible your impression is skewed by the types of doctors you know - Ortho is among the best paid surgical subspecialties.

Is it wrong for physicians to be partially motivated by money? They incur a lot of debt and delay earnings longer than just about any other occupation.

 

[TripItUp]

So do I. It’s possible your impression is skewed by the types of doctors you know - Ortho is among the best paid surgical subspecialties.

Is it wrong for physicians to be partially motivated by money? They incur a lot of debt and delay earnings longer than just about any other occupation.

I don't think they are wrong, I think the system is wrong.   If the system weren't overpaying certain specialties and/or if there were more specialists out there, I believe medicine would attract less money-first professionals.  Other countries' physicians don't make what ours make, yet we are comparing our healthcare costs to those countries. If we want our costs to be comparable to other first world countries, should healthcare worker compensation be comparable?

I don't want to overstate this issue though and it's certainly not limited to physicians. This is just one of several opportunities to decrease the costs of medicine in the USA.  Doctor/Nurse/Administrator compensation is far from the only opportunity to cut costs,  just a part of the solution IMHO.

 

[Terminalxylem]

I don't think they are wrong, I think the system is wrong.   If the system weren't overpaying certain specialties and/or if there were more specialists out there, I believe medicine would attract less money-first professionals.  Other countries' physicians don't make what ours make, yet we are comparing our healthcare costs to those countries. If we want our costs to be comparable to other first world countries, should healthcare worker compensation be comparable?

I don't want to overstate this issue though and it's certainly not limited to physicians. This is just one of several opportunities to decrease the costs of medicine in the USA.  Doctor/Nurse/Administrator compensation is far from the only opportunity to cut costs,  just a part of the solution IMHO.

How does pay compare for other US professions and the rest of the developed world? Pretty sure Americans earn more across the board.

But I’ll agree that medical workers in the US are likely overpaid. I just don’t think that is the main problem with our horrifically overpriced healthcare.

 

[TripItUp]

How does pay compare for other US professions and the rest of the developed world? Pretty sure Americans earn more across the board.

But I’ll agree that medical workers in the US are likely overpaid. I just don’t think that is the main problem with our horrifically overpriced healthcare.

Agree it's not the main problem.

 

[Sand]

How does pay compare for other US professions and the rest of the developed world? Pretty sure Americans earn more across the board.

But I’ll agree that medical workers in the US are likely overpaid. I just don’t think that is the main problem with our horrifically overpriced healthcare.

That's one of the issues.  It isn't just one problem - it's split between many areas:  physician pay, subsidizing the world in pharma costs and R&D, govt. compliance costs, insurance compliance costs, and defensive medicine costs (i.e. legal liability).  

 

[Terminalxylem]

That's one of the issues.  It isn't just one problem - it's split between many areas:  physician pay, subsidizing the world in pharma costs and R&D, govt. compliance costs, insurance compliance costs, and defensive medicine costs (i.e. legal liability).  

Yeah, but the physicians are the only ones on that list actually taking care of patients. Speaking of which, you left out unrealistic patient expectations and poor health decisions as major contributors to costs.

ETA were subsidizing pharma profits as much or more than helping out the rest of the world 

 

[TripItUp]

That's one of the issues.  It isn't just one problem - it's split between many areas:  physician pay, subsidizing the world in pharma costs and R&D, govt. compliance costs, insurance compliance costs, and defensive medicine costs (i.e. legal liability).  

 

[The Narrator]

The level of performance of our health care is superior.  The only constant is these 'studies' heavily weight our lack of free government health care against us.   Why not do a study based on the actual quality of the care and not some preconceived notion that free markets suck?  

Imagine how it would sound if someone told you "Ferrari is the best car in the world. Lucky Italians!"

Our system has people dying from rationing insulin because they can't afford it. Accessibility matters no matter how much you'd like it not to. 

 

[The Narrator]

At the end of the day, when you insert a profit motive into health care, you're going to end up with health care companies making decisions that cause people to die in favor of the bottom line.

 

[Sand]

At the end of the day, when you insert a profit motive into health care, you're going to end up with health care companies making decisions that cause people to die in favor of the bottom line.

Dead people don't pay bills or buy health services, so on the whole this isn't correct.  If you switch the system over to completely non-profit you will get deaths due to system apathy.  That sword swings both ways.

 

[zoonation]

Dead people don't pay bills or buy health services, so on the whole this isn't correct.  If you switch the system over to completely non-profit you will get deaths due to system apathy.  That sword swings both ways.

Can you give an example of this from a public healthcare system in the western democratic world?  I can't think of an example of what you are talking about.

 

[The Narrator]

Dead people don't pay bills or buy health services, so on the whole this isn't correct.  If you switch the system over to completely non-profit you will get deaths due to system apathy.  That sword swings both ways.

What you get is that the system needs people who are alive to make money. What you're missing is that there's no profit difference between a broke person and a dead person.

 

[The Commish]

Dead people don't pay bills or buy health services, so on the whole this isn't correct.  If you switch the system over to completely non-profit you will get deaths due to system apathy.  That sword swings both ways.

What do you mean by system apathy 

 

[Sand]

What you're missing is that there's no profit difference between a broke person and a dead person.

Medicaid usually picks up the costs for broke people.  

 

[The Narrator]

Medicaid usually picks up the costs for broke people.  

Yes, it fills a big hole in our ridiculously expensive system that provides very poor health outcomes. 

Now imagine we had a cheaper system that provided better outcomes like most of the rest of the first world and didn't need it. 

 

[The Commish]

there is a lot to unpack here...don't even know where to start.

Have you been able to sit down and digest any of that article?  Interested in your thoughts.

 

[matttyl]

I have been very healthy.  My actually medical spending is a negligible percentage of all the health insurance premiums I had paid throughout the years..  I know by the time I really need the care I would be paying 100% out of my own pocket.  This really sucks.

I have the same experience with car insurance.  In my opinion, this insurance business is a big scam.

Until it doesn't.  I'm in the same situation as you.  I pay premiums, and rarely if ever go to the doctor.  Ok, I broke my wrist in college ~20 years ago.  Really that's been about it since. 

Then last year I took my 3 year old to the hospital.  He was admitted, then released a few days later.  A week went by and we went again, admitted, and released.  A third time.  The fourth time, this "children's hospital" told us that we had "exhausted their capabilities" and said we'd have to go to Children's National in DC.  There he had what can only be described as brain surgery, and he's completely fine now.  All in we spent 22 nights in various hospitals last year, and I'm sure raked up about $1M in medical claims. 

My point it that it might suck....until it doesn't. 

 

[Tau837]

If our healthcare quality is superior, why are infant mortality and life expectancy worse in the US than the other countries included in the Commonwealth report?

Free markets only works if your customer can afford your product, and the consequences of not buying it aren't life threatening.

We’ve done this before.  The US measures infant mortality differently.  There isn’t a universal standard.  We also struggle with prenatal care for poor urban women due to the lack of free healthcare.

Regarding the bolded, I posted this stuff back in 2016:

• Roughly 40% of the delta in infant mortality rates is explained by differences in reporting. Also, the US actually has one of the best neonatal mortality rates. Where the US lags behind other developed countries is in the postneonatal mortality rate, i.e., in months 2-11 of life. I'm not sure this reflects as much on the quality of our healthcare system as it does variance in socioeconomic status. See Why American Babies Die.
  
• The US has the best life expectancy in the world if you remove fatal injuries (e.g., auto accidents, homicides) from the calculation. See The Myth of Americans' Poor Life Expectancy.
  

 

[Terminalxylem]

Regarding the bolded, I posted this stuff back in 2016:

• Roughly 40% of the delta in infant mortality rates is explained by differences in reporting. Also, the US actually has one of the best neonatal mortality rates. Where the US lags behind other developed countries is in the postneonatal mortality rate, i.e., in months 2-11 of life. I'm not sure this reflects as much on the quality of our healthcare system as it does variance in socioeconomic status. See Why American Babies Die.
  
• The US has the best life expectancy in the world if you remove fatal injuries (e.g., auto accidents, homicides) from the calculation. See The Myth of Americans' Poor Life Expectancy.
  

Interesting info. A couple comments/questions:

1. Differences in infant mortality according to SES are abhorrent any way you cut it. Poor people shouldn’t receive substandard care in a country as rich as ours IMO.

2. The data from the link for life expectancy is pretty old. Any update from the last decade or so, during which our life expectancy has decreased, murder and fatal accidents have dropped, yet healthcare spending has skyrocketed?

3. I don’t know how accidental deaths were tabulated, but if they included anything other than people dead on arrival to a healthcare setting it’s possible they may reflect inferiority of our trauma care.

4. Even if you accept the life expectancy sans trauma stats, is the extra ~1 year of US life worth our colossal expenditures relative to other top countries? 

 

[Tau837]

Interesting info. A couple comments/questions:

1. Differences in infant mortality according to SES are abhorrent any way you cut it. Poor people shouldn’t receive substandard care in a country as rich as ours IMO.

Agree that we should never stop attempting to improve infant mortality.

2. The data from the link for life expectancy is pretty old. Any update from the last decade or so, during which our life expectancy has decreased, murder and fatal accidents have dropped, yet healthcare spending has skyrocketed?

I just pulled information from an old post. I expect one who is motivated and can use the internet effectively can find updated data.

The nature of your question seems to imply that you expect that updated data would show a different outcome. I see no reason to assume that.

3. I don’t know how accidental deaths were tabulated, but if they included anything other than people dead on arrival to a healthcare setting it’s possible they may reflect inferiority of our trauma care.

Not exactly true as phrased. Someone could reach a healthcare setting alive and still succumb to a fatal injury that has nothing to do with inferior trauma care. In the absence of data to the contrary, I see no reason to believe US emergency/trauma healthcare is inferior relative to other countries.

4. Even if you accept the life expectancy sans trauma stats, is the extra ~1 year of US life worth our colossal expenditures relative to other top countries? 

That is a different subject than you started with. You started by attempting to refute the idea that the quality of US healthcare is superior by citing infant mortality and life expectancy. I posted data that refuted both points. So you are changing the subject of the discussion.

The way you posed the question, I think answers will vary. What is 1 extra year of life worth to you?

 

[Tau837]

...is the extra ~1 year of US life worth our colossal expenditures relative to other top countries?

A couple of things to consider:

1. The US public sector spending is comparable to other OECD countries. The significant gap is in private sector spending. See How does health spending in the U.S. compare to other countries?
   
2. The US has the highest gross adjusted household disposable income among OECD countries.
   

How do these facts support the notion that US healthcare spending is a huge problem?

Also, here is an economic point of view, from The Value of Life and the Rise in Health Spending:

Viewed from every angle, our results support the proposition that both historical and future increases in the health spending share are desirable. The magnitude of the future increase depends on parameters whose values are known with relatively low precision, including the value of life, how rapidly that value has grown over time, and the fraction of the decline in age specific mortality that is due to technical change and the increased allocation of resources to health care. Nevertheless, we believe it likely that maximizing social welfare in the United States will require the development of institutions that are consistent with spending 30 percent or more of GDP on health by the middle of the century.

 

[Henry Ford]

If this was actually true then we'd have much, much higher premiums.  Fact is this isn't the case and most folks pay more into the system than they get out.  Medical expenses are dominated by the top few percent of cases.

If you and your employer pay a total of $500 per month for 30 years for your insurance you’re talking about $180,000 in premiums. Can you afford to pay $75,000 out of pocket for a procedure?

tim is just saying you end up with a giant bill you couldn’t pay out of pocket, not that you aren’t profitable ultimately.  

 

[Terminalxylem]

Agree that we should never stop attempting to improve infant mortality.

I just pulled information from an old post. I expect one who is motivated and can use the internet effectively can find updated data.

The nature of your question seems to imply that you expect that updated data would show a different outcome. I see no reason to assume that.

Not exactly true as phrased. Someone could reach a healthcare setting alive and still succumb to a fatal injury that has nothing to do with inferior trauma care. In the absence of data to the contrary, I see no reason to believe US emergency/trauma healthcare is inferior relative to other countries.

That is a different subject than you started with. You started by attempting to refute the idea that the quality of US healthcare is superior by citing infant mortality and life expectancy. I posted data that refuted both points. So you are changing the subject of the discussion.

The way you posed the question, I think answers will vary. What is 1 extra year of life worth to you?

A big part of improving infant mortality is accepting our system is flawed in its delivery to those with lower SES.

I can’t find updated data on life expectancy excluding traumatic deaths, nor do I completely accept the original premise. In the last couple decades, US healthcare has become increasingly fragmented, overwhelming ERs where trauma evaluation begins. So yes, I do have reason to believe our care may be inferior.

It seems you aren’t open to the possibility our healthcare is worse, discounting deaths due to trauma, infant mortality in disadvantaged communities, etc.  I’m taking the opposite stance, especially with regards to cost and access to care. But I agree if one has money and wants cutting edge technology, our care can be top notch. 

Unfortunately, cost must eventually factor into the equation, and healthcare expenditure as a percentage of GDP is off the charts in this country. For example, we spend a huge chunk of our healthcare dollar on end-of-life care, which arguably isn’t worth it.

How much is a year of life worth? There is a concept called a quality adjusted life year which tries to answer the question. It is an economic tool which has been used to help determine when medical care is warranted, based on its cost and expected benefit/prolongation of life.  It used to be set at $50K/yr, meaning an intervention costing more than that wasn’t worth it, but has climbed much higher in the last few years. 

 

[Tau837]

I can’t find updated data on life expectancy excluding traumatic deaths, nor do I completely accept the original premise. In the last couple decades, US healthcare has become increasingly fragmented, overwhelming ERs where trauma evaluation begins. So yes, I do have reason to believe our care may be inferior.

I would be interested in any objective evidence that the life expectancy data I posted has changed over time and/or that the quality of US trauma care lags behind other comparable nations. Without such evidence, I see no support for your opinions. I'm fine agreeing to disagree about it until/unless you have some actual evidence.

It seems you aren’t open to the possibility our healthcare is worse... I’m taking the opposite stance, especially with regards to cost and access to care...

I am quite certain our healthcare is worse than other comparable nations in some areas and better in other areas. Generally speaking, I think the quality of our healthcare is in the top tier of all countries.

I agree with you that high cost and lack of equal access to care are the two most significant problems. Unfortunately, I think both of those problems are extremely difficult to address, as we saw with Obamacare.

Unfortunately, cost must eventually factor into the equation, and healthcare expenditure as a percentage of GDP is off the charts in this country.

I noticed you didn't choose to comment on my post showing the delta between US spending and comparable country spending is in the private sector, yet the US disposable household income is the highest of all OECD countries. If the quality of care is top tier (my contention) and despite paying more than comparable countries, American households still have more disposable income, how big of a problem is healthcare spending?

For example, we spend a huge chunk of our healthcare dollar on end-of-life care, which arguably isn’t worth it.

How do you define "a huge chunk?" Consider:

• End-of-Life Care Is Only 9 Percent of Health-Care Costs
  
• Medicare May Be Spending Far Less On End-Of-Life Patients Than We Think
  
• End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported
  
• The Myth Regarding the High Cost of End-of-Life Care
  

The US actually spends less on care within the last 12 months of life than comparable countries.

How much is a year of life worth? There is a concept called a quality adjusted life year which tries to answer the question. It is an economic tool which has been used to help determine when medical care is warranted, based on its cost and expected benefit/prolongation of life.  It used to be set at $50K/yr, meaning an intervention costing more than that wasn’t worth it, but has climbed much higher in the last few years. 

I am aware of QALY, as well as the issues with using that economic tool in medical decision-making. Do you think the US healthcare system should incorporate QALY and refuse to apply public sector spending to patients based upon some calculus of projected QALYs vs. treatment cost? I do not.

Do you think any person or committee in the US healthcare system should be authorized to determine the value of an extra year of someone else's life? I do not.

 

[Terminalxylem]

I would be interested in any objective evidence that the life expectancy data I posted has changed over time and/or that the quality of US trauma care lags behind other comparable nations. Without such evidence, I see no support for your opinions. I'm fine agreeing to disagree about it until/unless you have some actual evidence.

I am quite certain our healthcare is worse than other comparable nations in some areas and better in other areas. Generally speaking, I think the quality of our healthcare is in the top tier of all countries.

I agree with you that high cost and lack of equal access to care are the two most significant problems. Unfortunately, I think both of those problems are extremely difficult to address, as we saw with Obamacare.

I noticed you didn't choose to comment on my post showing the delta between US spending and comparable country spending is in the private sector, yet the US disposable household income is the highest of all OECD countries. If the quality of care is top tier (my contention) and despite paying more than comparable countries, American households still have more disposable income, how big of a problem is healthcare spending?

How do you define "a huge chunk?" Consider:

• End-of-Life Care Is Only 9 Percent of Health-Care Costs
  
• Medicare May Be Spending Far Less On End-Of-Life Patients Than We Think
  
• End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported
  
• The Myth Regarding the High Cost of End-of-Life Care
  

The US actually spends less on care within the last 12 months of life than comparable countries.

I am aware of QALY, as well as the issues with using that economic tool in medical decision-making. Do you think the US healthcare system should incorporate QALY and refuse to apply public sector spending to patients based upon some calculus of projected QALYs vs. treatment cost? I do not.

Do you think any person or committee in the US healthcare system should be authorized to determine the value of an extra year of someone else's life? I do not.

That’s a lot to process; I’ll read your links and get back to you. In the meantime, here is a link showing US mortality for various disease states compared to other developed countries, including trauma mortality: https://www.healthsystemtracker.org/chart-collection/mortality-rates-u-s-compare-countries/

Spoiler alert: it ain’t great, which is part of the reason I question your initial life expectancy data.

 

[Terminalxylem]

How do you define "a huge chunk?" Consider:

• End-of-Life Care Is Only 9 Percent of Health-Care Costs
  
• Medicare May Be Spending Far Less On End-Of-Life Patients Than We Think
  
• End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported
  
• The Myth Regarding the High Cost of End-of-Life Care
  

The US actually spends less on care within the last 12 months of life than comparable countries.

I am aware of QALY, as well as the issues with using that economic tool in medical decision-making. Do you think the US healthcare system should incorporate QALY and refuse to apply public sector spending to patients based upon some calculus of projected QALYs vs. treatment cost? I do not.

Do you think any person or committee in the US healthcare system should be authorized to determine the value of an extra year of someone else's life? I do not.

If average life expectancy is approximately 79 years, should we allocate a tenth of healthcare spending to the final year? Maybe, if it resulted in a decent quality of life. But it usually doesn’t; we tend to flog our elders on their death beds. Part of that is cultural, as the process of dying is a relatively taboo subject in this country.

And yes, I think we should restrict some expensive treatments with marginal benefit in QALY. I don’t know the cut-off, but at some point economic consequences trump the prospects of a therapeutic Hail Mary.

 

[Tau837]

If average life expectancy is approximately 79 years, should we allocate a tenth of healthcare spending to the final year?

Perhaps you didn't have a chance to read the links. It is rarely possible to know with certainty that a given patient is in his or her last year of life. In most cases when a patient dies, healthcare professionals are treating the illness, not a patient known to be on the verge of imminent death.

From the first linked article above:

Only 10 percent of those who had a 50 percent probability of passing away within a year in fact did die.  Those considered most likely to die accounted for less than 5 percent of total spending...

The authors found that it is difficult to accurately predict death even for those Medicare patients who have been hospitalized, or even those who have been hospitalized with metastatic cancer...

For Einav, Finkelstein, and colleagues, the real story is not that we spend a lot of money on people at the end of life, it is that we spend a lot of money on people who are sick--whether they are dying or not.  The authors acknowledge some patients who truly are dying do receive futile, high-cost care. But  they do so far less often than the conventional wisdom suggests.

As for how much spending the US allocates to the final 12 months of life, from the third linked article above:

We used detailed health care data for the period 2009–11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies...

The idea that reducing wasteful spending just before death can make the growth in health care costs sustainable is not supported by this study. Spending in the last twelve months of life accounted for 8.5–11.2 percent of overall spending in eight countries and Quebec, with the United States at the bottom of that ranking. Reducing this spending would thus have only a modest effect on total medical spending.

 

[parasaurolophus]

I posted this before but my neighbor is a female doctor from Brazil who is at St Joseph's in Ann Arbor MI now. When she was certified here she and took a position she was shocked at all the paperwork, billing and administrative BS here.   In Brazil she said 80% of her job was treating and working with her patients.  Here she said 80% of her job is making sure she is filling out the correct paperwork for billing and running unnecessary tests so that the hospital won`t get sued. 20% treating and working with her patients.

Main thing she said is not getting sued, said they have meetings once a month lawsuits and about expensive running tests even though they know they are not needed.

So basically she was saying lawyers cause all sorts of healthcare issues. We can add it to the list. 

 

[Da Guru]

So basically she was saying lawyers cause all sorts of healthcare issues. We can add it to the list. 

Yes

 

[Terminalxylem]

Perhaps you didn't have a chance to read the links. It is rarely possible to know with certainty that a given patient is in his or her last year of life. In most cases when a patient dies, healthcare professionals are treating the illness, not a patient known to be on the verge of imminent death.

From the first linked article above:

As for how much spending the US allocates to the final 12 months of life, from the third linked article above:

I've read the links now. Thanks for pointing out some of the problems with end-of-life spending. I'll concede it's very difficult to predict the timing of death, but still think we spend way, way too much on futile care - identifying futility prospectively is the tricky part.  And I don't know how to interpret the international comparison of end-of-life spending, as the dataset is inconsistent across countries.

None of this changes my opinion that our system is wasteful, expensive and delivers substandard care. How do you reconcile the data showing international mortality across various disease states with your stance that our healthcare is top notch? 

https://www.healthsystemtracker.org/chart-collection/mortality-rates-u-s-compare-countries/#item-overall-age-adjusted-mortality-rate-decline-1980-2015

Among the major causes of death, the U.S. has lower than average mortality rates for cancers and higher than average rates in the other categories relative to comparable OECD countries. These categories accounted for nearly 74 percent of all deaths in the U.S. in 2015.

Aside from cancer care, US mortality is worse for all other conditions they studied. This includes diseases of the circulatory, respiratory, neurologic, and endocrine systems. We also do worse for mental and maternal health, and your favorite, trauma care.

 

[Terminalxylem]

A couple of things to consider:

1. The US public sector spending is comparable to other OECD countries. The significant gap is in private sector spending. See How does health spending in the U.S. compare to other countries?
   
2. The US has the highest gross adjusted household disposable income among OECD countries.
   

How do these facts support the notion that US healthcare spending is a huge problem?

Also, here is an economic point of view, from The Value of Life and the Rise in Health Spending:

This is also very interesting. If all that private spending resulted in better outcomes, the economists might have a point. Unfortunately, as far as I can tell, it doesn't. 

 

[Sand]

If you and your employer pay a total of $500 per month for 30 years for your insurance you’re talking about $180,000 in premiums. Can you afford to pay $75,000 out of pocket for a procedure?

That would put a bit of a dent into the hooker and blow budget...

 

[matttyl]

If you and your employer pay a total of $500 per month for 30 years for your insurance you’re talking about $180,000 in premiums. Can you afford to pay $75,000 out of pocket for a procedure?

tim is just saying you end up with a giant bill you couldn’t pay out of pocket, not that you aren’t profitable ultimately.  

I guess I'm missing your point here, but wouldn't the answer be "yes"?  As you didn't pay 180k into the system, you could pay that large bill out of pocket, and still have $100k left over.  You'd have a whole lot more, in fact, if you attach any "time value of money" into it, say even 3% over that 30 years. 

Or you you saying that you just blew that $180k that you and your employer didn't spend on insurance?