U.S. Healthcare: getting less for more
February 7, 2020 7:28 AM   Subscribe

America’s sky-high health-care costs are so far above what people pay in other countries (Peter G. Peterson Foundation) that they are the equivalent of a hefty tax, Princeton University economists Anne Case and Angus Deaton say. They are surprised Americans aren’t revolting against these taxes. Every American family basically pays an $8,000 ‘poll tax’ (per-head tax) under the U.S. health system, top economists say (Washington Post, Jan. 7, 2020) It Looks Like Health Insurance, but It’s Not. ‘Just Trust God,’ Buyers Are Told. Some state regulators are scrutinizing nonprofit Christian cost-sharing ministries that enroll Americans struggling to pay for medical care, but aren’t legally bound to cover their members’ claims. (New York Times, Jan. 2, 2020; archived link)
posted by filthy light thief (28 comments total) 28 users marked this as a favorite
 
Comments from Case and Deaton came from the 2020 annual American Economic Association conference.

If you want to dig into those health care cost figures, they come from the Organisation for Economic Co-operation and Development.

Health care in the U.S. is expensive enough that 5 of the 10 places to live abroad cheaply enough that you could retire early mention affordable health care (Forbes reporting on International Living's Annual Global Retirement Index, Jan. 2, 2020).
posted by filthy light thief at 7:29 AM on February 7 [6 favorites]


We believe in capitalism

Well bless your icy little economist hearts
posted by The Toad at 7:43 AM on February 7 [13 favorites]


Not only do we pay more for healthcare in the US, we have one of the lowest life expectancies of any OECD country. Now there's lots of things that could cause low life expectancy but shitty healthcare is clearly one of the big contributing factors.
posted by Nelson at 8:15 AM on February 7 [9 favorites]




where i live there's a walk in polyclinic with prices on the wall for stuff like various blood tests, examinations, vax, etc etc.

i still can't get over it. i know it's for expats and expensive for locals, but it's still less than or equal to my co-pay with really good insurance back in the states.

a price list. on the wall. at the doctor's office.
posted by affectionateborg at 8:25 AM on February 7 [17 favorites]


We're too sick to revolt.
posted by The Underpants Monster at 8:39 AM on February 7 [9 favorites]


I think a lot of Americans don't think about the costs (or at least the premiums) because with employer coverage, it's deducted pre-tax, and with direct deposit, you won't see it unless you log into your company's payroll website and take a look at your pay stub and look at all of the deductions that happen.

Also plenty of people think "I have good insurance" because the system is set up so it covers routine health stuff well enough to avoid general outrage, and only gets really expensive if you have something serious happen like cancer or major surgery.

In general, Americans are ignorant of how other countries provide healthcare, and it gets hushed up with cries of SOCIALISM, TAXES, etc.
posted by Fleebnork at 8:42 AM on February 7 [33 favorites]


yep - they think they'll pay more because they have no idea what they're actually paying now.

and are worried it's gonna run out like a limited edition and they won't get any.
posted by affectionateborg at 8:47 AM on February 7 [3 favorites]


nonprofit Christian cost-sharing ministries ... aren’t legally bound to cover their members’ claims.

First of all, this is just terrible, and shouldn't be legal (I dunno, implied contract or something? Seems like there oughta be some legal terrain that could be used against them).

Second, I am sorry, but apparently requiring a "christian lifestyle"? That should be a pretty big red flag. These days, any time someone starts talking about being "christian" they are either preparing to rip you off, or else justifying why they themselves got ripped off and why you should also get ripped off.
posted by aramaic at 8:52 AM on February 7 [18 favorites]


America’s health care prices problem, in four charts

Why U.S. Health Care Is Obscenely Expensive, In 12 Charts (HuffPost, Oct. 03, 2013; updated Dec. 06, 2017)

We're too sick to revolt.

Also, we're the proverbial frog in boiling water. Health care costs grew at the rate of the GDP from ~1960-1965 (graphic from HuffPost article), but between 1960 and 2010(ish), have grown 818%, compared to 168% growth for GDP and 16% for wages, in that same time period.
posted by filthy light thief at 8:53 AM on February 7 [13 favorites]


We believe in capitalism

I doubt they really do because every US dollar is co-owned by the American people, who print and guarantee it. So capitalism really only means that the profit taker must settle with the nation, because we were printing money to create an economic engine that works by allowing producers to create demand, then allowing them to profit from the risk, but not allowing them to monopolize or swindle. If it fails us at any time or in any sector, then we should just print money to give to suppliers based on contracted distribution of their product, no profit allowed, because they never had to take a risk or create demand. That latter is always an option for things like public utilities, though not preferred for most things, because then our sundry demands are dictated by dictators. So the cost of doing business in America is settling with the capitalist owners, who are not the producers at all, but the American people who went along with a method for innovation, not as public charity for entitled producers (which is what feudalism believes in, and its privatized government).
posted by Brian B. at 8:59 AM on February 7 [1 favorite]


Not only do we pay more for healthcare in the US, we have one of the lowest life expectancies of any OECD country. Now there's lots of things that could cause low life expectancy but shitty healthcare is clearly one of the big contributing factors.

Well, sure, you may be sick and in poverty and dying sooner, but you are creating value for shareholders. Let is not cloud this golden fact with irrelevancies.
posted by ricochet biscuit at 9:12 AM on February 7 [15 favorites]


As with just about any other industry in America, the business of healthcare is essentially that of redistribution—redistributing the income (in the form of premiums), along with what modest wealth remains, of workers to capitalists. American healthcare isn't meant to cure you, but to make capitalists rich. It's that simple. And I say this as someone whose research intersects a lot with the health policy field.

This is summed up in Prasad's Law: Medical goods and services that concentrate wealth can be paid for; medical goods and services that disperse wealth are “unaffordable.”
posted by un petit cadeau at 9:21 AM on February 7 [22 favorites]


I think a lot of Americans don't think about the costs (or at least the premiums) because with employer coverage, it's deducted pre-tax, and with direct deposit, you won't see it unless you log into your company's payroll website and take a look at your pay stub and look at all of the deductions that happen.

I actually think this is where a lot of the grumbling is starting to come from. It was true for a long time that employer coverage was just something you had, it didn't take a giant bite out of your pay, and you were covered when you went to the doctor. This is changing in a big way for a lot of people. I have what's considered to be decent insurance. It's a HDHP plan with a $4000 deductible and I pay $7500 per year to cover the two of us. If it was just myself, it'd be about $170 a month with a $2k deductible. But her job doesn't offer insurance. The plans on the exchange are worse (thanks Trump) for more money. Add the premiums and what I put in the HSA and that's over $10,000 a year. The HDHP is the least expensive plan offered. If you have kids and therefore need family coverage... oof, that's gonna hurt. Looking back several years, I'm no better off than I was, despite getting yearly raises. The raises have been swallowed up by health insurance increases. And I have it better than a lot of people. The yearly benefit enrollment comes up and people see what they're going to be paying for insurance the next year, as companies pass more and more costs onto employees, and people are starting to notice.

I have a co-worker who ranted and raved against Obamacare because she was afraid it was going to take away her current plan, which was extremely good. (Yeah, that was not going to happen.) She has coverage through her husband. Very low premiums, deductibles and co-pays because he was at an employer that had an excellent benefit package. She swore that there was nothing wrong with healthcare and that they were going to mess everything up to give coverage to people who weren't earning it (yeah...) "They had better not mess up my coverage!" Then her husband changed jobs, and she was navigating the new landscape for benefits. Holy shit did that noise end quick. She was absolutely shocked at how much premiums and deductibles were on the new plans. I told her, you do the books, you know how much I make, you know how much I pay for my benefits, what the hell did you expect? She grumbles about the health care system now.

The article talks about health care costs being in essence a tax, and I strongly agree. I've been saying for years to people who rant about taxes to stop and think how much money they give insurance companies every year. Health, car, home, etc. It's pretty staggering. When they rant about socialized medicine, all I say is that in other countries they pay far less and have better outcomes and life expectancy, but hey the "greatest county in the world" can't seem to figure it out.
posted by azpenguin at 9:28 AM on February 7 [21 favorites]


It's pretty cool, though. If it was a tax, then corporations wouldn't be getting very much of it as the govt would control the hell out of costs. This way, that $8000 is almost entirely profit. That's capitalism, baby, American style! Pick an industry, and follow the easy steps:

1) regulatory capture
2) erode health and welfare of 329 million+ people
3) profit!
posted by seanmpuckett at 9:31 AM on February 7 [9 favorites]


Also plenty of people think "I have good insurance" because the system is set up so it covers routine health stuff well enough to avoid general outrage, and only gets really expensive if you have something serious happen like cancer or major surgery.


I wonder what the rate of popular support for MFA is among diabetics vs. in the general populace.

Because when I have "good" insurance where the premium jumped by 20% from 2019 to 2020 with no corresponding increase in anything but their profit, and the first two routine pharmacy visits of the year cost about as much as three months of my mortgage, I know what my political priorities are.
posted by Foosnark at 9:51 AM on February 7 [5 favorites]


Not only do we pay more for healthcare in the US, we have one of the lowest life expectancies of any OECD country. Now there's lots of things that could cause low life expectancy but shitty healthcare is clearly one of the big contributing factors.

It doesn't hurt that we also lag far behind the rest of the developed world in elementary mathematics, wherein one would nominally learn the difference between mean and median outcomes. Turns out, giving everyone pretty-good coverage gives very different results than letting the ultra-wealthy buy whatever healthcare they want while everyone in the 25th percentile or below dies of preventable disease before they hit 70.
posted by Mayor West at 10:00 AM on February 7 [8 favorites]


This is one of the most depressing comment threads.. and I'm not from the US.. but just north of you, where single-payer healthcare has worked very well for generations.. well, it exists in a very tenuous position. More and more the people who win elections seem to be looking for weaknesses, looking for ways to shift us right over to the model where you get the Best Healthcare Money Can Buy if you know what I mean.
posted by elkevelvet at 10:02 AM on February 7 [6 favorites]


the Best Healthcare Money Can Buy if you know what I mean.

I live there too, and know all too well what you mean. I was diagnosed years ago with a degenerative and incurable neurological condition. Glad news arrived a couple of years ago in the form of a twice-yearly infusion which, by all evidence of the clinical trials, will halt any further damage. The bad news: the out-of-pocket cost would be about $75k, which is actually more than I make in a year these days.

The good news: the drug company has a "compassionate care" program for those who cannot afford the drug. My last year of infusions (the first year I was receiving them) was at no cost to me. The bad news: they called a couple of days ago with news that they were revamping the program (no doubt "to serve you better") and henceforth there would be a deductible, equal to about a quarter of my annual income.

I said I was not really in a position to pay this and I might have to discontinue the treatment: being slightly better off healthwise is not that necessarily that great if I am homeless. The CSR was quick to point out that that would still cover a significant portion of the cost of the infusion; I relied that it was not so much that the portion as the actual dollar figure I was going to be on the hook for -- if the stuff cost a million dollars a year, I would no more be able to cover the slice of the pie I was going to billed for than with the $75k. She then clarified that the drug company is committed to providing coverage to its patients and "even if you made five million a year," I would have the same options.

It is nice when a pharmaceutical company flat-out declares that they are as concerned with easing the financial burden on multimillionaires as much as on disabled people near the poverty line.
posted by ricochet biscuit at 10:35 AM on February 7 [20 favorites]


To add to my above comment, I have "good" insurance, meaning my coverage is good, but I certainly pay for it. My premiums are $1,800 per month for two adults and one child. My work covers about half of that, so my premiums are about $900 per month pre-tax.
posted by Fleebnork at 10:53 AM on February 7 [2 favorites]


Our premiums are $2300 a month. For two adults. And we own the business so we pay for ALL of that. This is for supposed "good" insurance. That, after insurance still managed to charge me almost $12,000 for a CAT Scan and a short 1.5 day hospital stay for a non-critical procedure.

While I was in Spain last year I researched getting an MRI. It was less than one third the cost than the US. However, if I did it from what babble I could get from our rep my insurance would force my sports med doc to charge almost twice the amount to look at it.

The mighty market at work!
posted by Everyone Expects The Spanish Influenza at 11:25 AM on February 7 [3 favorites]


Many Americans seem to have the "I have mine so everything is fine" mentality regarding things like health care. I think I read an article about daycare with the same sort of message: "Wow, I thought the system was fair until I was fucked over by it." Yeah.

Note: I was kinda fucked over by "Obamacare" when I was unemployed for a few months because that wasn't considered a "hardship" so I had to pay the tax penalty. But I still didn't want it to change because it provides a common good to all of us.
posted by Young Kullervo at 11:28 AM on February 7 [5 favorites]


I'm always shocked when I get my W2 and it lists a line item of how much my employer paid for my health coverage, which is only there because of the ACA. I'd love to see those numbers get a lot more visibility, because a once a year sticker buried in a form isn't going to awaken most people to the true cost of their healthcare. It needs to be shoved in peoples faces as much as possible to show them how much is being spent on their behalf.
posted by msbutah at 11:48 AM on February 7 [1 favorite]


we have one of the lowest life expectancies of any OECD country

U.S. Has The Worst Rate Of Maternal Deaths In The Developed World (NPR, May 12, 2017) NPR and ProPublica teamed up for a six-month long investigation on maternal mortality in the U.S. Among our key findings:
- More American women are dying of pregnancy-related complications than any other developed country.
- Federal and state funding show only 6 percent of block grants for "maternal and child health" actually go to the health of mothers.
- In the U.S, some doctors entering the growing specialty of maternal-fetal medicine were able to complete that training without ever spending time in a labor-delivery unit.


We finally have a new US maternal mortality estimate. It’s still terrible. Among 10 similarly wealthy countries, “the US would rank 10th.” (Vox, Jan. 30, 2020)

Among 20 wealthy nations, US child mortality ranks worst, study finds (CNN, January 8, 2018) "This study should alarm everyone. The US is the most dangerous of wealthy, democratic countries in the world for children," said Dr. Ashish Thakrar, lead author of the study and an internal medicine resident at Johns Hopkins Hospital and Health System in Baltimore. "We were surprised by how far the US has fallen behind other wealthy countries," he said. "Across all ages and in both sexes, children have been dying more often in the US than in similar countries since the 1980s."

Huh, the 1980s, what went on in the 1980s... it's on the tip of my tongue...
posted by Iris Gambol at 12:18 PM on February 7 [8 favorites]


My kid takes an orphan medication for his rare disease; it costs about $6000 for each 25mL bottle. My kid takes this medication three times per day; one bottle lasts us 4 days. The total list price is about $550,000 per year for that medication alone (he takes another that is compounded for him every two weeks and has a list price of about $2800 per year). The pharma company has a “copay assistance” program in part because they don’t want families to see a bill for the medication that includes the medication list price. Who knew how they would organize or what they would demand if they knew? Keeping Americans in the dark ensures the continuation of this bullshit.

I could go on for pages about the extreme difficulty I’ve had obtaining this medication for my child, and the quantity of fuck-ups I’ve experienced via shady mail-order specialty pharmacies (fuck you, Accredo! and fuck you, Walgreens Prime Alliance RX!). Yesterday my husband said, “I always wondered why someone looking at the med cost wouldn't think, ’I need to get my best people on this.’” I mean, I’m thankful that this medication exists and that I know how to navigate the system and hassle people via multiple angles and multiple levels to make sure that we don’t run out of it, but the system is so fucking broken.
posted by Maarika at 1:18 PM on February 7 [17 favorites]


That article about the fake Christian not-insurance companies is horrifying. Even more so the comments, many of which are from medical professionals who have encountered patients who learn the ugly truth about how badly they’ve been cheated when a serious medical situation arises. It’s devastating.
posted by Sublimity at 2:42 PM on February 7 [4 favorites]


I was talking to a drunk medical device sales rep ("I make doctors rich") about the high cost of healthcare. Her words: "I'm a big fan of survival of the fittest."
posted by RobotVoodooPower at 8:06 PM on February 7


We have terrible health outcomes AND very little access to self-euthanasia.
posted by The Underpants Monster at 11:16 AM on February 8


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