Green New Deal

[mspohr]

The economy isn't getting better for most Americans. But there is a fix

The economy isn't getting better for most Americans. But there is a fix | Heather Boushey

The economy is getting bigger, but not better. Not for most Americans, anyway. In the United States, additional income from productivity and growth has been going mostly to those at the top of the income and wealth ladder. Between 1979 and 2016, the US national income grew by nearly 60%, but after accounting for taxes and transfers, the bottom half of the income distribution experienced incomes rising by 22%, while those in the top 10% had income gains that were almost five times as much – 100%.

 

[SageBrush]

But these measures obscure an important fact of American life: Unlike workers in many other countries, the vast majority of American employees have private health insurance premiums deducted from their paychecks.

True for those with insurance, but if that is the group you want to talk about then be sure to include the employer contribution.

It is hard to believe but I think close to true that a working class USA family eats up about $1,000 a month in healthcare costs when all the inputs are considered. IIRC this about matches the numbers when fraction of GDP is used.

Sick, fat, demanding population = expensive healthcare. My somewhat fuzzy estimate is that a society with a healthy lifestyle and willingness to forgo the last year of life dance that Americans currently practice would have 1/10 the overall costs; and of course a *much* higher quality of life in the 5th through 8th decades.

 

[jerry33]

It is hard to believe but I think close to true that a working class USA family eats up about $1,000 a month in healthcare costs when all the inputs are considered.

That's probably a minimum for a two person household when you add eye care (the eye care insurance value is close to zero) and dental (similar, doesn't even cover normal examinations). The sad part is that most appears to go to paperwork, liability insurance, and CEO salaries. It certainly doesn't go to the healthcare staff.

 

[mspohr]

True for those with insurance, but if that is the group you want to talk about then be sure to include the employer contribution.

It is hard to believe but I think close to true that a working class USA family eats up about $1,000 a month in healthcare costs when all the inputs are considered. IIRC this about matches the numbers when fraction of GDP is used.

Sick, fat, demanding population = expensive healthcare. My somewhat fuzzy estimate is that a society with a healthy lifestyle and willingness to forgo the last year of life dance that Americans currently practice would have 1/10 the overall costs; and of course a *much* higher quality of life in the 5th through 8th decades.

Numerous studies have documented that US parents do not visit the doctor or hospital more than in other developed countries. Can't blame patients for high costs. It's the price charged by medical industry and private insurance profits.

 

[S'toon]

True for those with insurance, but if that is the group you want to talk about then be sure to include the employer contribution.

It is hard to believe but I think close to true that a working class USA family eats up about $1,000 a month in healthcare costs when all the inputs are considered. IIRC this about matches the numbers when fraction of GDP is used.

Sick, fat, demanding population = expensive healthcare. My somewhat fuzzy estimate is that a society with a healthy lifestyle and willingness to forgo the last year of life dance that Americans currently practice would have 1/10 the overall costs; and of course a *much* higher quality of life in the 5th through 8th decades.

I submit to you that Americans go to see the doctor less than people in other countries. You never hear of people in Canada not going to see the doctor because of the worry about co-payment. In the US people often go untreated for serious conditions because of the fear of cost.

 

[jerry33]

I submit to you that Americans go to see the doctor less than people in other countries. You never hear of people in Canada not going to see the doctor because of the worry about co-payment. In the US people often go untreated for serious conditions because of the fear of cost.

The choice in the U.S. is between not knowing and dying or knowing, going bankrupt, becoming homeless, and then dying.

 

[SageBrush]

Let's start with diabetes and obesity, courtesy of the CDC:

The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were estimated to be $147 billion.15
The annual nationwide productive costs of obesity obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual)16.


The total direct and indirect estimated cost of diagnosed diabetes in the United States in 2012 was $245 billion.
Average medical expenditures for people with diagnosed diabetes were about $13,700 per year. About $7,900 of this amount was attributed to diabetes.


Deaths and Cost | Data & Statistics | Diabetes | CDC
Adult Obesity Causes & Consequences | Overweight & Obesity | CDC

 

[mspohr]

Let's start with diabetes and obesity, courtesy of the CDC:

The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were estimated to be $147 billion.15
The annual nationwide productive costs of obesity obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual)16.


The total direct and indirect estimated cost of diagnosed diabetes in the United States in 2012 was $245 billion.
Average medical expenditures for people with diagnosed diabetes were about $13,700 per year. About $7,900 of this amount was attributed to diabetes.


Deaths and Cost | Data & Statistics | Diabetes | CDC
Adult Obesity Causes & Consequences | Overweight & Obesity | CDC

So?
How do costs compare to other developed countries?

 

[SageBrush]

So?
How do costs compare to other developed countries?

There are two "so"

1. is that these costs only apply to a population that is fat and/or diabetic
2. the other is that you are welcome to correlate obesity/diabetes with fraction of GDP spent on healthcare. That analysis is incomplete because tobacco, alcohol and last year of life spending are major covariates. Still, the simple analysis is informative.

 

[mspohr]

There are two "so"

1. is that these costs only apply to a population that is fat and/or diabetic
2. the other is that you are welcome to correlate obesity/diabetes with fraction of GDP spent on healthcare. That analysis is incomplete because tobacco, alcohol and last year of life spending are major covariates. Still, the simple analysis is informative.

Sick, fat, demanding population = expensive healthcare. My somewhat fuzzy estimate is that a society with a healthy lifestyle and willingness to forgo the last year of life dance that Americans currently practice would have 1/10 the overall costs; and of course a *much* higher quality of life in the 5th through 8th decades.

I'd just like some evidence that Americans have ten times the overall costs due to being fat (as well as demanding).
Feel free to use any other developed country (there are a few who are also fat).

Here's a good summary article to get started:
Health Costs: How the U.S. Compares With Other Countries

Pearson: It is likely that this is happening in some instances. The U.S. has fewer physicians and fewer physician consultations relative to its population. The U.S. also has fewer hospital beds for its population size and shorter average stays in hospital relative to other countries. Indeed, the lower numbers of physicians could help explain why they cost more; there is less competition for patients.

Pearson: A large amount of higher overall hospital spending in the U.S. can be explained by services costing more in U.S. hospitals rather than because U.S. hospitals are delivering more services. When we look across a broad range of hospital services (both medical and surgical), the average price in the United States is 85 percent higher than the average in other OECD countries. To put this in perspective, a hospital stay in the United States costs over $18,000 on average. The countries that come closest to spending as much — Canada, the Netherlands, Japan — spend between $4,000 and $6,000 less per stay. Across OECD countries, the average cost of a hospital stay is about one-third that of the U.S., at $6,200.

 

[SageBrush]

I'd just like some evidence that Americans have ten times the overall costs due to being fat (as well as demanding).

Considering that you quoted my statement right above your comment, I'll refer you to it.

From your prior posts I gather that you have medical school training and work experience as a public health administrator. Normalize for obesity and diabetes to the average OECD country and see how much the fraction of GDP spent on healthcare is accounted for.

Or just pause for a moment and consider that obesity+diabetes is a ~ 400 Billion annual bill in the USA. Some quick arithmetic should let you estimate the average burden that places on health insurance. And just as an aside, many of the costs of obesity are not complications that are not accounted for as obesity related.

We'll get to tobacco, substance abuse, lifestyle caused cancer, and last year of life costs shortly.

-- I find it interesting that you (rightly so!) decry AGW denialism but suffer from the same blinders when it comes to healthcare.

 

[mspohr]

Considering that you quoted my statement right above your comment, I'll refer you to it.

From your prior posts I gather that you have medical school training and work experience as a public health administrator. Normalize for obesity and diabetes to the average OECD country and see how much the fraction of GDP spent on healthcare is accounted for.

Or just pause for a moment and consider that obesity+diabetes is a ~ 400 Billion annual bill in the USA. Some quick arithmetic should let you estimate the average burden that places on health insurance. And just as an aside, many of the costs of obesity are not complications that are not accounted for as obesity related.

We'll get to tobacco, substance abuse, lifestyle caused cancer, and last year of life costs shortly.

-- I find it interesting that you (rightly so!) decry AGW denialism but suffer from the same blinders when it comes to healthcare.

I think we're talking a bit at cross purposes here.
I agree that fat lazy people have more disease. I just don't think that explains higher US health care costs.

I believe that you were saying that Americans are fat and demanding and that was the reason for high health care costs in the US.
I was trying to make the point that Americans don't make higher demands on the health care system (in spite of being fat) than other countries. The reason for high health care costs in the US is the high prices and private insurance, not excessive use of services.

Other countries have much lower health care costs in spite of having some of the same morbidity problems (fat, lazy people).

In order to bring this back to the Green New Deal topic, the Medicare for all part of the GND has a good chance of lowering health care costs by controlling prices and reimbursement and setting up a more efficient payment system.

 

[SageBrush]

When we look across a broad range of hospital services (both medical and surgical), the average price in the United States is 85 percent higher than the average in other OECD countries. To put this in perspective, a hospital stay in the United States costs over $18,000 on average. The countries that come closest to spending as much — Canada, the Netherlands, Japan — spend between $4,000 and $6,000 less per stay. Across OECD countries, the average cost of a hospital stay is about one-third that of the U.S., at $6,200.

You may want to look at revenue rather than billing. The US is (to my limited knowledge) quite unusual, perhaps unique, in collecting only a fraction of what they bill. The last university hospital I worked at averaged 30 -33% bill collection.

 

[SageBrush]

I was trying to make the point that Americans don't make higher demands on the health care system (in spite of being fat) than other countries.

What evidence would you offer to back up that assertion ?

 

[SageBrush]

I agree that fat lazy people have more disease. I just don't think that explains higher US health care costs.

We should also be able to agree that the USA has much greater levels of obesity and diabetes than the averaged OECD country.

Put the two together and we should be able to agree that the USA is a much sicker country.

 

[mspohr]

You may want to look at revenue rather than billing. The US is (to my limited knowledge) quite unusual, perhaps unique, in collecting only a fraction of what they bill. The last university hospital I worked at averaged 30 -33% bill collection.

This graph is actual spending, not "billing" prices.

 

[mspohr]

What evidence would you offer to back up that assertion ?

Here's a good reference.
How U.S. utilization and price of healthcare compare to other countries - Peterson-Kaiser Health System Tracker

Along with Switzerland, the U.S. has the fewest physician consultations per capita among comparable OECD countries. Twenty years ago, the U.S. had roughly half as many physician consultations per capita than comparable OECD countries, and the gap has remained generally consistent over time, even as consultation use has grown in both the U.S. and other countries. As noted in our earlier analyses, the U.S. also has fewer physicians per capita than the average of comparable counties and about one in every ten adults in the U.S. (11%) report that they delayed or went without needed medical care due to cost in 2013.

Notably, the U.S. performs fewer coronary angioplasty surgeries and more coronary bypass surgeries than comparable OECD countries, and the number of coronary angioplasties performed in the U.S. is declining. (Both procedures are used to treat heart disease, but bypass surgery is generally recommended for patients with the most severe disease.) For both procedures, prices are substantially higher than in comparable countries with available data.

Health Care Utilisation
Detailed data.

Hospital discharges per 100,000 for diabetes:
US 203 puts us behind Hungary (372), Austria(341), Germany(278), Czech, and Poland

 

[SageBrush]

We can certainly agree that the US spends a lot more money per capita on healthcare. Our disagreement is why. You think it is due to greedy, criminal doctors (there are a couple) and in general an inefficient, expensive system and I say it is overwhelmingly due to much higher rates of expensive morbidity and choice in care.

Here is a good abstract from the UK using I think 2010 data that tries to tabulate the cost of care of people with diabetes compared to a control group.This is a smart approach since it circumvents the problem of choosing what to attribute to diabetes. Cost and relative costs are reported:

Estimated costs of acute hospital care for people with diabetes in the United Kingdom: a routine record linkage study in a large region. - PubMed - NCBI

However, note that e.g., dialysis is not included. Their reference population was 3.6% diabetic and accounted for 10 - 12% of costs. I encourage you to look up diabetes prevalence in the USA.

 

[mspohr]

We can certainly agree that the US spends a lot more money per capita on healthcare. Our disagreement is why. You think it is due to greedy, criminal doctors (there are a couple) and in general an inefficient, expensive system and I say it is overwhelmingly due to much higher rates of expensive morbidity and choice in care.

Here is a good abstract from the UK using I think 2010 data that tries to tabulate the cost of care of people with diabetes compared to a control group.This is a smart approach since it circumvents the problem of choosing what to attribute to diabetes. Cost and relative costs are reported:

Estimated costs of acute hospital care for people with diabetes in the United Kingdom: a routine record linkage study in a large region. - PubMed - NCBI

However, note that e.g., dialysis is not included. Their reference population was 3.6% diabetic and accounted for 10 - 12% of costs. I encourage you to look up diabetes prevalence in the USA.

I think we will have to agree to disagree.

 

[SageBrush]

Along with Switzerland, the U.S. has the fewest physician consultations per capita among comparable OECD countries.

That is your best shot at a reference ?!

If you had practiced medicine you would realize that Europe uses GPs.