Life expectancy vs. Health expenditure

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Telmo Menezes

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Jul 14, 2022, 8:13:20 AMJul 14
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I am curious about what Americans in this list think about this:


Telmo

Lawrence Crowell

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Jul 14, 2022, 8:30:39 AMJul 14
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It is something I am reasonably aware of.

LC

Terren Suydam

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Jul 14, 2022, 8:34:18 AMJul 14
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Hi Telmo,

I’d want to know how they adjust for price differences between countries, as that could be a subtle way to introduce bias. But as an American and assuming the above is kosher, it doesn’t surprise me at all. Health care here is a worst case scenario. It’s the result of decades of anti competitive practices and perverse incentives. But you knew that!

Terren

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Telmo Menezes

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Jul 14, 2022, 8:45:02 AMJul 14
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Hi Terren,

You are right, I know that. I have the impression that a bad health situation can ruin people in the US. I have heard of stories of people refusing to call an ambulance after a serious accident, for fear of the bill. I think that another country were this is the case is South Korea. A colleague told me that it is common there for people there to invest in a second home, to use it to pay for the health bill in case they get cancer or something serious like that.

I guess what perplexes is that people seem to be more or less ok with this, when there is overwhelming evidence that a better systems is possible.

Telmo

Jason Resch

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Jul 14, 2022, 9:38:54 AMJul 14
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The graph begins to make a little more sense if one replaces the term "healthcare" with a more reality-representing term: "sickcare".

Healthy people don't need to spend a lot of money on their health.

This doesn't explain it all, but the relationship begins to become more intuitive when viewed this way: an unhealthy (but wealthy enough to spend a lot of money) population will spend more on sickcare, and will have worse health outcomes than healthier populations.

The US is one of the most obese nations on this chart. I recall reading some statistic that said if we returned to 1975 obesity levels we could reduce government health spending by 400 billion annually.

Of course obesity is just one aspect of many that might lead to poor health and shorter life expectancy in the US. (Insufficient preventative care, subsidized cheap and unhealthy foods, high stress jobs with little vacation, the opioid epidemic, prevalence of dysfunctional schools, etc.)

And all this is before exploring any of the many reasons we pay high costs for the sickcare we get (rationing of licensed doctors and treatment facilities, prohibitions on reimporting cheaply exported drugs, administrative and insurance overheads, lack of price transparency, emergency rooms as default care facilities for those who can't afford doctor appointments, medical malpractice insurance and high rates of lawsuits, multi-billion dollar cost of new drug development, etc.)

A lot has to be fixed. Unfortunately, the root of the problem may stem from a misalignment of objectives. In the same way private prisons work to incarcerate more prisoners, for-profit sickcare is discouraged from working towards a healthier population (which doesn't need as much of their services). If we could design a reward system where the decision makers in power were rewarded based on the health and well-being of the population as a whole, I think things would look very different.

Jason

Terren Suydam

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Jul 14, 2022, 10:14:57 AMJul 14
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Hi Jason,

One encouraging innovation that is beginning to pick up steam is subscription-based health care, and insurance companies are starting to come on board. You pay a monthly fee and get unlimited access to your primary-care doctor. It's a huge improvement because the incentives are much better aligned - in this model, the doctor's office is incentivized to keep people out of the office. In the existing model it's the opposite.

Terren

Terren Suydam

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Jul 14, 2022, 10:18:16 AMJul 14
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Hi Telmo,

I wouldn't say that people are ok with this. Even the people who are against universal health care recognize how broken the system is. I'd say it's more of a learned-helplessness kind of thing - there isn't much the average person can do about it.

Terren

Jason Resch

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Jul 14, 2022, 11:13:27 AMJul 14
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That's encouraging. Thanks for telling me.

I heard a claim, not sure if it's true, but that in China people pay their doctor for every month that they are healthy.

Makes sense to me. 🙂

Jason

Dirk Van Niekerk

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Jul 14, 2022, 12:39:11 PMJul 14
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The original source is here:

The source of healthcare expenditure data is the WHO:

Dirk

John Clark

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Jul 14, 2022, 2:12:03 PMJul 14
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On Thu, Jul 14, 2022 at 8:13 AM Telmo Menezes <te...@telmomenezes.net> wrote:

> I am curious about what Americans in this list think about this:

A good companion to your graph would be this one, and together they tell me that the US healthcare system is by far the most inefficient in the world. People have been trying to improve it for years but conservatives cry bloody murder every time anybody tries to change to the status quo.  

image.png

John K Clark    See what's on my new list at  Extropolis

6cx

 

Dirk Van Niekerk

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Jul 14, 2022, 2:30:21 PMJul 14
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I assume you meant this tongue in cheek, but that would be a terrible system.  If I were a doctor in China I would make sure to only take on young healthy patients.  No obese diabetic smokers for sure.

Dirk

Brent Meeker

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Jul 14, 2022, 3:41:57 PMJul 14
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If I take my money and move to Spain I'll liver forever.

Brent

spudb...@aol.com

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Jul 14, 2022, 4:11:08 PMJul 14
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Well assuming the accuracy of the graph, I would factor in the money spent on emergency room visits, which since the 1980's those who are deemed unable to pay for treatment medical bills are written off.
Your Rights in the Emergency Room (webmd.com)

Also, I wonder whether one factors in population size of various nations, including legal immigrants and illegal. As of today for example, the governor of California signed in a new law mandating medical care for undocumented migrants.

We'll get to see how this unfolds? 

spudb...@aol.com

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Jul 14, 2022, 4:12:00 PMJul 14
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I have also heard Jason, that if the patient dies, no bills are charged. 

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spudb...@aol.com

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Jul 14, 2022, 4:13:39 PMJul 14
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The main thing is that whatever goes for medical R&D is insufficient. 


-----Original Message-----
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Sent: Thu, Jul 14, 2022 9:38 am
Subject: Re: Life expectancy vs. Health expenditure

Dirk Van Niekerk

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Jul 14, 2022, 4:51:24 PMJul 14
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1) The data considers all costs including emergency room visits for all countries
2) The denominator is population census data which in most OECD countries would include refugees and illegal aliens.

Dirk

spudb...@aol.com

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Jul 14, 2022, 5:03:52 PMJul 14
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Very good. Thanks, Dirk. 

I am more about the advances to be obtained if we are able to push medicine and tissue engineering much faster? If we obtain advances, the money will follow. 




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spudb...@aol.com

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Jul 14, 2022, 7:11:53 PMJul 14
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Diabetic smokers can last a long while, long enough to make it profitable. Plus in China they have both modern medicine and traditional medicine to choose from. For adult onset diabetes, it has to run up against all the walking the all the Han do, to work, and market, etc. That limits the damage of the sedentary lifestyle by many nations. 


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Sent: Thu, Jul 14, 2022 2:30 pm
Subject: Re: Life expectancy vs. Health expenditure

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Brent Meeker

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Jul 14, 2022, 7:27:34 PMJul 14
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On 7/14/2022 1:11 PM, spudboy100 via Everything List wrote:
Well assuming the accuracy of the graph, I would factor in the money spent on emergency room visits, which since the 1980's those who are deemed unable to pay for treatment medical bills are written off.
Your Rights in the Emergency Room (webmd.com)

Typical Republican whataboutism.  You're "just asking" about the accounting for some small factor, while you're staring at the evidence that we pay TWICE what other advanced nations pay and don't get as good a results.



Also, I wonder whether one factors in population size of various nations, including legal immigrants and illegal.

It says right across the bottom "per capita".


As of today for example, the governor of California signed in a new law mandating medical care for undocumented migrants.

You don't know the difference between "mandating" and "offering"??  The premiums for Medi-Cal for Families are $13 for each child and no more than $39 per family per month.  Newsom is offering it.

Brent


We'll get to see how this unfolds? 

-----Original Message-----
From: Telmo Menezes <te...@telmomenezes.net>
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Sent: Thu, Jul 14, 2022 8:12 am
Subject: Life expectancy vs. Health expenditure

I am curious about what Americans in this list think about this:


Telmo
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Telmo Menezes

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Jul 15, 2022, 11:06:31 AMJul 15
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Am Do, 14. Jul 2022, um 15:38, schrieb Jason Resch:
The graph begins to make a little more sense if one replaces the term "healthcare" with a more reality-representing term: "sickcare".

Healthy people don't need to spend a lot of money on their health.

This doesn't explain it all, but the relationship begins to become more intuitive when viewed this way: an unhealthy (but wealthy enough to spend a lot of money) population will spend more on sickcare, and will have worse health outcomes than healthier populations.

The US is one of the most obese nations on this chart. I recall reading some statistic that said if we returned to 1975 obesity levels we could reduce government health spending by 400 billion annually.

Of course obesity is just one aspect of many that might lead to poor health and shorter life expectancy in the US. (Insufficient preventative care, subsidized cheap and unhealthy foods, high stress jobs with little vacation, the opioid epidemic, prevalence of dysfunctional schools, etc.)

Another thing that might contribute to this is the degree of car-centrism in the US. One of my culture shocks there was noticing how easy it is to not be in walking distance from anywhere, and how you can get away with basically not walking almost at all.

And all this is before exploring any of the many reasons we pay high costs for the sickcare we get (rationing of licensed doctors and treatment facilities, prohibitions on reimporting cheaply exported drugs, administrative and insurance overheads, lack of price transparency, emergency rooms as default care facilities for those who can't afford doctor appointments, medical malpractice insurance and high rates of lawsuits, multi-billion dollar cost of new drug development, etc.)

A lot has to be fixed. Unfortunately, the root of the problem may stem from a misalignment of objectives. In the same way private prisons work to incarcerate more prisoners, for-profit sickcare is discouraged from working towards a healthier population (which doesn't need as much of their services). If we could design a reward system where the decision makers in power were rewarded based on the health and well-being of the population as a whole, I think things would look very different.

In Germany there are standardized monthly payments (and assistance for those who cannot pay it), but both insurers and health care providers have to compete for the taxpayers "business". This prevents people from being finantially ruined by a health crises (or incapable of obtaining treatment), while at the same time promoting competition between providers. I think it is a good system, and perhaps sufficiently far away from "communism" to be acceptable in the US. Or perhaps not.

Telmo

Telmo Menezes

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Jul 15, 2022, 11:13:33 AMJul 15
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Am Do, 14. Jul 2022, um 21:41, schrieb Brent Meeker:


If I take my money and move to Spain I'll liver forever.


Yes, and keep in mind that a lot of Spaniards smoke! You just have to stay away from the delicious (but extremely fatty and salty) "jamón ibérico" and you will be fine :)

Telmo


Brent





On 7/14/2022 5:12 AM, Telmo  wrote:
I am curious about what Americans in this list think about this:


Telmo


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spudb...@aol.com

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Jul 15, 2022, 1:16:08 PMJul 15
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Brent Meeker

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Jul 15, 2022, 3:02:32 PMJul 15
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How are the standardized monthly payments and what they buy determined? 
I thought Germany had government negotiated prices for medical
insurance.  That's the way insurance is for US Civil Servants, including
Congress.  Insurance companies offer different plans and they are
negotiated with the government to meet certain minimum standards.  Then
civil service employees can select one of the plans based on what they
cover, deductibles etc.  I've long thought that instead of Medicare,
they should just have expanded the Civil Service plan to everyone which
subsidies for poor and unemployed persons.

Brent

Brent Meeker

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Jul 15, 2022, 3:32:34 PMJul 15
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I don't know who said it.  Can you quote them?  Were they right?

Brent

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