[yellowstuff]

A post from RCA's blog a year ago addresses that more directly:

https://randomcriticalanalysis.com/2018/11/19/why-everything...

He argues very convincingly that high income leads to high health care spending very directly. Not only is the US not an outlier in terms of inefficiency, but he can't find any compelling examples of countries significantly improving on health care spending predicted by actual household income. (Other countries have better health outcomes, but not significantly less spending relative to income.) So while common sense indicates that there's lots of room to reform the system, analysis of data from around the world indicates that no one's been able to do much to avoid spending roughly a fixed percent of actual income on health care.

> The most successful cost containment regime in the OECD was probably the UK (NHS), which was perhaps an accident of history. They rationed particularly aggressively and managed to hold costs substantially below what we would expect for a country of its wealth for a few more years than usual.

> However, people (voters) ultimately wouldn’t stand for it, so this rationing effort was radically reduced (budgets expanded). Today they are much closer to expected spending levels.

[beagle3]

First time I hear of RCA, I will have to read the analysis to evaluate, and it might already have been addressed, but ...

a) many (perhaps the majority, don't have time to source now) of the bankruptcies in the US are due to medical issues and spending, and at least 75% IIRC of those going bankrupt from medical spending HAD insurance. This is practically unheard of outside the US.

b) The rate of growth of US spending on healthcare, especially government spending on healthcare, far outstrips the rate of growth of money / wages / any other measure of something that can pay for it.

c) The same medicines by the same manufacturers and often the same production lines (not just equivalents or generics, which are much cheaper still!) often cost 10-100 times more in the US than they do in other places. The DaraPrim and QuestCor cases are famous for being outliers, but they are only outliers in the speed of price increase, not in the fact that prices in the US (but not outside the US) keep going up irrespective of costs.

It was not until I lived in new york that I heard gainfully employed people say things like "I have to stitch my cuts my self because I cannot afford medical care"; neither could I understand George Carlin's "dirty doctor" joke.

So perhaps the overall spending/GDP analysis is not direct proof, but the US medical and healthcare system is very, very sick. Karl Deninger at the https://market-ticker.org has been documenting these atrocities very dilligently since 2007.

[rcafdm]

> a) many (perhaps the majority, don't have time to source now) of the bankruptcies in the US are due to medical issues and spending

The vast majority of medical bankruptcies have nothing to do with the cost of medical care, but the disruption to career/income flow imposed by illness. This is clearly a problem in other countries as well.

https://www.nejm.org/doi/pdf/10.1056/NEJMp1716604

> The rate of growth of US spending on healthcare....far outstrips the rate of growth of money

This is true in other OECD countries too. Further, this doesn't mean what you think it does. As our productivity rises, the share spent on consumption categories with high productivity growth (increasingly low relative prices) can decline, which frees up spending to be spent on health and other areas subject to less productivity growth (the majority of the expenditure growth corresponds to rising real health consumption tho)

https://randomcriticalanalysis.com/2019/12/03/no-means-no-th...

> The same medicines by the same manufacturers and often the same production lines ... often cost 10-100 times more in the US than they do in other places

One might be able to find outliers of this sort, but that clearly doesn't reflect anything close to central tendencies (mean, median, mode, etc), especially when compared (accurately) to other high-income countries. Richer countries, like the US, generally pay relatively higher prices.

The US may pay a somewhat higher premium, but there are tradeoffs here vis-a-vis incentivizing innovation in the long run. It's also not widely appreciated that the US pays markedly less for generics....