The conventional wisdom in health policy is that the United States spends far more than any other country and enjoys mediocre health outcomes. This judgment is repeated so often and so forcefully that you will almost never see it questioned. And yet it may not be true.
Indeed, the reverse may be true. We may be spending less and getting more.
The case for the critics was bolstered last week by a new OECD report that concluded:
The United States spends two-and-a-half times more than the OECD average health expenditure per person … It even spends twice as much as France, for example, a country which is generally accepted as having very good health services. At 17.4% of GDP in 2009, U.S. health spending is half as much again as any other country, and nearly twice the average.
Similar claims were made recently in The New York Times by former White House health advisor, Zeke Emanuel, who added that we are not getting better health care as a result. The same charge was aired at the Health Affairs blog the other day by Obama Social Security Advisory Board appointee Henry Aaron and health economist Paul Ginsburg. It is standard fare at Ezra Klein’s blog, at The Incidental Economist and at the Commonwealth Fund. It is also unquestioned dogma for New York Times columnist, Paul Krugman.
What are all these people missing? On the spending side, they are overlooking one of the most basic concepts in all of economics.
When you and I buy something, the cost to us is the price we pay for it. But that is not necessarily true for society as a whole. The social cost of something may be a whole lot more or a whole lot less than what people actually spend on it; and that is especially true in health care.
In the United States and throughout the developed world, the market for medical care has been so systematically suppressed that no one ever sees a real price for anything. Patients never see the real price of the care they receive; doctors never receive a real price for the care they deliver; employees never see a real premium for their health insurance, etc.
In the United States, for example, a typical doctor is paid one fee by Medicare, a different fee by Medicaid, and a third fee by BlueCross. Moreover, there are different fees for all the other insurers and for all the employer plans. These fees do not count as real market prices, however. Instead, they are artificial payments that often reflect the bargaining power of the various payer bureaucracies. When government accountants sum up all the spending on health care, therefore, they are adding artificial price times quantity, for all the separate transactions, to arrive at a grand spending total.
Here is the kicker: since each separate purchase involves an artificial price, no one knows what the aggregate number really means. To make matters worse, other countries are more aggressive than we are at shifting costs and hiding costs. They use their buying power to suppress the incomes of doctors, nurses and other medical personnel much more than the United States does, for example. In addition, formal accounting ignores the cost of rationing in other countries. In Greece, patients spend nearly as much on bribes and other “informal” payments as they do on “formal” costs such as insurance co-pays. Yet these bribes do not show up in the official statistics. Bottom line: in comparing international spending totals, we are usually comparing apples and oranges.
Let’s take doctor incomes and government health care programs. One way to pay doctors is to pay market prices — whatever fees are necessary in order to induce them to voluntarily provide medical services. Another way is to draft them and pay them little more than a minimum wage — as the government has done in the past in times of war. Obviously, the second method involves a lot lower spending figure. But to economists, the social cost is the same in both cases.
The reason? To economists, the social cost of having one more man or woman become a doctor is the next best use of that person’s talents. Instead of becoming a doctor, the pre-med student might have become an engineer, say, or an architect. So what society as a whole must give up in order to have one more doctor is the loss of the engineering or architectural goods and services the young man or woman would otherwise have produced. This cost, called “opportunity cost,” is independent of how much doctors actually get paid.
The principle also applies to other medical personnel and to buildings and equipment. The opportunity cost of a hospital, for example, is the value of a commercial office building or some other use to which those same resources could be put.
The concept of opportunity cost allows us to see that if we don’t trust spending totals in the international accounts, there is another way to assess the cost of health care. We can count up the real resources being used. Other things equal, a country that has more doctors per capita, more hospital beds, etc., is devoting more of its real income to health care than one that uses fewer resources — regardless of its reported spending.
On this score, the United States looks really good. As the table below (from the latest OECD report) shows, the U.S. has fewer doctors, fewer physician visits, fewer hospital beds, fewer hospital stays and less time in the hospital than the OECD average. We’re not just a little bit lower. We are among the lowest in the developed world. In fact, about the only area where we “spend” more is on technology (MRI and CT scans, for example), as is reflected in the second table.
Almost a decade ago, Mark Pauly estimated the cost of health care across different countries based on the use of labor (doctors, nurses, etc.) alone. The finding: The U.S. spends a lot less than such northern European countries as Iceland, Sweden and Norway and even less than Germany and France!
What about outcomes? Do we get more and better care for the resources we devote? Here the evidence is mixed. As the second table shows, we replace more knees per capita than any other country and it’s hard to believe that any of these are unnecessary procedures. On the other hand, if you think that there are too many tonsillectomies and Caesarean births, our ranking there (2nd and 8th, respectively), may be less admirable. Avik Roy has a nice presentation of cancer survival rates. The U.S. basically leads the world.
What about life expectancy statistics — a favorite of the critics, since Americans don’t score very high? It turns out that when you remove outcomes doctors have almost no impact on — death from fatal injuries (car accidents, violent crime, etc.) — U.S. life expectancy jumps from 19th in the world to number one!
This isn’t to say we don’t have problems. There is a lot of evidence of waste and inefficiency in U.S. health care. Still, it’s not clear that we have any reason to feel inferior to the rest of the world.
John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.
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«Vous savez vraiment votre truc … Continuez votre bon travail! “
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Everyone who reads these 2 statements will realize that your definition of “best” has become near meaningless and that your argument is therefore of little value, since it relies only on spin/unfounded assumptions.
“I did not have sexual relations with that woman”
“It’s hard to argue with you, nate, when you arguments remain a blurry but moving target:”
How are those two statements in conflict with each other? You don’t have to have all 100 of the top 100 hospitals to still have the best care overall.
How much more simple do I need to state things for you?
It’s hard to argue with you, nate, when you arguments remain a blurry but moving target:
Nate 1 “US has the best healthcare in the world and that is why the world comes here for healthcare”
Nate 2 “I never said we had a monopoly on centers of excellence just that we have more of the top hospitals then anywhere else.”
(Not at all surprising that a 310 Million Nation spending close to a fifth of a huge GDP on HC and a world language as native language has peak performing facilities).
“We are being told that less care is better care and if patients understood what is being done to them, they would naturally choose less.”
I strongly suspect that this is not the full story. Sure, it applies to a reasonable majority, but to me, it seems that there is a small but important subset of patients who overuse the system – I mostly perceive, as the underlying problem, a mixed bag of psychiatric/behavioral factors (mostly anxiety, in combination with physiologic symptoms) plus unrealistic expectations/attitudes (“we need to do something/investigate” – i.e. watchful waiting is never enough, “the newest is always best” etc). In that respect, referring to the reasonable majority may prove futile.
Shouldn’t be unsustainable at all. Everybody and their grandma is now advertising “patient-centered” care, which is defined as follows:
“The experience (to the extent the informed, individual patient desires it) of transparency, individualization, recognition, respect, dignity, and choice in all matters, without exception, related to one’s person, circumstances, and relationships in health care”
Note the “without exception” part.
We are being told that less care is better care and if patients understood what is being done to them, they would naturally choose less. Go for it….
so you don’t allow for any management of cost? If he and her aren’t paying for it aren’t you creating an unsustainable expense? Who tells the patient when their wishes are out of line?
I don’t have any objections to managed care if it is managed for the benefit of the patient and respecting his/her wishes whatever those may be.
“every single treatment opportunity is owed to anyone who pursues it.”
___
See Elhauge. “Allocating Health Care Morally.” 1994. This is not exactly news.
http://bgladd.blogspot.com/2009/05/us-health-care-policy-morass.html
“I am beginning to think this blog has scared away people who want to be realistic and grounded.”
No, some folks just give up on the same old banal iterative Perfectionism Fallacy whining.
“could you tell that to the Cleveland Clinic then, they go on and on about their plane that flies people here anjd world class care and how Interntaional they are. Really hurts to find out they have been lying to us this whole time.”
🙂 When you live long enough, you get to know lots of people. I just hired a fellow who trained at the Cleveland Clinic. No, they dont really take care of that many people. Having seen the insides of a couple of Saudi hospitals, I dont blame a prince for leaving there. It probably is for quality, though it is also for security. Based upon my limited encounters with Saudi royalty, I would also think it might have something to do with the availability of blonde woman while being far away from home.
What we have is an inconsistent system that provides good care if you can afford it. It provides very limited care to many of our working poor and to our welfare class.
(My training was Penn, CHOP and Hopkins. Not that great, but ok.)
Steve
Thanks Nate. I’ll give Dr. Thorpe’s paper a read tomorrow.
for some people managed care will always be a bad thing. Which is to bad becuase a sizeable portion of the population responds to it very well. From the studies I have read those enrolled in trial programs for dual eligibles respond very well and prefer it over traditional coverage from Medicare and Medicaid. This makes sense as they now have someone advocating for them and answering questions.
http://www.ahipcoverage.com/wp-content/uploads/2011/09/Dual-Eligible-Study-September-2011.pdf
see page 3-5 for good summary of the problem and what they are trying to do. Personally I think they could achieve better results if they shopped outside BUCA and the big players but something is better then nothing.
Margalit –
I’m not sure I understand what your reference to “herding people into managed care” means. In the context of the dual eligible population, it includes everything from more thorough discharge planning following hospitalizations in order to reduce readmissions to health coaches to having patients report their weight and blood pressure daily or at appropriate intervals to catch deterioration in chronic conditions like CHF sooner rather than later. It also includes the use of electronic records so that multiple doctors treating most of these patients know what each other is doing or recommending. Increasing the use of living wills and advance directives is extremely helpful in order to reduce futile and/or often unwanted aggressive care at the end of life. There is plenty of room for improved oversight of care that takes place within skilled nursing facilities as well. In short, there are lots of opportunities to reduce the cost of caring for this medically expensive population. It’s not about herding them into some bare bones HMO.
Going only to sites where I dont have to give up my name, at my age the lowest quote I get is $300/month for individual coverage, with no pre-existing illnesses.
Steve
Interpretations change, if you have a right that was interpretated then as soon as someone in power interprets it differently those rights disappear. Rights are not something that should come and go with changes in power. We have a very clear and simple process to amend our constitution, there is no reason for anything to ever be interpreted.
People such as your self love to interpret the constitution as a way to force your political ideology on others that disagree with you. You make up and find rights to bolster your politicial power
Are you arguing genetics don’t exist? Why don’t you find a new right and pass a law saying everyone deserves to live the same length of time? Its a simple fact of life that some races live longer then others, its dishonest to irnore this fact and say our healthcare system is failing becuse we have a different racial make up then france.
when your debunking the same old boilerplate lies why would you not use the same boilerplate facts?
I never said we had a monopoly on centers of excellence just that we have more of the top hospitals then anywhere else.We do provide amazing and the highest quality care in the world, something those bashing our system deny.
“Does the US health care system deliver excellent service for the entire population, considering its huge cost?”
Your using a socialist measuring stick to argue our system, which is not socialist, does not measure up. I don’t recall an election where we voted to become socialist. In this country we place personal freeedom and the ability to fail or exceed over that of the social good. Our system was not designed to provide the best results over the whole population, it was designed to deliver the best results to an individual. And that it does better then any other country in the world.
Their are studies that control for stage of cancer. Isn’t higher diagnosis rate a sign of higher quality, just becuase your diagnosised doesn’t mean we should always treat but its always a good idea to know whats up
so your arguing people should be able to take my money and live off my labor without any obligation to need or deserve it?
Why don’t you be the first to start margalit, send me your bank account info and we’ll see how long you still believe this makes any sense
sure go to any carriers website and run rates for a closed panel HMO with low co-pays
could you tell that to the Cleveland Clinic then, they go on and on about their plane that flies people here anjd world class care and how Interntaional they are. Really hurts to find out they have been lying to us this whole time.
Why would a billionair prince fly all the way to the US to get care at a smaller community/academic center?
I think your comment debunks its self. Use a little logic, your not going to fly to the US to get your cold treated. For starters there is a very small population annually that has something serious enough to come here. Then further limit that to those that can afford to.
When someone is spending their own money and has the choice to be treated anywhere in the world and they choose here that is a sign of quality. It doesn’t need to be 1 million a year to be an accurate measure.
Maybe you should work at better faclities then you will get to meet more foreign visitors?
I agree, Barry, but I think that herding the “high spenders” into managed care is not quite enough. There is a post above discussing preemptive strategies to both reduce expenditure and provide tangible help to these folks by walking into the community instead of trying to bring the community to designated facilities. It is a simple example of doing well by doing good and I hope that governments at all levels understand that we cannot just discard entire sections of our society.
It is always mind boggling to me when folks defend our less than stellar mortality rates and education attainment results by arguing that if you only look at white guys in suburbia, we do as well as anybody in the world.
And these are the same folks that prefer to narrowly interpret the Constitution, in which case I would like to remind them that the term “indivisible” is not given to interpretation.
Margalit and Nate –
We really need to think of Medicaid beneficiaries as two distinct populations. The first group is the aged, blind and disabled (ABD). They account for roughly 25% of the beneficiaries and 70%-75% of Medicaid costs. The other group is mainly children and women with children. They account for 75% of the beneficiaries and 25%-30% of the cost. Children are cheap to cover averaging $1,500-$2,000 per year of medical spending each. In most states, childless adults are not eligible for the program.
Interestingly, slightly over 40% of the 4 million births in the U.S. each year are paid for by Medicaid which helps to account for why out infant mortality statistics don’t compare very well to other countries. Poverty is the issue here, not the quality of our healthcare system.
With respect to the dual eligibles, this population consists of between 9 and 10 million people eligible for both Medicare and Medicaid. Most are over 65 years old but some are younger disabled people who qualify for Medicare as well Medicaid. The medical spending on this comparatively small population exceeds $300 billion per year or roundly one-third of the combined cost of Medicare and Medicaid. Care is often fragmented, uncoordinated and unmanaged. There is a lot of room for savings here just from better care coordination which is starting to gain traction as both the states and the federal governments look to mitigate spending growth for these two programs.
You read threads like this and wonder why health care in this country continues to flounder and sputter on life support.
Boy, does “full of sound and fury, signifying nothing” really fit here. I guess when you have trillions of dollars floating around to be misappropriated and stolen, everyone has a stake in claiming as much as they can. Everybody wants to live forever, see no harm or pain in their loved ones, and thinks that every single treatment opportunity is owed to anyone who pursues it.
Except one little detail, isn’t expense finite? Like, life as well? And, how much is enough? Tough questions for those who really don’t want to examine, what, reality!?
I am beginning to think this blog has scared away people who want to be realistic and grounded. Same old banter from the same old suspects!
Again, happy holidays?
That’s all the same old boilerplate, Nate.
I know what I am talking about because I worked/trained in Germany and spent a few months in France.
There is no doubt that peak insititutions are preforming very well in the US and I would even admit that there are more peak performing institutions in the US than elsewhere (no wonder given all the resources going into it).
But there are many University- and private clinics that attract patients from all over the world as well (yes, Mayo may be number one for treating well off people from everywhere because they cover pretty much all subspecialties very well, i.e. they don’t have any true weak spots as far as I know). But these well off are very well served at the many European centers such as:
http://www.rhoen-klinikum-ag.com/rka/cms/dkd_2/eng/87839.html
http://www.klinikum.uni-muenchen.de/International-Patient-Office/en/Treatment/index.html
http://www.charite.de/en/clinical_center/international_patients/
Does the US health care system deliver excellent service for the entire population, considering its huge cost? All in all, considering overtreatment, waste (services of marginal value) and access/bankruptcy problems, the answer is a resounding “no”, and most people in the US know that. (As a side note, I don’t think medical errors are a larger problem in the US than elsewhere as many here claim – which does not mean there is no need for improvement.)
BTW, the cancer survival rates are deceptive: if you diagnose more cancers, you will treat more individuals with milder -or even misdiagnosed – cancer, which automatically results in better survival rates, but this will not necessarily imply that you truly benefitted the individual (in particular true for prostate cancer and probably many cases of breast cancer). I actually suspect that US oncologists MAY do, on AVERAGE, a better job than oncologists elsewhere ON AVERAGE, but this remains to be seen and differences are unlikely to be dramatic.
What Steve said + looks to me more like $500 per month/per person on average.
As to your personal distaste for smokers and drinkers, this is precisely why medical care should not be viewed as a charity. When you engage in charity giving, there is a tendency to expect that one can pick the recipients based on their being “worthy” or “deserving”. Today it’s drinking and smoking, tomorrow it’s obesity, later on it’s laziness, or maybe religion or sexual orientation or promiscuity … The sky is the limit.
Could you link to these $100/month programs as good as Medicaid?
Steve
Very few people come here for care. This has been pretty well debunked. As well, you should remember that a lot of docs comment here. Having trained at some of the top rated programs in the country, we rarely saw anyone from outside the country. Working now at smaller community/academic center, the foreigners we treat are those who have moved here.
Steve
“I’m saying you could buy an individual policy in most states for $100 per month with benefits as good as Medicaid”
“As good as Medicaid” – which providers then would accept it? $100/mth – age, medical condition, deductibles, co-pays, how about spouse included?
““US has the best healthcare in the world….” Prove it.”
That was sarcasm, but the line definitely needs a re-write. Mr. Goodman (sophist arguments) flips between saying European systems are inferior to ours to saying a libertarian system here would solve all our problems.
no Medicaid cost on Average 1-5K depending on the state. I’m saying you could buy an individual policy in most states for $100 per month with benefits as good as Medicaid. That does exclude your Medicare dual eligible population. And it wouldn’t allow for people waiting until they were at the hospital and checking out to enroll. But it would eliminate the rampant fraud in Medicaid and it would actually pay the providers better. Some States are spending less then that but making a total mess of the healthcare system in doing so.
Here is some good data
http://statehealthfacts.org/comparemaptable.jsp?ind=183&cat=4
I do think the States should take care of the truly disabeled, I would provide better care then what Medicaid gives them though. We short the deserving in order to help those that don’t need it, i.e. smokers and drinkers.
We couple triple what we spend on truly disabeled and give them great care, eliminate Medicaid for the rest and still save a fortune.
since their are many measures we’ll need to take them one at a time;
Access to top quality care, anyone want to argue we have the top hospitals? If you have a rare condition or need aggresive treatment there is no better place in the world to be, people come from all over the world to use our facilities.
Next would be outcomes. Studies have shown that a person of certain ethnic background is likely to live longer in the US then their native country. At worst they live just as long in the US as they do in their native country. While our health system does not help asians live longer then say being in Japan we do add a number of years of life to the average african american or hispanic life.
Our survial rates for cancer are better then the rest of the world.
Except in political measures we perform better then everywhere else.
“…what would a close panel HMO with benefits similar to Medicaid cost. ….. roughly 80-90 in low cost states like Utah and $150 in your high cost states”
Just want to make sure I understand this, Nate. Are you saying that Medicaid costs are on average between $1000 and $1500 per year per beneficiary? Or are you saying that they should be?
“US has the best healthcare in the world….” Prove it. Even the sophist Goodman doesn’t try to go down that hopeless path.
http://www.ibj.com/feds-proposed-indiana-medicaid-expansion-premature/PARAMS/article/29883
Unlike the proposals in Obamacare this has been tried and is successful.
Which most likely means Obamacare will kill it off before people learn how effective it can be.
HIP, which Daniels touted as a success in his new book, “Keeping the Republic,” provides about 41,000 enrollees up to $500 in free preventive care such as cancer screenings and a $1,100 medical savings account. When medical costs exceed that limit, benefits of at least $300,000 are provided.
Enrollees make monthly contributions based on their ability to pay, but many pay nothing because they earn too little. State officials say they are working on expanding the program to another 8,000 people.
Don’t you ever tire of being so wrong?
MUSEUMS LOSE BIG IN LEHMAN COLLAPSE
Whatever the fate of Neuberger Berman, however, the collapse of Lehman Brothers is destined to pass like a cold wind through the museum world, which has leaned on the investment firm for untold millions of dollars in arts patronage (charitable giving at Lehman Brothers totaled $39 million in 2007, according to a story by Bloomberg reporter Philip Boroff). In recent years, Lehman has been the lead sponsor for a range of museum initiatives, from the Brice Marden retrospective at the Museum of Modern Art and the Jackson Pollock show “No Limits, Just Edges” at the Guggenheim Museum to the “Young Friends of the Norton” program at the Norton Museum of Art in West Palm Beach, Fla., and a show about the pleasures of collecting contemporary art at the Bruce Museum in Greenwich, Conn.
And if they are to be a successful artist…..good chance someone like Lehman will have a hand in that as well;
http://www.artnet.com/magazineus/news/artnetnews/artnetnews9-17-08.asp
Indeed, within the art world, Neuberger Berman principal Roy Neuberger (b. 1903), who cofounded the firm in 1939, is known as much for his taste in art as for his investment savvy — the Neuberger Museum of Art in Purchase, N.Y. is named after him, established with the help of Nelson Rockefeller in 1974 to let the financial titan show off his collection. Since 1990, his namesake company has had a fund to purchase “emerging to mid-career artists, with an emphasis on the former,” according to the press release for a show of the firm’s collection that toured U.S venues in 2004 — making Neuberger Berman one of the harbingers of the finance industry’s recent infatuation with emerging art.
Neuberger Berman was an asset manager owned by Lehman Brothers. Who do you think buys the art that allows emerging and mid-carrer artist to pratice their art instead of spending all day waiting tables?
“Not to mention that one of those kids may very well be the one to discover a cure for cancer….or write a beautiful song. No such hope from Lehman.”
Really, that kid is going to discover a cure for cancer using pots and pans in his mom’s apartment? Or is he more likely to do it at a state of the art lab funded by someone like Lehman?
The Lehman Brothers Foundation has pledged $6 million to help support the establishment of the Lehman Brothers Lung Cancer Research Center, a core component of the newly established Lung Cancer Research Institute at Weill Medical College of Cornell University. The Center, led by renowned lung-cancer clinician-scientist Dr. Nasser K. Altorki, is dedicated to the efficient translation of laboratory discoveries into novel and more effective treatment strategies for lung cancer patients.
Ignorance of liberals knows no end.
clearly if your looking through the crap stained lenses of liberalism. US has the best healthcare in the world and that is why the world comes here for healthcare when they can’t get it at home. Do we offer the cheapest healthcare no, like everything american we do it big and to much. Doesn’t mean we still aren’t better. You pick one meaningless and schewed data point and by that say we fail.
” Don’t forget to include co-pays and deductibles, and of course if it’s an HSA, given all the disposable income Medicaid recipients have”
Peter if your bothered to think even a little before you posted you might actually contribute something. Many Medicaid plans have co-pays and Indiana has HSAs so you have already asked the wrong question.
The proper way to make the argument is what would a close panel HMO with benefits similar to Medicaid cost. With age and zip it would be all over the place but roughly 80-90 in low cost states like Utah and $150 in your high cost states like MA and NY. Not saying their is causation but it seems the states with higher tabacco taxes tend to have higher health insurance premiums. Its pretty consistent that a pack a day smoking habit would be enough to purchase an insurance policy similar to Medicaid.
Yeah, that’s funny, it’s usually all about money, but when the US system clearly fails like it is the case in health care, “opportunity costs” are pulled out of the hat. And it’s idiotic: no sane person can doubt that huge amounts of effort/talent/work/hours are used realted to HC services.
“We may be spending less and getting more.”
Typical John Goodman lead statement from his Alice in Wonderland logic trying to repeat his mantra that the U.S. has the best system in the world, and of course he links to his own opinion piece to close his circle of proof.
“the cost to us is the price we pay for it. But that is not necessarily true for society as a whole. The social cost of something may be a whole lot more or a whole lot less than what people actually spend on it;”
Usually it’s, “a whole lot more” as people/business transfer the true costs to someone else’s books. The statement is true but certainly does not justify health costs in the U.S. or does not negate our direction of financial Armageddon unless our actual health costs are slashed. Just try to go to your bank and pay your mortgage with “opportunity cost”.
“Why are the 34.9% of Medicaid smokers given coverge they obviousluy can afford to pay them selves”
Well Nate if someone even qualifies for Medicaid it means they are the lowest of the low for income/assets. Maybe you could give us the numbers for cost of cigarettes against health insurance premiums. Don’t forget to include co-pays and deductibles, and of course if it’s an HSA, given all the disposable income Medicaid recipients have.
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About Plan
“So I come full-circle to the HSA idea. When patients have a serious amount of “skin in the game” they will behave more like “consumers.” Unfortunately that is not an option for most working people”
The money the patient spends when they swipe their HSA card could have come partially or totally from someone else.
It is possible to spend someone else’s money – we do it all the time. With proper incentives and disincentives, we might even be coaxed into spending it as wisely as if it were our own, i.e. subject to the beneficial feedback of a free market system.
Money collected from a socialist system can in turn be spent by an individual in a free market environment.
Placing incentives and disincentives on patients does not single out the poor for punishment.
etc.
Good point. This is why I’m getting upset sometimes and not getting enough for healthcare particularly I have a 5 children. I care about their future and it includes their health insurance and how much they get from it since I am spending much more and work so hard for it. Thanks!
The thing people forget is that spending is not evenly spread. 3% of medical spending is done by 50% of people. Most spending is done by a small percentage of people. When people need a major cardiac procedure or need cancer therapy, they do not shop for price. If you have not been through it, talk with relatives who have.
Steve