R
Robert Chung
Guest
Steven Bornfeld wrote:
> To a certain extent, the results speak for themselves. Not only do we
> get less bang for our buck, but we get poor results in absolute terms.
I try not to say this. In absolute terms, our health system produces
outcomes that put us in the ninth decile of all countries, and that ain't
bad. It puts us about average among the major developed countries of the
world. The problems are: 1) we pay enormously more than any other country
and 2) jingoists think our system really does rank enormously better than
any other country. We spend 5% of GDP *more* than the next highest spender
in the world. If we're going to pay more than anyone else, I want better
performance; if we're going to get average performance, I want 5% of GDP
back.
> At the base of this (as has probably been mentioned several times in
> this thread) is the question of whether health care is a right or a
> privilege. A person's answer to this question will determine to a great
> extent their reactions to any other point in the argument about social
> welfare.
> Can our healthcare dollars be used more efficiently? Of course, but
> not without regulation. I've heard that 1/3 of healthcare dollars are
> spent on the last 6 months of life (I know, like the joke goes, the only
> thing is, how do it know?).
I'm not sure the "right vs. privilege" thing is central. I think the more
central issue is structural: that so much of health care spending is
concentrated in one or two spells, i.e., the skewness of the lifetime
consumption pattern of healthcare dollars. Basically, we go for 80 years
needing only to consume small, relatively steady, amounts of health care
dollars but then whammo! we start burning through $10,000 (or more) per
day. Normal insurance systems can't easily cope with that kind of skewness
because it's hard to build up enough of a risk pool, so they have to
charge extra in order to manage their risk. The larger the system, the
less of a risk premium they need to charge.
> To a certain extent, the results speak for themselves. Not only do we
> get less bang for our buck, but we get poor results in absolute terms.
I try not to say this. In absolute terms, our health system produces
outcomes that put us in the ninth decile of all countries, and that ain't
bad. It puts us about average among the major developed countries of the
world. The problems are: 1) we pay enormously more than any other country
and 2) jingoists think our system really does rank enormously better than
any other country. We spend 5% of GDP *more* than the next highest spender
in the world. If we're going to pay more than anyone else, I want better
performance; if we're going to get average performance, I want 5% of GDP
back.
> At the base of this (as has probably been mentioned several times in
> this thread) is the question of whether health care is a right or a
> privilege. A person's answer to this question will determine to a great
> extent their reactions to any other point in the argument about social
> welfare.
> Can our healthcare dollars be used more efficiently? Of course, but
> not without regulation. I've heard that 1/3 of healthcare dollars are
> spent on the last 6 months of life (I know, like the joke goes, the only
> thing is, how do it know?).
I'm not sure the "right vs. privilege" thing is central. I think the more
central issue is structural: that so much of health care spending is
concentrated in one or two spells, i.e., the skewness of the lifetime
consumption pattern of healthcare dollars. Basically, we go for 80 years
needing only to consume small, relatively steady, amounts of health care
dollars but then whammo! we start burning through $10,000 (or more) per
day. Normal insurance systems can't easily cope with that kind of skewness
because it's hard to build up enough of a risk pool, so they have to
charge extra in order to manage their risk. The larger the system, the
less of a risk premium they need to charge.