Why does healthcare take up a lower % of GDP in developed countries other than the US

[Gorsnak]

@Kimstu

Many developed countries have publicly funded healthcare along with parallel systems of private medical practice and insurance for those who can afford them. (Including, according to this site, Canada.)

I’m not exactly sure what that wiki article means by private health services, but there are none in Canada outside of things not covered by basic health care. This varies a bit from province to province, but typically includes dentistry, optometry, and the like.

I really don’t know where Sam gets stories like

Conditions that could be caught early and reversed with aggressive treatment become chronic in Canada, because it takes so damned long to get and receive treatment. Rheumatoid arthritis can be controlled or even reversed with aggressive drug therapy. But if it takes your months from the time your knee starts hurting until your doctor will see you, the knee may already be suffering bone damage. Then the doctor will refer you to a rheumatologist - who will see you in three or four months. Then he’ll start you on a conservative treatment, and you won’t see him again for another four months. Etc.

from. When I was diagnosed with ulcerative colitis, I walked into a clinic and saw a doctor within an hour. I got referred to a specialist (gastroenterologist) whom I saw about two weeks later, and I had a colonoscopy about two weeks after that. Just recently I had a flare-up. I called my family doctor and got an appointment for two days later. A month later I had a followup visit. I told the receptionist explicitly that there was no rush. The appointment was scheduled for the following Wednesday. My experience is not in any way out of the ordinary from all that I’ve heard from friends and acquaintances.

Yes, our system is currently underfunded, and is deteriorating. There are growing problems, especially with some big ticket procedures. But it’s not as bad as our market-worshipping friend makes it out to be, either, unless Alberta has a vastly worse system than Saskatchewan.

[Desmostylus]

@Sterra

I don’t think that the US enjoys significantly longer life expectancy than most Western European countries.

IIRC its generally shorter.

I think you do recall correctly. From the CIA factbook, life expectancies at birth, total population:

U.S. - 77.14

U.K. - 78.16
Germany - 78.42
France - 79.28
Italy - 79.40
Sweden - 79.97

Canada - 79.83
Australia - 80.13

There’s not a huge difference in life expectancies, but it looks like there’s not much of a case to be made in favour of the U.S. system simply on the basis of life expectancies.

[RandomLetters]

From what I can find on the net the average time from seeing a doctor to getting treatment in Canada is almost 18 weeks.

[Desmostylus]

Australia, BTW, has a dual system. Everyone’s covered by the public system. In addition to that, you can choose to take out additional insurance which will cover procedures carried out in private hospitals. (Being insured isn’t a prerequisite for using the private system, you can choose to just pay cash.) Private hospitals generally have shorter waiting times, and have things like private rooms available rather than shared rooms.

[Kimstu]

RL: From what I can find on the net the average time from seeing a doctor to getting treatment in Canada is almost 18 weeks.

That doesn’t seem to be quite what your linked article says. It’s referring to a study of waiting time (from first referral to treatment) for a number of particular specialties:

Among the various specialties, the shortest total waits were for cancer surgery (6.1 weeks), cancer radiation (8.1 weeks) and general surgery (10.3 weeks), while patients waited longest for orthopedic surgery (32.2 weeks), eye treatment (30 weeks) and plastic surgery (28.6 weeks).

So long waits for non-emergency treatments are driving up the average waiting time for these selected specialties. Routine medical care, emergency care, and other specialties are not included in the study.

[Sterra]

@Quint Essence

one reason for the ridiculous cost of healthcare is the need for physicians to insure themselves at absolutly ludicrous prices.
But, simple greed is definitly another factor. Dentists in particular I think must go to a “how to scam the public” seminar.
The costs that we pay are no where near the actual cost of the procedure. Hospital operating rooms and physicians fees are at the point where simple thievery is the only explanation. It really is a shame how the greed of some professionals has turned what was a noble occupation into such a disgraceful opportunity for theft but that is the USA in the 00’s.

Actually the explanation is that tons and tons of people don’t pay hospitals. Hospitals generally have a set amount a procedure costs and then they charge you double that because of losses due to people not being able to pay.

[SentientMeat]

One thing Sam has omitted in his question is this:

In a socialised system you can still opt for specialised private care.

Of course, like those Canadians who jump the waiting lists by opting for US private care you end up “paying twice”, but the point is that the tax dollars go a lot further. It beggars belief that the US Government spends a similar percentage of GDP on Health than EU governments but gets nowhere near universal coverage, resulting in the utter horror of having to sell one’s house for eg. cancer treatment for an absurd number of residents of the world’s richest country.

[clairobscur]

@UDS

First, I’ve read that, in the US, for the typical individual something like half of all lifetime medical expenditure is incurred in the last twelve months of life. I don’t know whether the same is true in Europe.

I don’t know the %age, but I read similar statements concerning France. Anyway, it makes sense that most health expenses are made during the last year of life, when treating terminal disease, with, I assume, costly treatments/operations, and this is probably true everywhere.

FWIW, I don’t think that the US enjoys significantly longer life expectancy than most Western European countries.

AFAIK, at the contrary, life expectancy in the US is amongst the lowest in developed countries (the longest being Japan, IIRC).

[Planet_of_the_Shapes]

@Sam Stone

Looks like no one has mentioned one of the big factors: In countries with socialized medicine, access to health care is rationed.

It is also rationed in the US system. The only difference is that in public healthcare systems it is rationed primarily by need, and how much benefit it would grant the patient. Also things like patient, doctor, or politicians priorities will enter into the equation too. A private healthcare system rations healthcare by wealth, and also patient, doctor, or managerial priorities. I know which method of rationing i prefer…

[London_Calling]

Because one system has a profit margin on top of a profit margin on top of a profit margin . . hence you get 6 x-rays instead of the necessary two, and everything else gets similarly blown up, before ading in your margin.

So of course more people are going to want to work in such a system – the US health care system is a license to print money – but to state the exceedingly obvious, its crap for everyone except the rich, and for everyone who’s health care insurance (and their families) is tied to their employment/employer - we’ve got the choice between private and state, between contributory, emplyment based insurance or not. That’s three more choices than Americans have.

And if it’s so bad (a) why doe the resy of the developned world vote for it and support it, and (b) why does the US persisit with socialised school education ?

[London_Calling]

Whoa – double strength dyslexia this morning !

[Neurotik]

@Desmostylus

There’s not a huge difference in life expectancies, but it looks like there’s not much of a case to be made in favour of the U.S. system simply on the basis of life expectancies.

Maybe. You also have to factor into account the general obesity epidemic in the United States and junk like that, too. If, say, Great Britain had the general health problems brought on by poor diet, etc. like the United States, would their life expectancy be higher or lower because of their health system?

I don’t know the answer to that.

[clairobscur]

@Sam Stone

Looks like no one has mentioned one of the big factors: In countries with socialized medicine, access to health care is rationed. Waiting lists in Canada are much longer than they are in the U.S.

Except that, as usual about this topic, you’re comparing the USA with the two countries which have a big “waiting list” issue : the UK and Canada. And conveniently forget that most countries with a public healthcare system don’t have such waiting list. It isn’t a problem inherent to public healthcare systems, but to underfounded public healthcare system.
You mention having to wait 16 weeks or so to see a general practitionner. The most I’ve waited to see mine was 2 days, and this only because I wanted an appointment, rather than just going and waiting (in which case I could see him this afternoon if I wanted to) or making a house call (in which case, I could see a doctor within an hour). And concerning “no heart bypass after 65”, one of my great aunts had one past 75. You’re delusional in your belief that public healthcare systems just can’t work properly. You just have to pay more if you want your system to be efficient. Whether you pay taxes or insurance fees doesn’t change a thing.
Also, the idea that having free healthcare means that it will have to be rationned doesn’t stand. If you offer free cars, for instance, you’ll have to ration them because everybody will want one (or even a dozen). But if you offer free heart surgery, people won’t try to get one just because it’s free. They might tend to see more often their doctor for not so serious health problems but this might be a good thing (see below).
At the contrary, as I already mentionned, free healthcare have a tendancy to reduce the overall cost, because people will be less less reluctant to see a doctor, and won’t wait until the only thing which can be done is, say, a very costly kidney transplant.
Finally, something you seem to forget is that though people might abuse a public healthcare system because it’s basically free for them (after they’ve paid their taxes), they might abuse too a private healthcare system because it’s basically free for them (after they’ve paid their insurance fees). Once you know you’ll be reimbursed, why would you be less likely to abuse because you (or you employer) had paid for an insurance? What difference does it make for you? The only ones who will tend not to abuse will be those who don’t have coverage at all (be it public or private). And this isn’t necessarily a good thing (see above)

[London_Calling]

@Sam Stone

And you guys want this kind of system?

Nah, we want to be tied to employers, ripped off for thousands of pounds each year, have zero choice in the matter and not be able to afford to cover our families.

Actually, unlike the poor citizens of the US, we have choices, lots of them, including the way the health care system is operated and funded (because political parties always suggest different ways). And whether we have such a system at all - we vote for which we want electorally; political parties adopt popular policies, and don’t adopt what people won’y vote for - it’s a natual mechanism.

There are numerous other choices, both in the workplace and outside, about whether we want to contribute to private insurance schemes or not.

There’s so much choice – none of which you need because the state provides a good service. The US, I believe, offers a choice between being ripped off for ridiculous amounts of money, and not being insured.

As for that 16 weeks crap . . .

That’s just bizarre. All my life . . you just turn up at the Doctors, wait a while and get seen . . . I have no idea what this is supposed to reflect because such a system wouldn’t be supported by the public in the UK, and presumably anywhere else.

It’s insane to even think that would be acceptable . . we vote for this thing and for how its funded, you do know that, right ?

[Kimstu]

LC: And if [publicly funded health care] is so bad (a) why doe the resy of the developned world vote for it and support it, and (b) why does the US persisit with socialised school education ?

Oh, there are plenty of market fundamentalists trying to get rid of that too!

My personal take on the whole situation is this: There are some human endeavors that are simply, inherently, not financially profitable on a whole-society scale. Providing decent basic health care and providing decent elementary education, especially to poorer segments of society, are two of them. Too many of the benefits are externalized, and there just ain’t enough money in the consumer base to guarantee profits. (Relevant anecdote: A teaching colleague of mine once suggested our starting a private school together. After informally costing out the most essential expenses for even a very bare-minimum day school, we came up with minimum annual tuition requirements of around US$10K–$15K per student. That is cheaper than many private schools, to be sure, but it is still just not possible for, e.g., the average minimum-wage single parent.)

Private enterprise in these fields can be an excellent supplement to publicly funded endeavors, increasing choice for those who can afford it and sharing the load with the public system. However, if private enterprise is left to run the whole show, market failures force it to protect its profits by focusing on consumers who can afford high prices, withdrawing service to poorer consumers, and indirectly shifting costs to taxpayers as much as possible.

This means that, although you get very good service at the top end, overall coverage is poor and the system is excessively complicated and inefficient. Market fundamentalists, of whom I think the US has more than most other developed countries, don’t like to consider the possibility that a market system can be more inefficient and wasteful than a government system. But so it is.

I readily admit that for making, say, shoes or cell phones, competitive markets are far more efficient than some kind of universal government production system. But when it comes to making major social investments such as universal retirement/disability insurance, universal education, universal health care, the opposite is true: the publicly funded system, flawed and limited though it inevitably is, will have lower overhead and better coverage than the tangle of cherry-picking private providers.

[Ned]

Remember house calls? Well get this: the waiting list just to see a general practitioner in Canada averages 16.2 weeks.

This sort of statement makes me wonder if you live in some sort of alternate reality Sam. I have never had a significant wait to see a GP. I can almost invariably get in the next day.

This isn’t really surprising in a system based on generous and unfettered access to primary care physicians who act as gatekeepers to more expensive proceedures and specialists. I haven’t got the statistiucs off the top of my head but part of the reason for the cost difference is our vastly higher proportion (and reliance upon) GPs compared to specialists.

By the way Sam, I do remember housecalls. I don’t even have to strain my memory since my doctor still provides them.

[SentientMeat]

You also have to factor into account the general obesity epidemic in the United States and junk like that, too. If, say, Great Britain had the general health problems brought on by poor diet, etc. like the United States, would their life expectancy be higher or lower because of their health system?

I don’t know either, Neurotik, but there is still a lot of obesity here, and the difference “healthwise” would be, I venture, more than made up for by the higher rate of smoking and the much greater alcohol consumption.

As undeniably tricky as it is to compare two countries’ health, I would suggest that simple statistics such as infant mortality, life expectancy and survival rates are the best way to do this.

[jshore]

@Gorsnak

I really don’t know where Sam gets stories like …

I don’t think there is any big mystery on this point. His one link was to Pacific Research Institute whose homepage says: “Pacific Research Institute (PRI) is a free market think tank providing practical solutions for the issues that impact the lives of all individuals. Our mission is to champion freedom, opportunity and personal responsibility by advancing free-market policy solutions.” There are lots of libertarian-leaning think-tanks out there that are going to be ideologically opposed to a single-payer health care system…And, they are going to receive a lot of money from corporations that are making an absolute killing on the current U.S. health care system. After all, these corporations would be derelict in their duties to their shareholders if they didn’t fund this stuff.

Of course, this doesn’t mean that everything that gets said by these people is false but it does mean that everything has to be checked very carefully since we know they would argue pretty much the same thing whether it was true or not.

[Sam_Stone]

SentientMeat said:

One thing Sam has omitted in his question is this:

In a socialised system you can still opt for specialised private care.

No, you can’t. Unless you are willing to leave the country. Right now Alberta is fighting with the federal government over this, because Alberta wants to offload some of the burden on the public health care system by allowing people to seek private treatment at their own cost. The feds have threatened Alberta with all sorts of countermeasures if we go ahead with this. In Canada you are NOT allowed to pay more for private care. This would create a ‘two tier’ system, with the lower tier being free, and the upper tier being extra-cost, and this is anathema to Canada’s social planners. Hence the story I linked above about people in Canada being able to schedule a next-day CT scan for their cat for $20, while Grandma has to wait weeks or months for the same procedure.

Here’s a link to an article about a study on waiting lists in Canada: Waiting for Medical Care in Canada. I was going to link the source document as well, but it crashes my browser if I try to load it.

The 11th annual survey of Canadian health care waiting lists conducted by the Vancouver-based Fraser Institute found that the median waiting time for non-emergency surgery and treatments in Canada increased from 13.1 weeks (3 months) in 1999 to 16.2 weeks (3.7 months) in 2000-01.1

And here’s one reason why our costs are lower:

Given these waiting times, it is not surprising that Canadian physicians reported in the survey that 1.7% of all their patients instead obtained medical care in another country - presumably most in the U.S. In fact, 5.6% of all Canadians needing radiation therapy for cancer obtained treatment outside of Canada.

It’s well known that a small percentage of patients consume a big chunk of overall health care dollars. In Canada, our wealthiest, sickest people simply go to the United States and bypass our system altogether. So if you guys turn to socialized medicine, it will drive up our costs as well and make our system worse.

[Northern_Piper]

@Sam Stone

Well get this: the waiting list just to see a general practitioner in Canada averages 16.2 weeks.

Like Gosnak, I just have to call bullshit on this, Sam, based on my own experience and that of friends and family. If I want to see my own GP, I call for an appointment, and have never had to wait longer than a couple of days. But if it’s something pressing, I just go to the clinic and ask to see one of the doctors. If my GP’s available, I might see him, or I might get one of the other doctors in the clinic. My choice - if I want a doctor right away, it’s always been same-day service - and I’ve never heard of anyone else amongst my friends/family having any other experience. Got a handy-dandy cite?

@Sam Stone

Conditions that could be caught early and reversed with aggressive treatment become chronic in Canada, because it takes so damned long to get and receive treatment. Rheumatoid arthritis can be controlled or even reversed with aggressive drug therapy. But if it takes your months from the time your knee starts hurting until your doctor will see you, the knee may already be suffering bone damage. Then the doctor will refer you to a rheumatologist - who will see you in three or four months. Then he’ll start you on a conservative treatment, and you won’t see him again for another four months. Etc.

Actually, I’ve seen articles (off-line, sorry) that suggest that just the opposite is true - that Canadians tend to go to doctors much earlier when they have a problem, so medical conditions get caught earlier, when they’re cheaper to treat, and more importantly, have a greater chance of sucessful treatment. Americans tend to wait longer, until it’s a real problem, because of concerns about cost and the effect on their health insurance premiums. In fact, a doctor I know moved to the U.S., lured by the big bucks, but came back after a few years. One of the reasons was that he was depressed by the number of patients who came in only when their conditions were essentially untreatable, because they’d waited too long, a pattern he had not seen when practising in Canada.

@Sam Stone

I know people in the States who have a problem like that and they call their doctor and are in in a few days. Then they start a round of treatment under direct care, seeing the doctor every week or two until the problem is fixed or controlled.

Let me guess - your friends all have access to private insurance plans - or are you saying that anyone in the U.S. can see a doctor in a few days and start treatment, regardless of their income level and job status?

To respond to the OP - one difference that I’ve seen cited comes from the cost of providing health care to those without insurance. My understanding is that if you go to the emergency room at public hospitals in the U.S., most states provide that the hospitals have to treat you, regardless of insurance coverage or lack thereof. Problem is, treating bad colds and minor illnesses in the E.R. is an incredibly wasteful, inefficient way to treat people. Those rooms are set up for emergencies, not minor ailments. But if that’s the only way people without insurance can get treated, naturally they will go there. (This problem isn’t unique to the U.S. - in Canada, hospitals are always trying to encourage patients to go to the walk-in clinics for the same reason, but some people just automatically go to a hospital if they want to see a doctor. However, it’s not driven by concerns about lack of health coverage.)