STILL BREAKING: In search of The USA 9400!

MONDAY, MARCH 27, 2017

Bernie schools Anderson Cooper:
Now that Ivankacare has crashed and burned, we thought we'd revisit a question we posed two week ago:

What explains the disappearance of the group known as The USA 9400? You saw health care discussed many times in the past few weeks. Did you see this important group mentioned even once?

For ourselves, we never saw the group explicitly cited. The closest we came involved Bernie Sanders' appearance with Anderson Cooper last Friday night.

Who are The USA 9400? They're the amazingly large number of dollars spent in this country, per person, on health care every year. Rather, in the recent year 2015, when the OECD's very strange, disappeared numbers looked, in part, like this:
Per capita spending, health care, 2015
United States: $9451
Canada: $4608
France: $4407
United Kingdom: $4003
In his new column today, Paul Krugman discusses the problem caused by the "high deductibles" sometimes found in Obamacare insurance policies. Obviously, the background to all such problems with our American health care is lodged in that remarkable spending figure for the United States.

For unknown reasons, it costs $9451 to provide health care to the average American. This is massively more than what it costs in comparable nations.

This explains why premiums and deductibles are so high—why it's so hard to provide universal coverage and care in this, our exceptional country. And yet, The USA 9400 are essentially never mentioned, even when the problems of health care and coverage are holding center stage.

Did you see The USA 9400 mentioned at all last week? Frank Richly, we did not! The closest we came involved that chat between Sanders and Cooper.

You can read the whole interview here. In answers to three of Cooper's six questions, Sanders cited the need to lower the bloated prices we pay for prescription drugs in this country. In response to Cooper's second question, he even offered this:
SANDERS (3/24/17): Anderson, I am talking to you tonight 50 miles away from the Canadian border. We can get there in an hour. They manage to provide health care for every man, woman, and child in their country at half the cost per person than we do.

The cost of prescription drugs in Canada significantly lower than it is in the United States. So the question is why are we not moving forward with a "Medicare for all," single-payer program guaranteeing health care to all people which will be much more cost effective than what we presently have?
On its own, a "Medicare for all," single-payer program wouldn't lower our health care spending to the level of Canada. But Sanders made an accurate statement about this remarkable state of affairs:

Canada provides health care for every man, woman, and child in their country at (slightly less than) half the cost per person than we do.

Sanders said it; Cooper heard it. The transmission ended right there. Here's our guarantee to you, the misused American citizen:

You will never see Anderson Cooper do an actual "news report" in which he dumps his cast-of-thousands panel and simply informs his viewers about the apparently crazy level of American health care spending.

You will never see Cooper present the numbers we have presented above. You'll never see him ask actual experts—not Jeffrey Lord!—to explain the craziness of those numbers, the craziness of that U.S. figure as compared to all the others in the developed world.

You'll never see Cooper do that! You will see him pretend to debate Lord night after night. But you'll never see Cooper tell Lord to scram so he can discuss those remarkable numbers.

You'll never see Cooper do that! And not only that:

You will never see Rachel Maddow present those remarkable data. You'll see her mug and clown and embellish and entertain, night after night after night.

But you'll never see her present those astonishing figures! The USA 9400 are among the missing, the disappeared, on her entertaining, corporate-fueled TV show.

Why don't you ever see those data on these cable "news" shows? We can't answer that question, but we can tell you this:

You haven't seen The USA 9400 in the New York Times either!

Two Sundays ago, you did see Anu Partanen, a Finnish journalist, write a long essay about the wonders of Finnish health care. (Plainly, the Finns are among the world's leaders in relentless self-affirmation.) Along the way, in paragraph 16, you even saw her write this:
PARTANEN (3/19/17): Overall, Americans spend far more of their hard-earned money on health care than citizens of any other country, by a very wide margin. This means that it is in fact Americans who are getting a raw deal. Americans pay much more than people in other countries but do not get significantly better results.
If you read all the way to graf 16, you got to read that sentence. Even then, you see the actual numbers, which would have looked like this:
Per capita spending, health care, 2015
United States: $9451
Finland: $3984
Ow ow ow ow ow ow ow! Subtracting, that's almost 5500 missing dollars per person per year! No wonder insurance is dear!

In those numbers, you see the basic mystery of American health care. But, for reasons we can't explain, you will never see such numbers in the New York Times—and certainly not on the paper's front page, where those remarkable numbers belong.

Why won't Rachel tell you these things? We can't answer that.

That said, she's being paid maybe $10 million per year. (You aren't encouraged to know that.) Evidence suggest that corporate groups maybe don't, for whatever reason, want you to worry your little heads about The USA 9400, an important disappeared group.

No one can solve our health care problem! Also, no one is permitted to tell you about that important group!

Final point: Chomsky had a term for this. It was called "manufactured consent."

For that reason, he was disappeared! Do you ever hear him mentioned by your favorite entertainers?


  1. No, I don't hear Chomsky mentioned by my favorite entertainers, and I've never heard his voice on NPR, even though thousands of people turn out for his talks. But you can find many hours of those talks on Youtube, and you can buy his books on Amazon.

    1. After a quick search it looks to me like media critic Bob Somerby has included a mention of Noam Chomsky in a Howler post a grand total of nineteen times in eighteen years. About a third of those times Somerby, himself, wasn't commenting about Chomsky at all, the professor's name happened to appear in some passage being quoted as someone else's example of a fringe character.

      Quaff enough of that Clinton/Gore-ism over the years and you're bound to be suffering from a case of orthodoxitis whether you know it or not.

  2. For unknown reasons, it costs nearly $16,000 to provide education and ancillary services to the average American child. This is massively more than what it costs in comparable nations.

    Per capita spending, education, 2011
    United States: $15,750
    Canada: $7,250 (comparable time period)
    France: $10,200
    United Kingdom: $10,200

    Sources: and

    I suspect that if you made a comparison like this along any number of lines, such as housing, food prices, energy costs, you would find the same huge disparities. It costs more for everything here, compared to OECD countries and Canada and the disparities are greater compared to yet other countries.

    So, does that necessarily reflect something wrong with us or with our health care system? I agree that we should be concerned about the quality of care being provided compared to what we spend, just as we should be concerned about educational outcomes, but when you break health outcomes out (disaggregate the statistics) you see that these outcomes are worst for those in poverty, just as educational outcomes are worst for the poor.

    I agree with Somerby that poverty is an important issue that needs to be addressed in our society. I would welcome another war on poverty like the one that occurred in the 1970s (which produced demonstrable improvement). I disagree that a demagogue like Sanders will produce that kind of change. I think Clinton would have. But that ship has sailed.

    Somerby needs to stop beating around the bush and come out and say that we need better health care for poor people and we need affordable health care for all (affordability makes no sense for someone with no money).

    1. I suspect that if you made a comparison like this along any number of lines, such as housing, food prices, energy costs, you would find the same huge disparities.

      When you see these figures they are in Purchasing Power Parity (PPP) dollars. That means there is a dollar cost determined for a basket of diverse goods and services in the United States and the cost in another country's own currency determined for a comparable basket of goods. Once those figures are determined you have a basis for comparing what one dollar will buy in the United States and what it will buy in another country.

      An American with twice the income of someone in a foreign country will be able to buy twice the amount of private sector goods and services as their counterpart- not the same amount of goods and services at twice the price.

      That's why the cost and outcome differentials for health care in the United States and other OECD nations is so significant. And if the case were to be made at the micro level there would be more cause for outrage.*

      Now, of course, someone in Maine will be able to buy lobster for less than someone in Austria. That's why there is a lot of complexity for the World Bank to consider in coming up with comparable baskets of goods to compare to determine what a given standard of living would cost across countries.

      The World Bank's PPP calculations, which are re-calibrated every two or three years, do not match up with the daily Foreign Exchange rates because traders react to changing assessments of expected inflation, central bank interest rates, natural calamities, political stability, commodity prices, and other factor.


    2. * Here's Dean Baker in a recent post [LINK]:

      [QUOTE] Taking these in turn, the largest single source of savings would be reducing what we pay for prescription drugs. We will spend over $440 billion this year for drugs that would likely sell for less than $80 billion in a free market without patent monopolies and other forms of protection. If we paid as much as people in other wealthy countries for our drugs, we would save close to $200 billion a year. We spend another $50 billion a year on medical equipment which would likely cost around $15 billion in a free market.

      If the government negotiated prices for drugs and medical equipment its savings could easily exceed $100 billion a year (see chapter 5 of Rigged). It could use some of these savings to finance open-source research for new drugs and medical equipment.

      We already fund a huge amount of research, so this is not some radical departure from current practice. The government spends more than $32 billion on research conducted by the National Institutes of Health. It also picks up 50 percent of the industry’s research costs on orphan drugs through the Orphan Drug Tax Credit. Orphan drugs are a rapidly growing share of all drug approvals, as the industry increasingly takes advantage of this tax credit.

      The big change would not be that the government was funding research, but rather the research results and patents would be in the public domain, rather than be used by Pfizer and other drug companies to get patent monopolies. As a result, the next great breakthrough drug will sell as a generic for a few hundred dollars rather than hundreds of thousands of dollars. And MRI scans would cost little more than X-rays.

      ...The second big potential source of savings would come from reducing the protectionist barriers which largely exclude foreign-trained physicians. Under current law, a foreign doctor is prohibited from practicing in the United States unless they complete a U.S. residency program. This keeps hundreds of thousands of well-qualified foreign physicians from practicing in the United States. As a result, our doctors earn on average more than $250,000 a year, roughly twice the average pay in other wealthy countries.

      ...The third big source of saving would be having Medicare offer an insurance plan in the exchanges. This would ensure both that everyone had at least one good option regardless of where they lived and also that the private insurers in the system would face real competition. In 2010, the Congressional Budget Office projected that a public option would save the government $23 billion a year by 2020 and $29 billion by 2023. [END QUOTE]

    3. How do you determine whether someone with foreign medical training is "well qualified" or not without some supervised evaluation of their work? Savings should not come at the cost of quality of care.

    4. Dave the Guitar PlayerMarch 28, 2017 at 12:27 PM

      Anon 10:15 - You seem to doubt that having foreign medical training results in "well qualified" doctors. Yet we know that in the countries that these doctors come from (and are certified in) have health care outcomes comparable to our own. I think we could easily determine which foreign doctors were qualified, based on their qualifications, just like in this country. Ideally, of course, we can increase the number of doctors we produce here, but the AMA and the high cost of college education prevent that solution.

  3. Somerby quotes Partanen of Finland: "This means that it is in fact Americans who are getting a raw deal. Americans pay much more than people in other countries but do not get significantly better results."

    Actually, the Americans who do pay a lot for their health care get excellent results. It is the people who do not pay for health care at all, or who pay very little, who get the bad results. American health care outcomes vary widely by income level. The people who get preventative care and who can afford to see specialists and who take care of problems during early more treatable stages, tend to have better outcomes than those who discover they have cancer when it is stage 4 because they avoid seeing any doctor earlier because they cannot afford even minimal health care.

    Partanen has a smug tone, but she seems to ignore the contribution of lifestyle and other factors to general health, and she utterly ignores poverty, which is greater in the USA than in Finland, and largely goes untreated.

    Then there is the matter of affordable health care and the call for "Medicare for all". Are people unaware that retirees pay medicare premiums every month? It is deducted from their social security check. Medicare isn't free. It just costs a lot less than a private health care plan. But the $109 paid each month would be an insurmountable burden to many of the working poor. Affordable is a term that means nothing outside the context of a specific person's income and expenses. Medicare for all will make health care cheaper but not free.

    If you include a lot of previously uncovered individuals with delayed health problems needing expensive care, will it increase or lower costs for everyone else? My guess is that it will make costs higher. I think it is an important social good to cover such people anyway, but lets not pretend it would be neutral in terms of health care costs to everyone else.

    1. Dave the Guitar PlayerMarch 28, 2017 at 12:33 PM

      If what you say is true, then if everyone in the country could actually pay for the health care they needed, the cost-per-person in the United States would be even *higher* than it is now.

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