In search of Eduardo Porter!


Also in search of the very high cost of our American health care: Eduardo Porter is one of the nation’s most interesting journalists.

His “Economic Scene” analysis column appears in the New York Times every Wednesday. The column appears on the front page of the Business Day section.

Porter’s columns are rather lengthy and they’re always intelligent or intelligent-seeming. Perhaps for those reasons, we don’t think we’ve ever seen his name mentioned in the national discourse.

Consider yesterday’s piece, which ran 1255 words. As he started, Porter cited a troubling prediction about health care costs.

That said, there’s something else we want you to notice about that column.

The column bore an unhappy headline:
“Acceleration Is Forecast for Spending on Health.” As he started, Porter recalled an upbeat prediction about health care spending—an upbeat prediction from 1993 which turned out to be wrong:
PORTER (4/23/14): Standing before a roomful of economists, policy makers and health care experts earlier this month, Amitabh Chandra, director of Health Policy Research at Harvard's Kennedy School of Government, closed a presentation about the slowdown in health care spending over the last decade by citing an article in The New York Times.

''Changes in the way doctors and hospitals are paid—how much and by whom—have begun to curb the steady rise of health care costs in the New York region,'' the article declared. ''Costs are still going up faster than overall inflation, but the annual rate of increase is the lowest in 21 years.''

Then came the punch line. The article, written by my now-retired colleague Milt Freudenheim, was published in December 1993, when the so-called managed care revolution promised for a few hopeful years to...curb the breakneck rise in health care costs for good.

It is a sobering reminder that the recent improvements could wither away just as they did two decades ago.
Alas! That upbeat prediction from 1993 turned out to be wrong. At the time, it looked like health care costs were being reined in. Then they took off again.

In yesterday’s column, Porter discussed some of the reasons why that ancient prediction failed. He also discussed the possibility that our current lull in health care spending might soon go away too:
PORTER (continuing directly): And that experience undergirds, in part, a fairly ominous forecast by Mr. Chandra, Jonathan Skinner of Dartmouth College and Jonathan Holmes of Harvard that spending on health care, which already consumes nearly 18 percent of the nation's gross domestic product, will continue to grow 1.2 percentage points faster than the economy over the next 20 years.

''It's very scary,'' Professor Chandra told me.

At the very least, it suggests that health care reform is by no means over. The Affordable Care Act may well be on track to meeting its primary goal of providing coverage for most uninsured Americans and protecting everyone against the risk of losing their insurance. But for all its innovative proposals to flush waste out of the system, reining in health care spending still appears well beyond the grasp of Obamacare.
For ourselves, we can’t judge these predictions and assessments. That said, no one else is going to judge them either. For whatever reason, Porter’s semi-egghead columns never seem to produce any external discussion.

Does Porter know what he’s talking about? In the case of this topic, we don’t know. But he’s in a somewhat gloomy mood as he considers the possibility that recent slowing in the growth of health costs may not continue long.

We think it’s interesting that Porter’s work is never discussed. We thought yesterday’s piece was intriguing for a second reason—because of that famous old hound, the dog that didn’t bark.

Porter wrote his usual lengthy, erudite piece. He talked about the terrible difficulties this country seems to have in controlling the costs of health care.

Here’s what Porter didn’t do—he never mentioned the baseline from which our growth in health care spending starts.

Per person, we already spend two to three times as much on health care as other developed nations. Starting from a baseline like that, you’d almost think it would be easy to find ways to reduce our health care spending, let alone rein in the growth.

But in an erudite seeming piece, Porter never mentioned the crazy baseline from which our growth in spending starts. Readers weren't asked to process the fact that we already spend twice as much per person (or more) as everyone else in the developed world.

As Humphrey Bogart once said: Our of all the health care systems in the world, we had to get born into ours!

Since we already spend so much, why should our health care spending continue to rise? We have told you many time—the data we post below seem to be carefully kept from American eyes.

A conspiracy theorist would say this: American citizens aren’t allowed to know about our nation’s rising test scores. And we also aren’t allowed to know about our crazy health care spending.

These are the craziest data we know about.
In big newspapers like the Times, these data are verboten:
Health care spending, per person, 2011:
United States: $8508
Canada: $4522
Germany: $4495
France: $4118
Australia: $3800
United Kingdom: $3405
Japan: $3213
Spain: $3072
Italy: $3012
All that extra money disappears from American pay checks. And remember, that figure’s per person.

Who knows? Maybe Eduardo Porter is nuts and that’s why no one discusses his work.

His columns never strike us that way. But even Porter doesn’t mention our highly exceptional level of American health care spending.

You’re allowed to discuss the way it goes up, pretty much not where it starts.


  1. The moral degeneracy of the Salon left causes lower income sufferers of extreme income disparity to stick with Republicans. They would rather be poor than bankrupt.

    1. Is the "Salon left" a subset of the "emerging pseudo-liberal culture" or vice versa?

  2. Well said again, Bob. We NEVER debate why our health care costs so much more than other developed countries and we don't com close to covering everybody.

  3. How much do people pay for other necessities in those other countries? For food, for housing? Should we be upset about that too?

  4. Glad to the Finns are still disppeared from the chart. Heck all those Scandanavians are missing. And Amanda Ripley's good buddies in Korea and Poland as well.

    1. Now that you mentioned Poland, the chart Bob links to shows per capita health care spending at a very modest $1,452.

      Why, the poor Canadians, Germans and French are paying TWICE that!

      Must be some looting going on there. Can be no other possible explanation for why Canadian health care costs twice as much per capita as in Poland.

    2. More Polish miracles!

    3. Yes, but if we mention Poland, we need to what they pay in Minnesota per capita.

    4. What happens when we disaggreagate?

  5. "All that extra money disappears from American pay checks."

    To quote what a leading Republican once said to Rachel Maddow on Meet the Press,

    "Not exactly!"

    1. "And remember, that figure’s per person."

      And again, "Not exactly!"

      It is a per capita average, Bob. It's not how much each person spends.

    2. The money also doesn't exactly "disappear" either, does it?

  6. Watching pbs news last night about a story on the new drug Sovaldi to treat Hepatitis C. Each pill costs 1,000 dollars for a treatment of one pill taken for 120 days. Apparently the regimen is 90 to 100% effective. That would be at a cost of 120,000 dollars for that treatment. That is an enormous amount of money that is being redistributed upward. Most people will not be able to take this cure due to the enormous cost involved. To me this is obscene. There are other ways to pay for research and development of drugs, this one is not working.

  7. Somerby's all wet once again. We have the best healthcare system in the world, it couldn't be more perfect.

    USA! USA! USA!

    1. At least you got the first part right.

  8. Off the top of my head, I could be wrong but: Hospitals are paid per visit and a lot of corruption goes on there (which has made headlines in the Times). Groups are bribed to be in "studies" of new drugs which only a specific company holds the patent to (has not). Each individual insurance company has huge overhead (has not). It would seem the insurance and drug companies have sway in the media. What do they pay in advertising?

  9. Honest question, are any of those commenting actually interested in some of the answer as to why health care costs are so much higher in the US?

    Just in case you are, here are a few elements:
    *An ultrasound in France costs between 70€ and 80€, the equivalent in the USA costs $450
    *A visit to your GP in France costs 23€, a visit to your GP in the US costs between $120 and $150 (negotiated rate). In addition, thanks to this low cost and universal HC coverage, people go to their GP on a regular basis for checkups and such, instead of waiting for an urgent event that requires going to the ER or being hospitalized.
    *Doctors overuse expensive imaging modalities such as MRI and CT - motivated either by CYA or because they are part owners in the imaging facility to which they refer patients - whereas in Europe, due to cost constraints, inexpensive triage modalities such as ultrasound are more frequently used (and effective).
    *The governments don't hesitate to use their weight to negotiate or fix reimbursement rates for pharmaceuticals. Don't worry, contrary to what your are told in the US, big pharma in the EU is still making huge profits.
    *High administrative costs relative to other countries.
    *Doctors in Europe are well paid but do not expect that exorbitant salaries docs in the USA expect (med school in Europe also costs very little when compared to the USA). A GP in France makes a good living, somewhere between 65,000€ - 90,000€ on average, in the US GPs make twice that.

    The list goes on and on but I hope that you get the point. Read the Time Article by Steven Brill, it goes detail describing the unstructured (and borderline fraudulent) fee system (other than Medicare/Medicaid) in the USA.

    1. Much appreciated, especially here.