Part 1—Those same old disappeared data: We're going to start this week's report with those same old disappeared data.
They constitute the most eye-catching data set of which we are aware. But alas! Despite the remarkable nature of these data, you will almost never see them, or even hear them described, within our "public discourse."
For reasons at which we're forced to guess, these remarkable data don't seem fit for human consumption within the rules of modern political culture.
Who knows? Maybe data have been judged to be too boring in general. Perhaps it's been judged that we news consumers wouldn't be sufficiently entertained by data of this type.
We can't explain the wholesale disappearance of these remarkable data. But these data, while quite amazing, will rarely intrude on your gaze.
We've cited them a million times. You'll see them nowhere else!
Per capita spending, health care, 2015Those data come from the OECD; we'll provide the links below. In accord with our theme for the week, they're hard to find on one's own.
United States: $9451
United Kingdom: $4003
South Korea: $2488
What makes those data so remarkable? Formally, you rarely see a set of data in which one number stands out so glaringly from all the rest.
(We refer to the spending figure for the U.S., not to the spending figure for South Korea.)
Formally, those data simply look odd. Substantively, they account for two of the biggest political problems of our time.
Those data explain why this country has had so much trouble achieving full health care coverage. Obviously, it's much harder to provide health care at $9451 a head than at France's much more manageable number.
Those data explain a second problem which is endlessly pseudo-discussed. As economist Dean Baker has often noted, those data, in and of themselves, account for the annual federal deficits we constantly pretend to discuss.
A large portion of health care spending is done by the federal government. If you could wave a magic wand and bring our health care spending down to the level of spending in France, our annual deficits would be gone. Big problem disappeared!
Those remarkable data are amazing in all those ways. Despite this fact, they're virtually never presented, let alone discussed, within the American press corps.
Americans almost never see those data. As if by some widespread group agreement, those data are disappeared.
With that in mind, we'll focus, in the next three days, on a recent Charlie Rose broadcast. The broadcast occurred last Thursday night. It included a discussion of health care costs, a discussion we found quite amazing.
In a 21-minute segment, Rose discussed health care policy with Ezra Klein, "editor in chief of Vox," and Peter Orszag, "vice chairman of Investment Banking and global co-head of health care at Lazard, another investment banking house."
In an earlier life, Orszag was director of the CBO under George W. Bush, and director of the OMB under Barack Obama. He focused on health care spending during his tenure at each of these posts.
Programming note: it's safe to say that Orszag and Klein both know what they're talking about. Such situations almost never occur, let's say, in "cable news" discussions.
Rose spent the last nine minutes of Thursday night's segment with discussing health care spending. The discussion was remarkable for at least three reasons:
First, Klein and Orszag agreed on the general reason for the remarkable size of American health care spending. Despite Rose's incessant interruptions, their analysis, while rudimentary, was quite clear.
In that sense, Klein and Orszag explained the reason for those remarkable data! That said, something else which occurred that night which struck us as remarkable too.
You see, Klein and Orszag agreed on something else. They agreed that Americans will always spend much more for health care than people in comparable nations. They even agreed on the reason for this unfortunate state of affairs.
Amazingly, they seemed to feel this point was so obvious that it wasn't even worth debating. The situation will ever be thus!
Might we note a third key point about last Thursday's discussion? We think this may be the most remarkable fact of them all:
At no point did Charlie Rose present those disappeared data! Millions of people were watching his show, but at no point were they allowed to see the remarkable size of the problem Rose and his guests were discussing.
Those data, which come from the OECD, are astounding and also quite basic. That said, a group agreement seems to exist:
We, the pathetic American proles, must never see those data.
For ourselves, we'd posted those data that very same Thursday, reacting to a puzzling post by Kevin Drum in which they failed to appear. That night, those data failed to appear again in the course of Rose's discussion. Hence our current report.
For the next few days, we're going to show you what Klein and Orszag said last Thursday night. Spoiler alert:
They seemed to agree. You will always pay much more for health care then do people in France.
During the course of this striking discussion, no one made any effort to define the size of the disproportion which was being discussed. At one point, Klein even offered a standard figure—a standard figure which, alas, massively seems to understate the size of the disproportion.
At no point in Rose's program did those remarkable data appear. Krugman discussed them in a series of columns way back in 2005. Ever since then, in almost all settings, those data get disappeared.
(For his part, Krugman had moved on to a new jihad, in which he batters working-class "whites" for their failure to understand everything he understands, and for failing to frog-march in to say he was right all along. He doesn't batter the lofty elites who keep our discourse data-free, thus keeping us barefoot and clueless.)
Last Thursday's discussion was fascinating. As has been decreed by the gods, those key data never appeared!
Tomorrow: "You could almost not do it worse than we do it. I will start there."
In search of those disappeared data: Those data come from the OECD. To peruse them, just click here.
To peruse them in a simplified fashion, you can just click this.
To watch Rose's discussion with Klein and Orszag, you can just click here. The first twelve minutes of the segment largely concern the current GOP health care bill. From the 12-minute mark to the end of the tape, Klein and Orszag discuss health care spending.
That instructive discussion runs nine minutes. As has been decreed by the gods, those data never appear.
Which of the countries on that famous list has gun violence equivalent to the US? Which has as many car accidents? Which has as strong an anti-vaccine movement? Which has poverty at the same levels? Which eschews preventative medicine the way we do? Which has problems with addiction like ours?ReplyDelete
All of these things have consequences for health care -- all of them make our need for services higher. All of these things add to our costs.
We treat health care like a commodity and patients like consumers because we are a hyper-capitalist economy. We hire people to care for our loved ones instead of nursing them at home. We believe in individual freedom so we permit people to do health-destroying things that are illegal or not permitted in other countries.
There are many ways we are different and those are reflected in our costs. Does Somerby care about any of that? Of course not. He is fixated on what he considers to be the cause, even though he never states it himself and never directly quotes anyone discussing it himself. You will hunt in vain for the answers to any of the "causes" Somerby alludes to above. I used to think it was some form of exaggerated Socratic method of teaching his readers, but now I think he is just too lazy and too chicken to state his own views plainly, directly, and take ownership of them. So he hints. It is annoying -- just like it was the 10,000 other times he has written this particular post.
If Somerby weren't such a coward, he would get to his point -- we should all be voting for Bernie. Only an arm-waving socialist can save our country from its ratty doctors.Delete
Anon @ 10:15: Once again, you, like so many others, seem to not understand Bob's purpose in these posts. Look at the top of the page, where it states, "musings on the mainstream 'press corps' and the American discourse."Delete
Pay attention, please: Bob is discussing the coverage of this topic, NOT the policy or reasons why it is so costly.
This blog is not any kind of analysis of journalism.Delete
That's a really good point 10:15. Are there any source to back up the claim poverty, gun violence and car accidents make our per capita healthcare so much more? That makes sense but I never seen it suggested. Pls provide if you have, thanks.Delete
Don't know about "so much more" but there are many other cultural differences I have noted here before. Who treats car accident victims? We have far greater alcoholism than most of those other countries. Greater obesity. These create health consequences Somerby and others here like to ignore in favor of blaming capitalism, which no doubt also contributes but isn't going away any time soon.Delete
That excessive aggregate cost for healthcare in the United States is not because of a culture that promotes unhealthy lifestyles here, it's not because of some unique demographic configuration here, it is largely a product of relying on capitalism to provide a service where the power relationships between supplier and consumer are completely skewed and there is neither a substitute good for the consumer to choose to use nor an option for the consumer to do without the service all together that is not blocked, in a de facto sense, by coercion.Delete
1:49 - so much more as in so much more $ per capita. Just wondering what your source is. Thanks,Delete
Anon @ 10:15 - You've made great points and indirectly made Somerby's, too!Delete
If the MSM actually used those numbers in their health care coverage as many times as Somerby has, don't you think we'd have more discussions about the REASON(S) we pay so much more in the US?
Anon 1:49 - "We have far greater alcoholism than most of those other countries."Delete
No we don't. See for yourself: http://gamapserver.who.int/gho/interactive_charts/substance_abuse/bod_alcohol_prevalence/atlas.html
Sorry, you are correct. I also looked at figures for cirrhosis and liver cancer. Europe has slightly less but not enough to justify what I said.Delete
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"A large portion of health care spending is done by the federal government. If you could wave a magic wand and bring our health care spending down to the level of spending in France, our annual deficits would be gone. Big problem disappeared!"ReplyDelete
How do you wave a magic wand and magically make everyone so healthy they no longer need health care services?
How do you wave a magic wand and make those companies that deliver health care no longer require payment and yet still solvent and able to provide services?
If we could wave a magic wand and make everything the government does cost free, we would no longer need to pay taxes and we could all go on vacation to Disneyworld! Huzza! Have I used the word fatuous yet?
Once again, if doctors in the US were paid at the same level as in other OECD countries, and, if we got rid of patent monopolies for pharmaceutical drugs and medical devices, we could save a lot on our healthcare costs, probably putting us in line with what other OECD countries pay. If we switched to a single payer, "medicare for all" healthcare system, some modest savings would also be had.Delete
Once again, it would be fair to pay doctors less only if medical education were subsidized as it is in those other countries. These comparisons are misleading.Delete
Once again, median yearly income for physicians in the US is $200k, enabling them to pay back their medical school debt, and enabling them to be the professionals with the highest income and most wealth, at the expense of US healthcare consumers.Delete
Doctors in England do very well because they are paid to keep their patients healthy.Delete
That's easy for you to decide for them. This is a job no one will do for less pay. It requires deferring income until 8-10 years after high school, studying science, working at tasks others avoid, often for too many hours, but you think people will do that for lower pay. Won't happen. You want to put your life in the hands of someone who would do that job for less. Most people don't.Delete
I don't want to decide how much doctors are paid, I want to let the market decide. Doctors use residency requirements to constrain the supply of doctors in the US, artificially inflating their incomes. Many foreign doctors, who are very skilled and have excellent training, would love to come to the US and practice, but can't because of the residency requirement. That's wrong, and costs US healthcare consumers a lot of money.Delete
Residency trains doctors.Delete
Doctors are trained in medical school. Many foreign doctors who want to practice medicine in the US have been in successful practices for years, so a residency would be redudant. Perhaps some additional training could be required, but a lengthy residency seems like an artificial barrier to competition so domestic doctors can inflate their incomes at the expense of everyone else.Delete
Costs shouldn't determine length of training.Delete
Actually a magic wand is not needed - do all those other countries have magic wands? There is no one single source of the higher expenses, but a) there are profits being taken out in many places; and b) in health care there is really little competition on prices, so it is not really a "free market". In the other countries prices are set by the government, or limits are placed on them.Delete
"This is a job no one will do for less pay." Except in almost all other countries - average pay for doctors is about half that in the US. Of course most of those countries also have public education and not the catastrophic student debt situation of the US.Delete
Cut medical spending in half and you gut the entire economy by 10%. Good luck with that.Delete
Anon 3:28 - Then let's pound MORE money down that rathole! Think of the economic growth! We'll ALL be rich!Delete
I dont' think it is a rathole when it keeps people healthy and helps ease their deaths.Delete
We gut healthcare down to other countries levels and you contract GDP back down to 2012 levels and have massive unemployment. The curtain will be pulled back on how awful the economy has been for decades. Too many people in power will be in trouble I'd that happens. They will be better off keeping the behemoth running on inertia as long as possible until it just falls over.Delete
Houses cost too much in the Los Angeles area. The median is higher than most other places in the US. People have begun to protest that by living under the freeway bridges and in the dry river beds. Tent cities exist in many LA suburbs. Is it because those ratty real estate agents are charging too much or is it because we as a nation don't care about housing or is it because Somerby hasn't yet compared those costs against the costs in other countries?ReplyDelete
You really need to get a life!Delete
I don't know if sadness is the order of the day here but certainly it is impossible to escape the fact ad hominem hurts or helps Bob Somerby more than rancor.ReplyDelete
Going back to the not so greatest hits, eh?Delete
The Gods decreed whiners will pronounce a set of numbers to be the most important fact then endlessly complain that others do not discuss them.ReplyDelete
This is a much more solid issue for DH to pursue than the alleged condescention of liberals towards the white working class.ReplyDelete
Seldom is the question asked: Where does all that money go? Yes, we in the US spend way more than other industrialized countries for health care. Who gets that money? Doctors get some of it, but then so do insurers, pharma, hospital consortiums, shareholders, and real estate investment trusts. Untangling the money streams would provide an ambitious researcher a lifetime of work.ReplyDelete
Exactly! That's why these numbers are important to every American - so there will be more interest in discussions/articles asking where all that money goes!Delete
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