MONDAY, DECEMBER 22, 2025
...when Paul Krugman wrote about this: On December 13, the New York Times ran a guest essay concerning the cost of health insurance. Headline included, the essay started like this:
$27,000 a Year for Health Insurance. How Can We Afford That?
The debate over whether to extend the expanded Affordable Care Act subsidies has consumed lawmakers over the past two months, precipitated a government shutdown and sparked Republican infighting. Unfortunately, it’s the wrong debate.
While I believe we should extend the subsidies, which expire at the end of the month, to help families pay their insurance premiums, doing so wouldn’t fix the underlying problem: surging health care spending. That’s the reason we need the subsidies in the first place, and it’s bankrupting families and shredding jobs for low- and middle-income workers across the economy.
And so on from there. The essay was written by Zack Cooper, an associate professor of public health and economics at Yale.
Topics like that have largely slid beneath the waves in this modern era, in large part due to the flooding of the zone. Distractions come thick and fast these days. Who has time for a discussion of a topic like that?
It occurred to us that it's been a while since we reviewed a basic type of health care spending data. Why does our nation's "surging health care spending" seem to exceed that of other comparable nations?
Nostalgically, we started to click. Soon, we came upon these data, courtesy of Peterson KFF:
Health expenditures per capita, U.S. dollars, 2023 (current prices and PPP adjusted)
United States: $13,432
Germany: $8,441
France: $7,136
Canada: $7,013
Australia: $6,931
United Kingdom: $6,023
Japan: $5,640
Peterson KFF includes a "Comparable Country Average." It includes the spending figures from some smaller Euro nations. That average is said to be this:
Comparable Country Average: $7,393
People, we're just saying!
We've been puzzling over numbers like that ever since Paul Krugman did a series of columns on this topic back in 2005 or 2006, also for the New York Times. From that day to this, we don't think we've ever seen a major news org tackle the challenge of attempting to tackle this question:
Why do we Americans spend so much more, on a per capita basis, than other nations do?
Why do we Americans spend so much more? The daily flooding of the zone makes it even less likely that you'll ever see a serious effort to tackle a question like that.
Meanwhile, if someone did develop such information, the findings would be sifted in different ways within Silo Red and Silo Blue. We've become a spectacularly unintelligent nation, which, just to be perfectly honest, doesn't differ all that much from The Way It Always Was.
We've shown you the start of Professor Cooper's essay. Before long, he's also saying this:
...Rising health care spending is killing the American dream.
Despite devastating out-of-pocket costs, Americans are generally insulated from the true cost of health care premiums. However, the expiring subsidies on the Affordable Care Act marketplaces, where more than 20 million Americans get their insurance, show just how exorbitant premiums have become. Consider a 60-year-old couple earning $85,000 a year. Without subsidies, their health insurance premiums next year will approach $32,000 (akin to buying a new Toyota Camry).
Those of us who get health care insurance from our employers—some 160 million Americans—may be breathing a sigh of relief. But our health care premiums are also staggering (an average of $27,000 a year for a family of four), and the fact that our employers pay part of the tab isn’t much of a reprieve.
That’s because decades’ worth of research shows that, even though employers pay most of workers’ premiums, those costs are passed on to workers in the form of lower wages and fewer jobs.
There's a lot more to Cooper's essay than that. But such essays lead nowhere within our flailing American discourse. Thanks to the incessant flooding of the zone, that discourse is almost surely dumber now than it's ever been before.
At one point, we Americans occasionally pretended to discuss such topics. Those discussions rarely went anywhere, but today we pretty much don't even bother.
The zone gets flooded all day long. Inevitably, our attention is drawn to the endless string of inanities which rush through as part of the flood.
Way back when, Paul Krugman tried to make this a topic. Through zero fault of his own, Paul Krugman tried and he failed.
Trump has contempt for Republican voters, which is something our media should be emulating.
ReplyDeleteAnonymouse flying monkey 3:21pm, if you’re going to be an anonymouse flying monkey can’t you strive to be a better one? You’ve been doing the same three put-downs for years. I want my money back.
DeleteFuck off Cecelia. People here are tired of you.
DeleteSomerby is correct.
ReplyDeleteThe Republican Party is an amoral dumpster fire.
Unfortunately, that won't stop the Somerby haters from claiming he's Conservative.
Does Somerby realize he too is flooding the zone with his silly quote from Moby Dick?
DeleteThere is no claim that Somerby is conservative; the claim is that Somerby is right wing, which he clearly is.
DeleteSomerby says that while he finds some Republicans distasteful - Trump, Gutfeld, etc - he agrees with many of their values.
Furthermore, Somerby is quite squeamish when it comes to calling out racism, sexism, and xenophobia, further indicating his right wing stance.
Additionally, Somerby goes out of his way, typically via misinformation, to trash Dems.
“Somerby says that . . . he agrees with many of [the Republicans’] values.”
DeleteAre you just making this up, or can you provide a quote?
Quotes have been provided in the past, DIRECTLY TO YOU.
DeleteIn fact, Somerby has indicated his inclination towards some right wing values in the past few days. He indicates this all the time, if you have your head in the sand about it, THAT IS ON YOU.
So, I guess you can’t.
Delete
ReplyDeleteEveryone says that European and Canadian healthcare is crap. Horrible. Especially British. And in Canada they apparently offer assisted suicide to sick people.
Swiss healthcare is okay, but their spending per capita is close to American, and, like American, it's based on private insurance.
So, idiot-Democrat squealing aside, what's the solution, Bob?
Nope.
DeleteWhy does their crappy healthcare result in longer life expectancies? And don't worry, RFK jr is working overtime to make sure it is not even close. A whole deluded pack of idiots and fucking morons. Sad.
DeleteWhy does their crappy healthcare result in longer life expectancies? And don't worry, RFK jr is working overtime to make sure it is not even close. A whole deluded pack of idiots and fucking morons. Sad.
DeleteA healthier lifestyle is one factor.
DeleteNonsense.
DeleteIlya, a healthier lifestyle is not nonsense as to the impact on costs. Other factors, such as greed, play a bigger role, but that doesn’t mean you have play lifestyle down.
DeleteNonsense was mostly an assessment of the original post, claiming that other countries' healthcare were shitty. The US healthcare is absolute garbage, which comes about -- and this is fundamental and dovetails with yours and David's inane comments below -- because it's treated as a business. It's not.
DeleteIt's garbage because doctors are conditioned to move patients along; it's garbage because of inaccessibility; it's just fucking the worst.
Healthier lifestyle is a personal prerogative and a public policy approach. To the extent that making people healthier is a public policy, we are failing miserably on that front as well.
Ilya 6:05pm, I don’t know how you can say that US healthcare is unfortunately run like a business, and then say my comment about the price of Tylenol is inane. No, the price of Tylenol in U.S. hospitals for people who are insured is THE bottomline. It is THE emblematic picture that should be on the banner of anyone marching against the for-profit system. I’m not your choice of messenger. You can add attorneys to the stew too.
DeleteTo cover high operational costs, including administrative expenses, hospitals may mark up the prices of commonly used medications as part of a broader strategy to balance budgets.
DeleteSo the specific case of overpriced Tylenol is irrelevant, the issues are structural.
Health care providers don’t have an incentive to be frugal. Their incentive a to provide whatever is covered by insurance. Compare this with electronics, e.g., where the manufacturer seeks to build their product as economically as possible.
ReplyDeleteAs a UofC grad, are you really that fucking stupid? Why not compare apples and oranges for Christ's sake you moron.
DeleteDavid -- your analogy is just so, so...off the mark (although another word comes to mind)! See if you can discern the difference between making widgets and healthcare.
DeleteNo, it’s not. Go ask a hospital what they charge an insurance company for a couple of Tylenol tablets.
DeleteYeah, yeah, yeah, we all heard the Tylenol story. I give a much more comprehensive example below. And if you talk to anyone who knows anything, they will come back with: oh, but we have to charge so much, because so many people can't and don't pay. David's analog is ludicrous. At its core: healthcare cannot be treated as a widget manufacturing business. Start with that understanding.
DeleteIf you’re going to go with the widget trope, then start talking about the price/cost of some actual…widgets. The cost of the widgets as to compared to… elsewhere and as to insured and uninsured. I appreciate your accident story and I’m very glad you’re ok, but you don’t own this topic, no matter how much you think that you do.
DeleteThe only people given tylenol are hospitalized and receiving other forms of care as well. Otherwise the doctor tells the patient to go home and take tylenol without charging them anything.
DeleteAnonymouse 7:02pm, is hospitalization no longer a part of health care? Otherwise, what’s your point?
DeleteAbout 30% of our private healthcare costs goes to administrative costs, mostly the operating costs of insurance companies.
DeleteWith government run healthcare - Medicare and Medicaid - administrative costs are about 2%.
Government is way more efficient than private.
Government programs are designed to provide care rather than generate profits, allowing them to allocate more funds directly to patient care.
The government can leverage its size to negotiate better rates for services and medications, minimizing overhead costs.
Even right wing think tanks have run the numbers and found that Medicare For All will save something like $150-300 billion a year. The ACA is in fact a Republican policy, first instituted by Republican MA governor Romney.
In surveys the vast majority of Americans support M4A, including many Republicans. Republican leaders will not let it pass because it would give the Dems a win, and corporations a loss. That is all there is to it; to Republicans life is just a game, a game they must win at all costs.
Our country is becoming a shithole because corporations have all the power.
Corporations have power because Republicans gave it to them, and some Dems (Clinton, Obama) did little to change that.
Ceceliia, I get it that you’re stupid, but an individual patient has less overhead associated with stocking tylenol than a hospital does. At home there is no nurse fetching it from a pharmacy shelf and writing the info in a chart. Use your head.
DeleteWhy do we Americans spend so much more?
ReplyDeleteBecause there is an infinite demand for health care and the government provides an infinite amount of money trying to satisfy that demand. Endless demand and endless supply means higher and higher prices.
Sorry, you missed the plot, man. That is just sad.
DeleteIt is sad. The inability to see the forest for the trees is mind-boggling.
DeleteYes, our media, while harping how the healthcare is about to become unaffordable (I understand that the whole affordability thing is a "Democrat Hoax(tm)" ) for millions of Americans are missing the forest for the trees. We are constantly forced to fix things with duct tape and chewing gum. Why? Because at its very core, our healthcare system is idiotic on many different levels. Insurance companies are just one profiteering entity who feeds at the trough of our broken systems. There are others, including some doctors, private equities, medical device manufacturers (worked for a few), pharmaceutical companies.
ReplyDeleteA fundamentally new approach is a must. Healthcare cannot be treated as just another "free market" business.
Agreed. Every nook and cranny in the healthcare system is a profit center. The complexity requires the kinds of wholesale changes that I think are beyond the vested interests of congress. I don't see enough public input from experts (healthcare economists). Any solution will require the control of costs via government action. The process of insurers contracting with hospitals and providers and passing on inflationary costs to patients is a large part of the problem.
DeleteAbsolutely! Everyone is trying to squeeze out a dime without providing and discernible contribution to anyone's healthcare. I forget to mention pharmacy management companies.
DeleteThe idea that health care workers do not care about patient health is wrong. In fact, it is insulting to the sacrifice and risks they all took to help people live during covid, and the caring and concern that you cannot put a pricetag on because it is above and beyond any job description. Health care workers are often frustrated by the economic emphasis of their managers and try to help patients work around them.
DeleteBecause of our society, doctors and many others in healthcare tend to be more motivated by financial benefit than helping those in need.
DeleteThis is very different than most countries, where doctors are middle class, and have no expectation of becoming rich, as most US doctors do.
Look at all those doctors and nurses who burned out saving lives during covid. Obviously they did it to get rich, even when staff were getting sick and dying themselves. Those greedy bastards!
DeleteWhy would a med student or intern work their asses off to become doctors if they can earn a lot more designing computer games? Top students are going into fields where they can get rich, like Vance did. So who does that leave? The competition for smart hard working talent means higher salaries, to keep those students out of tech & finance. Doctors are not plumbers.
DeleteAt the beginning of August, I had a little bicycling mishap on the way home from work, where I ended up separating myself from the bicycling and meeting the pavement at 25+mph. I spent about four'n a half hours in the ER; mostly idly sitting in the nursing station, observing a stream of ailing humans, and making small talk with the nurses. I had x-rays and a CAT scan -- took about half-an-hour for the two procedures. Two doctors stopped by for the total of 15min. In the end, I left with the same diagnosis with which I came in: a broken bone in the hand and a few broken ribs. The ER bill -- which I don't have to pay, but I happen to know -- was close to $19K. I am sure my insurance will pay about half of that, which is still about 70% too high.
ReplyDeleteHow's it that we have ended with our healthcare being so massively bloated? I will defer to Dr. Elisabeth Rosenthal on that. She was a long-time New York Times reporter and wrote a book called An American Sickness. Per Dr. Rosenthal: first and foremost it is because we treat healthcare as business. Per Bob's post, no one, save for Bernie Sanders, talks about the big picture.
If you didn't go to the ER and had a serious untreated problem that became life-threatening, you wouldn't be so cavalier about the costs. The wait times are because others are using the equipment too.
DeleteThere are plenty of books written about the hospital experience, different ways of organizing and providing care, the success of medicine in various countries and so on. Somerby doesn't bother reading them and appears to have no background info about the changes in the US in medical care. It is easy to say that it all ought to be different, but you need a committee like the one Hillary Clinton ran back when her husband was first elected, some serious proposals and then a campaign to get change enacted. That is a lot of work, given that things have changed since HIllary first tried to improve things (and got no thanks for it).
When the US stops being capitalist and declares itself socialist, you will have different complaints but there will still be problems and compromises and inconveniences. Then people will say that all the difficulties are because we have socialized health care (as they currently say about public health care in Canada and the UK and other countires that have side-by-side public and private health options. There is no magic solution. I find Somerby's gripes particularly annoying because he puts so little effort into understanding the issue.
Old parable
ReplyDelete"Only the government would believe that you can cut a foot off the top of a blanket, sew it to the bottom, and get a longer blanket."
Similarly, only the government would believe that they can take money from the people and use that money to pay the peoples' health care costs, and thus lower the overall cost of health care.
I recommend taking MoCa, David.
DeleteOnly a Republican would look at a system in which employers pay for the majority of healthcare expenses while the government calls those subsidies nontaxable, and tell everyone left out to just "make better choices."
DeleteI agree with you Quaker. Employer-funded health insurance came about during a time of wage controls during WW2 IIRC.
DeleteA better system would have people get higher salaries, buy their own health insurance, and generally not buy insurance coverage for routine medical care. Our current cockamamie system is all tied up in tradition and tax treatment. so we're stuck with it.
David doesn't remember the times before ACA when people were routinely refused insurance for preexisting conditions, such as diabetes or a prior cancer, a child's birth defect or a chronic illness such as asthma.
DeleteDavid is a troll, nothing he says is real, including his personal story, it is all made up. Don't be a sucker.
DeleteBack in 2010, T. R. Reid published "The Healing of America," a book that offered a comparative view of healthcare in the United States and other industrialized countries. It was an insightful work that drew almost no attention. One reason out of many that our system is so expensive and complex is because we refuse to learn from other countries while we congratulate ourselves that we have the best of all possible systems.
ReplyDeleteMedical malpractice lawsuits are an enormous difference between the US and everyone else. Years ago, I had some figures showing the cost of med mal lawsuits ten times any other country's. Not only did these suits directly add costs, they provoked defensive medicine that added a lot more costs.
DeleteMedical malpractice suits account for a little over 1% of the healthcare costs. But, hey, I an fine if we impose a limit on malpractice lawsuits if we also impose limits on healthcare costs. In other words, if you want to socialize this aspect of healthcare, we should socialize the other aspects as well.
DeleteIlya - they’re not quite parallel. If we impose a limit on lawsuits, nothing happens. We don’t need anyone’s cooperation. But a limit on healthcare costs will work only into the healthcare providers are willing and able to keep providing their services and products for less money.
DeleteAI is now being used in medicine. We’ll see whether people like interfacing with a bot when their health is at stake.
DeleteSomerby is understandably concerned about health issues, given his age. But why does he not discuss what has been going on in Congress involving ACA subsidies and the Republican refusal to keep health insurance affordable? That is more relevant than anything happening in other countries, unless you are thinking of self-deporting. I wouldn't expect heath care if you are put in a camp or forcibly deported though.
ReplyDeleteMeanwhile Somerby continues to deflect attention from the Epstein Files non-release that didn't happen last Friday. Here is what Mark Epstein (Jeffrey Epstein's brother) has been saying:
ReplyDelete"Mark Epstein, the brother of Jeffrey Epstein, lobbed an explosive claim at the Trump administration Monday as its Justice Department continues to face scrutiny over its botched release of files on the disgraced financier.
The DOJ released a trove of Epstein-related files on Friday, but has faced backlash over failing to adhere to the Epstein Files Transparency Act, which required the agency release all of its files on Epstein by Friday, and with limited redactions. Instead, only a fraction of the agency’s files on Epstein were released, and redactions were made that critics have called unlawful.
President Donald Trump also initially opposed efforts to compel his DOJ to release the files, dismissing inquiries around Epstein as a “hoax” created by Democrats, though ultimately flipped in support of the effort after it became clear that enough Republicans were disregarding his objections.
“I’ve been recently told [that] the reason they’re gonna be releasing these things, and the reason for the flip is that they’re sanitizing these files,” Mark Epstein said during an appearance Monday on NewsNation.
“There’s a facility in Winchester, Virginia where they’re scrubbing the files to take Republican names out. That’s what I was told by a pretty good source.”
While Mark Epstein provided no additional evidence supporting his claim, his remarks were partially consistent with previous reports that suggested FBI agents had been instructed to “flag” mentions of Trump within the DOJ’s trove of Epstein files for potential redactions or suppression.
Mark Epstein has not been accused of any wrongdoing, and has said he was unaware of his brother’s crimes until 2006. Mark Epstein has also cast doubt on the circumstances surrounding his brother’s death in 2019, which, while officially ruled a suicide, has sparked speculation due to several oddities surrounding the incident.
“It looks more like a homicide,” Mark Epstein said of his brother’s death last month."
Or Somerby might discuss Trump's threats to invade Greenland again.
Recently Krugman has spoken out about his time at the NY Times, saying he was severely hampered by the more conservative values of the decision makers at the NYT.
ReplyDeleteThis blog is completely out of touch.
Yes, I saw him talk about that with Heather Cox Richardson.
DeleteBill Clinton seems to enjoy the company of young women while flying around the world with Jeffrey Epstein on his fuckplane.
ReplyDelete