In the NZZ, Thomas Hürlimann reviews his experience as a patient in Swiss and German hospitals. Top: Stans, Prof. Dr. Bachmann. Flop: Baar, Berlin Friedrichshain.
A blog post on Random Critical Analysis argues that high wealth (proxied by high consumption) rather than GDP explains US health care expenditures.
Total per capita health care spending increases as wealth increases because people actually demand more goods and services (volume) per capita and because it is relatively labor intensive sector that does not enjoy the productivity gains found in some other sectors of the economy, i.e., overall costs increase through both volume and price together (volume * price). GDP per capita is a relatively weak measure for these purposes and those few other high GDP countries happen to be much more export dependent (which does not independently predict significant increases in expenditures). If you use a better measure like Actual Individual Consumption (AIC) or run multiple regression analysis on GDP expenditure categories most of the apparent excess health care spending shrinks quite dramatically.
Additional analysis of several major claims here (e.g., high prices due to limited market power of payers, high physician incomes, etc) show that these arguments suffer from similar issues. The best available evidence show that across multiple measures our healthcare labor costs and overall apples-to-apples price levels are generally very much inline with our material standard of living. US total per capita costs are probably somewhat more than expected, but this appears to be driven through higher volume (~100% more than EU28 average according to PPP study estimates), though even this is significantly, if not quite entirely, explained by our higher material standards of living.
In an NBER working paper, Liran Einav, Amy Finkelstein, and Atul Gupta document similarities between healthcare for humans and pets in the US:
(i) rapid growth in spending as a share of GDP over the last two decades; (ii) strong income-spending gradient; (iii) rapid growth in the employment of healthcare providers; and (iv) similar propensity for high spending at the end of life.
This figure is taken from The Economist’s Graphic Detail blog.
In a blog post, John Cochrane proposes step-by-step (politically unattractive) measures to increase growth:
- Smarter (growth-oriented) regulation, in particular
- Higher equity requirements and less short-term funding rather than complex financial regulation
- Deregulation of health care supply
- More cost-benefit analysis in environmental policy
- Broad-based consumption rather than investment taxes
- Clear separation of allocative and distributive fiscal policy
- Focus on distortions in social programs
- Deregulation of labor markets
- Rational immigration rules distinguishing between permits to entry, reside, or work and citizenship
- Less government intervention in the student loans market
- Less protection, more free trade
- More spending for the legal and criminal justice system
How many years of care in a nursing home does a typical single family house buy? In Der Spiegel, Christina Elmer, Patrick Stotz und Achim Tack have done the math for Germany. Accounting for price variation in care and real estate yields large regional differences: 3 years in poor regions in Eastern Germany versus 40 years in downtown Munich (see the map in the article).
- reform of the tax system: www.thepurpletaxplan.org;
- reform of the health care system: www.thepurplehealthplan.org;
- reform of the social security system: www.thepurplesocialsecurityplan.org;
- an overhaul of banking: www.thepurplefinancialplan.org;
- intergenerational fairness: www.thepurplegenerationalbalanceplan.org;
- an energy tax: www.thepurpleenergyplan.org;
- a reform of the education system: www.thepurpleeducationplan.org.