NCH Watch

Everyone talks about spending levels on health care, yet no one discloses the data that underlie those spending claims. What, exactly, is included? Excluded? Direct payments to providers? Insurance premiums? Medical R & D? Pharmaceuticals? Pharma R & D? Over-the-counter medicines? Long-term care? Hospice care? What? Does it include all those millions in fraudulent U.S. Medicare payments?

And when comparisons are made between the U.S. and other countries, are they “apples to apples” or “apples to grapes to oranges to kiwis”?

I’ve read that comparisons of birth rates may be faulty, since the definition of live birth varies from country to country.

Just as “rich” should be defined as wealth or income, and “poverty” should be defined as including or excluding transfer payments, I’d like to see some defined terms w/r/t health care spending so that we’re speaking a common language.

Obamacare will only make this worse.

End Stage Renal Disease began to be covered by Medicare in 1970. I believe, as a direct result, that dialysis is now the dominant (if not only) modality for treatment of kidney failure, written if not chiseled into Social “Security” (ahh, ropesmanship) law as if handed down from the Lord Himself. What prudent entrepreneur would risk his own capital to unseat the dialysis providers with his brilliant, but unknown, technology – what possible benefit could there be to him, when the payment schedules, billing codes and large employment base are all in place and he has no hope of breaking into that fortress?

Dialysis costs anywhere from $500 to $2200 per session, at two-three sessions per week, 52 weeks a year. According to the American Association of Kidney Patients, “according to the United States Renal Data System, the estimated ESRD population will be over 500,000 by the year 2010 and cost the Medicare program (i.e., American taxpayers) over $28 billion.”

PPACA in one version threatened to perpetually cut the top 10% highest patient expenses every year. I asked my clinic to cut my treatments from three times to twice weekly to cut my expenses, but others are so sick they don’t have that luxury. Maybe I’m not in the top 10% now but I will be, with costs going they way they are. So I’m in a quandary and others are in a worse quandary. Add up the expenses and dialysis costs between $50,000 and $250,000 per year, per patient. Medicare pays a low price that barely covers the cost, but Medicaid and private insurance pay the balance. That upper end of the scale is way more than I make per year. Something has to be done. I guess the 10% cut means that someone gets to decide that dialysis costs less or else, or that certain people are denied care. Is that what FCCCER was for?

And to top it off, immigrants get dialysis even if they’re here illegally. Are we going to become the “free” dialysis clinic to the world?

This is why we have to repeal PPACA as soon as possible. We should repeal the ESRD provision of Medicare too, and then the insurance companies would have an incentive to move the research ball forward – maybe.

“…Annual public and private health-care spending in the U.S. stands at $7,538 per person, 2.41 times the OECD average and 51% more than the second-biggest spender, Norway….”

As with all other prices, a failure to try to adjust for differences in per capita money supply renders all such raw comparisons meaningless.

Regards, Don

Sorry, no chart, but this roughly confirms your suspicions:

“At the combined elementary and secondary level in 2006, the United States spent $10,267 per student, which was 41 percent higher than the OECD average of $7,283. At the postsecondary level, U.S. expenditures per student were $25,109, more than twice as high as the OECD average of $12,336.”

http://nces.ed.gov/programs/coe/2010/section4/indicator38.asp

In 2003, the U.S. ranked 15th of 29 OECD countries in reading literacy and 21st of 30 OECD countries in scientific literacy. (comparison was of 15 year olds.)

http://www.geographic.org/country_ranks/educational_score_performance_country_ranks_2009_oecd.html

“Health care and education are, of course, the New Commanding Heights. That is, they are the growing sectors of the economy which, if you were Lenin, you would want to be sure that the state controls.”

That’s a terrific comparison. Lenin, Mao, and Stalin thought that industrial production such as steel and heavy machinery were the most important outputs of their national economies. They took it as a point of person pride in their country to maximize these outputs.

These things were considered too important to be left to the market. Now that history has unfolded, we know that these countries did awful, even in these sectors that they considered their top economic priorities.

I think your causality may be around the wrong way. How about the possibility that the state controls health and education, and because of that control, they are the growing sectors of the economy?

After all, the state paying for so much takes away the consumer discipline to keep prices down, and I’m not aware of a government around the world that has found a way to force productivity improvements on the education and healthcare sectors without that discipline.

Never attribute to malice what can be explained by stupidity.