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Life expectancy at birth and health spending per capita, 2011 (or nearest year)
Take a gander at that chart. See that diamond well to the right on the horizontal axis (money spent) and well below the big cluster of diamonds on the vertical access (life expectancy)? That's us, placed on a map with the rest of the developed world in what probably is the most depressing graph in American health care. We spend a ton of money on health care, and we're obviously not doing it right.

We have the crappiest healthcare system in the developed world, to be precise. That's not just a disgruntled, single-payer supporting blogger talking. That's the Commonwealth Fund talking. Who are they? A private foundation that's been conducting healthcare policy research for generations. For the past decade, they've released reports detailing how the U.S. healthcare system measures up against other countries' systems. The results for 2014 are in, and are grim.

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.
Worth noting here, before we carry on, this isn't about the Affordable Care Act in large part. It's about the massive, incoherent, excessively complicated and expensive system that the ACA can maybe put a dent in. While the new law is most definitely helping people, it's not enough to address most of the larger issues at work making our system so irrational.

Let's start at the beginning, with the overall rankings. Spoiler alert: We're last.

Commonwealth Fund rankings for 11 industrialized nations with six metrics for success of systems.
In 2011 dollars, we spent $8,508 per capita, the next highest spender was Norway at $5,669. With all that money spent per person, we still rank dead last in access, efficiency, equity and healthy lives. We rise up to No. 3 in effective care and No. 4 in patient-centered care, but lead in absolutely nothing.

With that depressing overview established, head below the fold to find out how else we don't measure up.

It's worth reiterating here, in graphic form, just how much more we as a nation spend on health care than anyone else, because it's pretty remarkable:

Two graphs showing U.S. expenditures on health care.
While all that money is being poured into the system, we have the most unaffordable system.
[P]eople in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study.
Related to the access deficiency noted by Commonwealth, we have an equity problem.
The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.
Sarah Kliff at Vox has a graph to show the difference in the number of people reporting that they skipped getting medical care because of the cost involved:
Bar chart showing U.S. way out ahead in number of people reporting they didn't get health care because of cost.
Then there's efficiency, where we're a clear last:
On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing. Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.
Administrative costs are so high because we have so many payers—hospitals and doctors have multiple insurance companies to deal with, most of which are not paying the same rate for the same procedures. There's a tremendous amount of paperwork not just for doctors and hospitals, but for patients as well.

What all of this adds up to relates to the graph that opened this discussion: For all we're spending in the U.S. in the healthcare system, we're not healthy.

The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.
We rank last on infant mortality—meaning we have the most of it—on preventable deaths, and on life expectancy. The reasons for this are still sort of mysterious, because the lower life expectancies and relatively poor health outcomes are a feature across demographic groups in the U.S.:
We rank poorly if you look at survival until age 50, looking just at deaths among younger adults. And we rank poorly if you look at survival after age 50. We rank poorly if you restrict the analysis to non-Hispanic whites (who, statistically, tend to be in the best health overall). Even if you only look at well-off Americans who aren't obese and don't smoke, they generally experience poorer health compared to their counterparts in other countries.
We've got very good health care for those who can afford it and have access to it, and in fact, we rank third in providing effective care. That includes high marks for proactive doctors who remind patients about their regular preventive care, and America doctors lead in talking to patients about exercise and living healthy lifestyles. But we're still dying younger—even those who have this great health care.

The Commonwealth Fund does see some hope for the U.S. now that Obamacare is implemented:

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. Under the Affordable Care Act, low- to moderate-income families are now eligible for financial assistance in obtaining coverage. Meanwhile, the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.
The key common denominator that all the nations leading the U.S. have is universal coverage. Even were all the states to implement the Medicaid expansion under the law—which would help significantly—we're still going to have millions of people without insurance, some non-citizens but the majority of them "white, low-income, working-age adults, many of them employed." In other words, the population that consistently falls through holes in the safety net.

If there is a key takeaway from the Commonwealth Fund report, it is this:

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes.
For a nation that is spending nearly $3,000 per person more than its nearest competitor, that has some of the finest physicians and facilities in the world, we could be doing a hell of a lot better and we should be looking to the rest of the industrialized world about how to do that. It doesn't necessarily have to be a socialized, single-payer system. The Swiss have achieved high marks and high satisfaction with an Obamacare-like system. But it is going to require more government intervention, namely in what the Swiss are doing very effectively—regulating drug prices and fees for medical tests. The insurance companies aren't the only greedy bastards jacking up the cost of health care in the U.S. and those interests have to be taken on if this system is going to be fixed.

And it still needs to be fixed. We do have a good start in Obamacare. It has significantly reduced the number of uninsured. It is starting to separate insurance from employment. It has helped control costs in Medicare to a surprising degree. And, maybe most significantly for further reform, it's shown all the stakeholders that healthcare reform can be accomplished in this country. But we're far from finished.

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Comment Preferences

  •  Can't be here yet (70+ / 0-)

    for discussion. A family obligation interrupted my day, so I'll have to came back and respond this evening.

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Sun Jun 22, 2014 at 11:34:42 AM PDT

  •  Single Payer is what we need in the US (17+ / 0-)

    "The end of democracy and the defeat of the American Revolution will occur when government falls into the hands of lending institutions and moneyed incorporations." ~ Thomas Jefferson

    by Lefty Coaster on Sun Jun 22, 2014 at 12:05:43 PM PDT

    •  Single payer is not the only successful model (13+ / 0-)

      among developed countries with universal healthcare.

      •  Indeed. A willingness to REGULATE could make (21+ / 0-)

        a massive difference, particularly as a complement to the ACA.

        "The opposite of a profound truth may well be another profound truth.”" -- Paul Dirac

        by Rikon Snow on Sun Jun 22, 2014 at 12:29:12 PM PDT

        [ Parent ]

        •  Then the successive Nerocons (7+ / 0-)

          Will cut those regulations back.

          Take the profit motive away. Heath care is something that clearly promotes the general welfare. Something I'm guessing we will have to re-learn as vectors driven by climate change initiate epidemics amongst the population.

          I need your support, my paypal is:

          by Horace Boothroyd III on Sun Jun 22, 2014 at 01:21:52 PM PDT

          [ Parent ]

        •  It could happen if. . . (2+ / 0-)
          Recommended by:
          Rikon Snow, EastcoastChick

          All Teabaggers spontaneously combust  AND the rest of the Right Wing go up in the Rapture.

          "The measure of a man's real character is what he would do if he knew he would never be found out." Thomas Babington Macaulay

          by Deja on Sun Jun 22, 2014 at 01:35:15 PM PDT

          [ Parent ]

        •  Reality check (3+ / 0-)
          Recommended by:
          Rikon Snow, Lefty Coaster, YucatanMan

          1. Regulation would only work with price control

          2. We have a system more adaptive for political and com law reasons to single payer (Medicare and Medicaid expansion ) than price control (lots of con law challenges to price control
          And Americans aren't as comfortable with concept as Medicare )

          3. Even if you succeed evidence abroad is that you would be still higher costs which is the real outcome of concern

          •  What are talking about? (3+ / 0-)
            Recommended by:
            bruh1, cocinero, ebohlman
            And Americans aren't as comfortable with concept as Medicare )
            I would guess that Medicare is one of the most popular federal programs. Medicaid is by necessity and probably people are happier having health insurance that trying to get into the emergency room.
            Regulation would only work with price control
            We actually have data cited that many, many countries - in fact all countries BUT the U.S.A. - are able to use whatever control or lack thereof in place, and get better, physical results than we do. The good news, as such, is that we have plenty of money to spread around and still save a bundle. As long as it is OUR money being spent, the doctors, hospitals and insurance companies had better accept what we give them or move elsewhere or find other employment.
            evidence abroad is that you would be still higher costs
            Evidence abroad is that you have LOWER costs. Thats's what the study is all about.

            Every human being has paid the earth to grow up. Most people don’t grow up. And you find out what it costs us to love and to lose, to dare and to fail. And maybe even more, to succeed. What it costs, in truth.—Maya Angelou

            by TerryDarc on Sun Jun 22, 2014 at 05:08:40 PM PDT

            [ Parent ]

            •  Missing phrasing in my last comment (1+ / 0-)
              Recommended by:

              I meant to say Americans are more comfortable with Medicare than fee control bc they know Medicare. Americans do not know price control.  In addition , we have legal infrastructure for Medicare but not price control.

              The price control does not control cost as well as single payer.  

              •  Americans don't care about price controls (0+ / 0-)

                on health expenses.

                Really, they don't. Nobody even ASKS what something is going to cost, except for some preventive and elective procedures.

                If you're in an accident, or have a heart attack, or think you have appendicitis, do you go cost shopping? Of course not - you go to the hospital.

                The only ones who care about price controls are the doctors and hospitals.  

                And that's the reason why health care prices NEED price controls. Going without, especially in an emergency situation, is NOT an option. Nor is comparison shopping.

                At least we should have something in effect to keep us from getting ripped off when we're literally in a life or death situation.

            •  Follow up (3+ / 0-)
              Recommended by:
              TerryDarc, Meteor Blades, YucatanMan

              In short , I believe Medicare for all is both the easier sell and the best at cost control than price control.

            •  the evidence is only that THEY (1+ / 0-)
              Recommended by:

              have lower costs.

              They don't have doctors raking in over a million dollars a year in their take home pay. They don't have hospital administrators making a million buck a year and often several million for the top guy and for a bunch of administrators.

              They are getting that out of what is paid by insurers and also what is paid by Medicare.

              How are you going to fix that?

              I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

              by samddobermann on Mon Jun 23, 2014 at 05:25:40 AM PDT

              [ Parent ]

              •  Michael Moore made that point in Sicko (0+ / 0-)

                Where he asked French and British doctors how they could "survive" on cut-rate pay...tongue in cheek, b/c those drs. were doing very well indeed. Just not incipient plutocrats.

                No, some selfish bastards (drs.) are going to have to take a pay cut and some selfish bastard hospital administrators and selfish bastard insurance co. execs are all going to have to take less.

                There is waaaay more than enough money in the pot to pay everyone well and have good healthcare.

                Every human being has paid the earth to grow up. Most people don’t grow up. And you find out what it costs us to love and to lose, to dare and to fail. And maybe even more, to succeed. What it costs, in truth.—Maya Angelou

                by TerryDarc on Mon Jun 23, 2014 at 12:08:10 PM PDT

                [ Parent ]

          •  the same problems that plague (0+ / 0-)

            the main health care system also plagues Medicare and Medicaid.

            There are two things needed, price control is only one of them. The vast overuse and misuse of tests and procedures is the thing that is hardest to control.

            Docs, some, think they are entitled to get as much as they can.

            Sloppy care is another big thing that costs a lot of money. Fixing the mistakes that the health care providers make costs a hell of a lot. But they have worked hard

            The problems have nothing to do with the method of financing — whether single payer or through insurers. Actually the possibility is higher that the private insurers can force more change than any government action can. They are exerting pressure by not giving in to extortionate demands by high cost facilities. to the extent these providers are impacted costs may come down. If the federal government was doing that hysteria would ensue.

            I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

            by samddobermann on Mon Jun 23, 2014 at 03:33:37 AM PDT

            [ Parent ]

        •  Don't even need to be heavy handed in the (2+ / 0-)
          Recommended by:
          ebohlman, mmacdDE


          Do need to be heavy heavy heavy in information distribution, but...

          I keep thinking a public insurance approach that let you seek any treatment you want (this is American, after all) but would pay only the cost of known effective treatments (there would have to be some special provision for situations where there is no known good treatment) appropriate to a set of circumstances.

          That would allow you to get effective treatment free of cost, but, if you really wanted to flush your money down a toilet hole, take the allotted money and add your own to it for whatever treatment you wanted (more or less).

          Would even (hello, free market American) allow for a supplemental insurance market for health whackos.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Sun Jun 22, 2014 at 05:56:24 PM PDT

          [ Parent ]

      •  On the chart above , (4+ / 0-)

        Switzerland is rated as #2
        Netherlands is rated as #5
        France is rated as #9
        Canada is rated as #10

        "please love deeply...openly and genuinely." A. M. H.

        by indycam on Sun Jun 22, 2014 at 01:44:50 PM PDT

        [ Parent ]

      •  True. But all the developed countries have... (3+ / 0-)
        Recommended by:
        YucatanMan, mmacdDE, kfunk937

        ...universal health care, as do many that aren't developed. But not the good ol' U.S. of A.

        Four of the nations on the Top 11 list are single payer, four are two tier (meaning that the government covers everyone for basic needs and for catastrophic events but allows people to buy in the private sector as well). Two of the 11 countries have an insurance mandate.

        But all 10 of the nations have universal health care.

        No. 11 doesn't.

        Don't tell me what you believe, show me what you do and I will tell you what you believe.

        by Meteor Blades on Sun Jun 22, 2014 at 10:57:13 PM PDT

        [ Parent ]

  •  Excellent diary, Joan, thanks (12+ / 0-)

    We've made a start. If we can vote more progressive Democrats into state legislatures as well as Congress, we can make significant gains.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Sun Jun 22, 2014 at 12:11:38 PM PDT

  •  There's too much money in the system, and too m... (12+ / 0-)

    There's too much money in the system, and too many monied interests unwilling to loosen their grips. Nothing changes until that simple fact is acknowledged and addressed.

    •  Exactly. Every dollar spent (7+ / 0-)

      is going to someone's pocket, be it hospitals, doctors, drug companies, insurance companies, lawyers, technology, whatever. Those that know a more efficient system will reduce their income (also known as waste) will fight significant change.

    •  For profit healthcare, and the profits are big (10+ / 0-)

      Why should it cost $1,000. for an American visit to Emergency, and $75. for a Canadian visit?

      Those were the figures the last time I checked - they may have gone up since then but I believe the ratio has stayed the same.

      •  And then every conservative (6+ / 0-)

        like to being up some story of a Canadian they know who thinks their system sucks and America's is awesome.

        I lived in the UK for a time and can't convince any American that the system there is better than here. Like anyone.

        Americans will live and die with their pride.

        •  We do have wait lists for non-elective surgery (0+ / 0-)

          and a shortage of family doctors. Minor complaints. I've had 4 surgeries, 1 of them major at the cost of $0.

        •  :-) The "big" criticism I heard about Canada (1+ / 0-)
          Recommended by:

          ... years ago by some Congress Critter or other was that 'people had to wait for surgery in Canada under their socialized medicine system.'

          Well..., yes.  For ELECTIVE surgery there was a waiting period.  Emergency surgeries were taken care of immediately.

          Same system in the US for ELECTIVE surgeries.  One is put on a schedule.  From diagnosis to surgery for my knee replacement a few years ago was a few months (three, IIRC).  I had the pain for years before and kinda figured I knew the problem because fifteen years I was diagnosed with advanced degenerative arthritis in my back and waited another year or two before having surgery altho I should have had it much earlier.  I had vertebrae bone rubbing on bone it was so bad.  By the time my pain level got bad enough I had to do something about the right knee, I had zero cartilage left because of the advanced degenerative arthritis (it's pretty much in every bone joint in my old body).  My left knee is now feeling the same, has been for a few years, so I've no doubt that when I get it X-rayed I'll get the same 'surgery to replace the knee' diagnosis.

          Still, unless something like an accident or nasty fall is involved and emergency surgery is necessary, it's still considered ELECTIVE surgery, so there's a waiting period of weeks to months, depending on the doctor's and hospital's surgical schedules - and that's with insurance and/or Medicare.

          I don't know where these Congress Critters and critics are getting their info, but clearly they're not picking up on details like the difference between elective and emergency surgery.

          I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

          by NonnyO on Sun Jun 22, 2014 at 07:46:17 PM PDT

          [ Parent ]

      •  $75! That's outrageous... (0+ / 0-)

        I am an American but legal Canadian resident (Ontario). I just went to the ER for a cut that might need a stitch or two, on a Sunday morning. They saw me in about 15 minutes. And it was free.

        As an aside I mentioned to my regular MD last visit that I have had a persistent headache for some weeks.  He had me in for a head MRI the next couple days.  The headache is still lingering but at least I know I don't have a tumor or some such. Again, free, at least if you don't use their $5 parking lot.

    •  We've got a similar situation with our military (1+ / 0-)
      Recommended by:

      spending which is way out of whack with the rest of the world....
      yet Republicans will tell you the problem is we're spending too much on teachers and education and feeding the poor and there's no money to repair bridges and build infrastructure.

      Instead of investing in America we're allowing special interests to loot it.

  •  I read somewhere (sorry, I know that's kinda (3+ / 0-)
    Recommended by:
    thestructureguy, Pluto, fladem

    lame), but we're actually better if you look at the outcomes of individual conditions, like cancer or heart attacks. It's that our overall numbers get skewed by, well, guns and car wrecks. Any truth to this? If that's the case, then Obamacare might not help those numbers, and this will suddenly become a RW talking point, instead of a left wing one.

    •  Obscenity is a huge (no pun intended) cause of (3+ / 0-)
      Recommended by:
      niemann, Deja, YucatanMan

      lower life expectancy.  Big may be beautiful but it ain't healthy.  Throw in as you said, cars, guns, stress and other assorted unhealthy behavior and you get a lot of young deaths.  USA health care is a prime example of throwing money at the problem.  Do that with a lot of other issues as well.

      "The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubt." Bertrand Russell I'm very certain that is true. 10−122

      by thestructureguy on Sun Jun 22, 2014 at 12:32:45 PM PDT

      [ Parent ]

    •  Details on outcomes and quality measures (1+ / 0-)
      Recommended by:
      Peace Missile

      Can be found at this Link

      The Agency for Health Care Research and Quality provides scores on quality of health care and access in several categories. The link has national stats, but look further in the web site for your state's dashboard of quality measures.

      Money is property, not speech. Overturn Citizens United.

      by Betty Pinson on Sun Jun 22, 2014 at 12:48:34 PM PDT

      [ Parent ]

    •  Our right wing won't let us study the health (1+ / 0-)
      Recommended by:

      effects of our gun policies. It is a health issue.

      The modern conservative is engaged in one of man's oldest exercises in moral philosophy;the search for a superior moral justification for selfishness

      by CTMET on Sun Jun 22, 2014 at 01:08:34 PM PDT

      [ Parent ]

    •  Not actually true. (4+ / 0-)
      Recommended by:
      Peace Missile, BradyB, bartcopfan, mmacdDE

      I see it as another attempt to blame the poor for their own victimhood.

      America does slightly better in the care of some extremely rare and complex conditions, among the fortunate minority with unfettered access to care and excellent insurance.

      But for broad measures of health care and well being like infant mortality, perinatal mortality, life expectancy and so on, we compare very poorly with other industrialized nations, even for affluent populations. We do a pretty good job of taking care of heart attacks...but we have way too many heart attacks because of lack of access to care of high blood pressure, terrible diets and lack of exercise. And 'Obamacare' may actually make a dent there.

    •  There is truth to that. (7+ / 0-)

      Those charts showing life expectancy are a snapshot of the nation as a whole, not health care outcomes. What you are looking at are premature deaths in the United States. These deaths impact adults between ages 20 and 50, who have a greater risk of dying earlier in the US than in other developed nations.

      There are several things that drag US life expectancy rates down, according to the OECD and the Commonwealth Fund. Lack of comprehensive national public transportation (traffic "accidents") and gun deaths are both huge factors that do not exist in other developed countries.

      But the big one is death by medical neglect. Other developed nations do not have this problem because health care is a human right in those countries.

      This chart from the Commonwealth Fund gives a partial view:

      It shows the number of deaths by medical neglect per state in 2014.

      For example, in FLORIDA, alone:

      16,035 - The number of FLORIDA citizens who will be deliberately killed in 2014 by Red States that withhold medical care available to them through the Federal Government.
      Just in Florida, the number of deaths due to medical neglect in 2014 equals half of the gun deaths in 2014.

      That's a huge human rights crisis -- as noted by the UN.

  •  We don't have a health care system which is (18+ / 0-)

    the problem.

    We aren't civilized; we're a very expensive third world country because the rotten rich have bid the price of everything up.  

    It's a feature not a bug.

    I voted Tuesday, May 6, 2014 because it is my right, my responsibility and because my parents moved from Alabama to Ohio to vote. Unfortunately, the republicons want to turn Ohio into Alabama.

    by a2nite on Sun Jun 22, 2014 at 12:30:15 PM PDT

  •  Spend the most, get the least. (9+ / 0-)

    How can anyone who truly considers themselves to be a conservative defend such a situation?

    Hey GOP! You'll get my Obamacare when you pry it from my cold, dead hands. And thanks to Obamacare, that just may be awhile.

    by jazzmaniac on Sun Jun 22, 2014 at 12:32:00 PM PDT

  •  OK, I'm confused (6+ / 0-)

    I heard during the ACA debate in Congress, on Fox News - Bill O'Reilly I think - that Canadians were massing at every border crossing desperate to come into the United States for health care.  If that's the case, I can't understand why Canadian life expectancy would be above ours.

    "Corporations exist not for themselves, but for the people." Ida Tarbell 1908.

    by Navy Vet Terp on Sun Jun 22, 2014 at 12:32:21 PM PDT

  •  That Chart is Biased! (3+ / 0-)
    Recommended by:
    niemann, p gorden lippy, rocksout

    It includes illegal immigrants and moochers!

    I am sure a chart that only includes job creators and real amerikans will be better!

  •  Also note that (2+ / 0-)
    Recommended by:
    p gorden lippy, ceebs

    The one criterion on which the UK falls down badly is "healthy lifestyle", which I suspect is as much cultural there as medical.

  •  More US "exceptionalism." MERDE. (2+ / 0-)
    Recommended by:
    La Gitane, sillycarrot

    "The soil under the grass is dreaming of a young forest, and under the pavement the soil is dreaming of grass."--Wendell Berry

    by Wildthumb on Sun Jun 22, 2014 at 12:39:09 PM PDT

  •  and the Dems running this fall, need to remind the (1+ / 0-)
    Recommended by:

    voters, this is EXACTLY where the GOP wants us to stay!!!

  •  We don't have a healthcare system. (5+ / 0-)

    If we did, from pregnancy our citizens would all be getting what they needed to be born, live, and eventually die in good health.

    We don't. From the profiteers who ensure no housing, no good food, and no access to good medicine, we're ensured to have worse outcomes than the rest of the world until we fucking wake up and realize making sure all our citizens have healthy lives is worth more than letting a few rich bastards take all our money to give us crap food and barely any housing.

  •  Wonder how countries such as (2+ / 0-)
    Recommended by:
    qofdisks, on the cusp

    S. Korea and Japan rate?
    Having been for medical treatment in both in recent past (sinus), I found the service exceptional in both countries, but as the bill was sent to my employer, don't know the cost.
    Last time in Korea was especially interesting: Involved acupuncture and a vile tea made from "mountain roots", which surprised me by actually working, although the Nuns at Temple I was staying at gave me odd looks when I asked them to brew the tea for me.

    Severely Socialist 47283

    by ichibon on Sun Jun 22, 2014 at 12:52:40 PM PDT

  •  One Major Problem Is That The US Doesn't Have A (7+ / 0-)

    Healthcare SYSTEM.  It's a patchwork of public and private, for profit insurance and mostly for profit hospital corporations.  It's the worst possible combination.

    Medical schools could help lower costs by admitting more qualified applicants and therefore graduating more doctors.

    If I was a communist, rich men would fear me...And the opposite applies. The history of all hitherto existing society is the history of class struggles.

    by stewarjt on Sun Jun 22, 2014 at 01:00:14 PM PDT

  •  But they failed to measure the proportion of he... (4+ / 0-)

    But they failed to measure the proportion of health care executives with off-shore accounts and the percentage of insurance executives with yachts. They've got to count for something, right?

  •  The $3,000 per capita is easily accounted for (9+ / 0-)

    You can find it in health insurance co's executive bank accounts.

    Mediocrity cannot know excellence ~ Sherlock Holmes

    by La Gitane on Sun Jun 22, 2014 at 01:02:56 PM PDT

  •  The Medicaid expansion as a standalone bill would (2+ / 0-)
    Recommended by:
    qofdisks, NonnyO

    have been fine, but the ACA has all this other crap in it that liberals used to hate.  I still do.  It's not good legislation, and it entrenches the rotten system we have, thereby making real reform more difficult.   I can see no path to fundamental change now that the ACA has caused millions of liberals to be emotionally invested in cheerleading for the insurance industry that we used to hate.    Go to any liberal blog other than Firedoglake and it's like a pep rally for the insurance industry.

    •  Hmmmm... "used to...?" (0+ / 0-)
      ... cheerleading for the insurance industry that we used to hate
      Still do hate, actually.

      After half a century of watching the insurance industry hike their rates ever higher as they give their customers the shaft, my hatred of these criminal cretins has grown to a white hot rage.

      The world would be MUCH better off without corporations, but especially the corporations that encroach on governments and force people to buy it ... which enriches the insurance corporations (and CEO bonuses) even more ... which makes rates go up so they can increase the bonuses... et cetera and so on and so forth.  It's an extraordinary vicious cycle.

      I'm sick of attempts to steer this nation from principles evolved in The Age of Reason to hallucinations derived from illiterate herdsmen. ~ Crashing Vor

      by NonnyO on Sun Jun 22, 2014 at 07:58:27 PM PDT

      [ Parent ]

  •  U.S. governments spend more per capita than other (3+ / 0-)
    Recommended by:
    Pluto, Nisi Prius, mmacdDE

    countries' TOTAL health spending per capita!

    If American individuals paid 100% of the medical bills, you could say, "Tsk Tsk Americans, you love your expensive health care" but U.S. governments spend MORE than other countries but cover only the poor, the elderly, and government workers. By failing to negotiate with drug companies, using their extraordinary buying power, U.S. governments are unnecessarily shifting health care spending from where it's needed - the working poor - to where it's not - Viagra and its knock-offs.

    To me, this means that U.S. governments could implement almost any type of universal health care system without increasing the amount governments spend on health care.

    I know you hate clicking on links but these two are essential to understand the government/private funding of medical care (and would recommend the author include some of this info in future posts). The first is Ezra Klein when he was at WaPo - easy to understand with great graphs.

    The second is from the Guardian - more countries, more raw data, and links to where the data came from (so you can update it if you're so inclined).

    Wiki also has good sortable tables. Don't freak about the data being two or three years old; like ocean liners, it doesn't change direction very quickly.

  •  Two huge problems that aren't being addressed: (10+ / 0-)

    1) Lack of access to primary care. America has far fewer primary care providers per capita than other industrialized countries, and a much higher percentage of physicians are subspecialists. Paradoxically, having too many specialists actually reduces the quality of care. They provide very intensive/expensive care in their narrow area of expertise,  but lack the capacity to work outside their individual silos to manage the whole patient. Adequate access to primary care lowers cost, improves quality, and increases patient satisfaction. Here in the U.S., we don't have that, and in fact it's worse every year. The average age of primary care docs is over 55 years, meaning most of us are looking at retirement or death/disability soon. The Affordable Care Act pays lip-service to primary care by providing some largely cosmetic increases in education funding. However, it also imposes massive new organizational and regulatory burdens that are intended to force docs into 'care networks' and 'accountable care organizations', which reduces the status and autonomy of primary care even further than its current 'back of the bus' reality.

    This has a lot to do with the fact that specialists are paid far, far more than primary care docs, while (only in America!) medical education is so obscenely expensive, docs tend to graduate up to a half million dollars in debt. So graduates are basically forced to subspecialize, unless they're independently wealthy to begin with.

    2) Economic inequality. America has the one of the lowest rates of socioeconomic mobility of any modern industrial state. If you're born poor, you're like to die poor, and so are your children. Born wealthy? You'll have to really do something horrible to end up anything but rich. And poverty is very closely linked to poor health outcomes. The Affordable Care Act does little to address this grim reality.

    •  Neither Does Education Reform, Another Goal Proven (5+ / 0-)

      by endless studies to be dependent on economics not union bustedness.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Sun Jun 22, 2014 at 01:19:53 PM PDT

      [ Parent ]

    •  Yes. And I would add that the missing 800 lb (8+ / 0-)

      gorilla in this thread is

                       PUBLIC HEALTH

      We don't have a public health system. What we have is system in which lobbyists for tobacco can tie up progress on public health anti-smoking regulations for generations.

      Now we have exactly the same situation with Archer Daniels Midlands and their ilk preventing the elimination of obesity-inducing ingredient streams, of fast food and soft drink lobbies impeding any regulations that prohibit them free access to school lunch rooms. Nothing should interfere with the right of private capital to enjoy the freedom to make everyone sick.

      Fear is the mind-killer - Frank Herbert, Dune

      by p gorden lippy on Sun Jun 22, 2014 at 01:25:22 PM PDT

      [ Parent ]

      •  Yep. We're busy disassembling our public health... (5+ / 0-)

        system as fast we we can.

        My rural county recently 'privatized' its public health nurse program. The services are now contracted out to private firms. Overnight, highly skilled public health nurses with decades of experience were terminated, and they were replaced with a significantly smaller workforce of much younger, less skilled, less experienced nurses who candidly can't do the job.

        My primary care office is now bombarded every day with phone calls from panicky young contract nurses working for the private companies nominally providing public health services. So I, and my very busy office nurses, have to spend part of every day on the phone coaching under-trained and overworked young contract nurses through their jobs. And we don't get a nickel for it.

        I'm sure the contractors are making out fine, though. And the county gets to claim they lowered costs, so they can cut the property tax rate a few pennies per $100,000 assessed valuation. Sucks for the patients getting inferior care, though. Especially because insurers are now forcing us to discharge hospitalized patients early because "public health nurses will follow up closely".

        •  that's why Bernie Sanders and VT in general have (1+ / 0-)
          Recommended by:

          expanded community health centers greatly under the ACA.

          It's an opportunity to at least address some of the health problems early. Preventing many of altogether will require a much more nationally coordinated movement.

          Fear is the mind-killer - Frank Herbert, Dune

          by p gorden lippy on Sun Jun 22, 2014 at 02:14:24 PM PDT

          [ Parent ]

          •  Vermont's a special case, in that... (1+ / 0-)
            Recommended by:
            p gorden lippy

            The entire state's population is under 700,000 which is less than metropolitan Rochester NY. Hence their problems tend to be on a manageable scale.

            In addition, metropolitan Burlington's Fletcher Allen health complex is basically a defacto public health system, because pretty much all the complicated sick people in the northern half of the state end up there. So it's already relatively 'integrated'.

            They provide excellent care.

  •  That first chart is awesome. (1+ / 0-)
    Recommended by:
    this just in
  •  Have to say how good UK socialised heathcare looks (4+ / 0-)
    Recommended by:
    GayHillbilly, mmacdDE, qofdisks, rocksout

    Best in the world in 9 out of 12 categories - and one of the cheapest.

    Some things are beyond the market, such as healthcare and education.

    Indeed, the state helps competitive capitalism by creating a genuine level playing field.

    It's not either/or - communism or freedom

    It's common sense

  •  But we are doing it right (3+ / 0-)

    We have capitalist health care.

    And the capitalist system requires there to be scarcity in order to extract the most profits. Because profits are the goal of our health care system. Not results.

    I need your support, my paypal is:

    by Horace Boothroyd III on Sun Jun 22, 2014 at 01:18:10 PM PDT

  •  Obviously False, Here's the Accurate Description: (1+ / 0-)
    Recommended by:

    +/- "We pay much more than other countries, but have no better outcomes."

    That was the description of our system prior to passing the ACA, frequently given by our chief cheerleader for reform, who was also our head of state.

    "No better outcomes" is a world better than "dead last" among developed nations, or "ranked number 37" or any of these other pessimistic evaluations.

    I think all these specifics about not being #1 are going to hurt some fee-fees.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sun Jun 22, 2014 at 01:18:58 PM PDT

  •  American exceptionalism on display!! USA! USA! (0+ / 0-)

    Wow, we're w-a-a-a-ay out there by ourselves. Noone within shouting distance of the system that RW'ers defend with so much passion and fury.

  •  Your last paragraph is significant. (3+ / 0-)
    Recommended by:
    Pluto, skepticalcitizen, Nisi Prius

    Thank you for enlightening those who may not know that other countries have far surpassed the U.S. in not only cost containment, longevity, infant mortality, but outcomes, as well.

    Obamacare absolutely is a "start" in the right direction.  Since its conception (first, as Romneycare), and then in 2009 when it began to unfold, many involved in patient care and allied health fields knew that we had to fix a very inequitable system.  In a country that professes to be the greatest, most bankruptcies before Obamacare were due to medical debt.  That was absolutely outrageous.

    It is my opinion that not only has the industry have to be reformed, but one of the biggest hurdles is the psyche of the American public.  They have to get over that, yes, some out of work, poor people, including families and children will receive subsidies.  That some (in their heads) will be "undeserving," (in their minds) and should not reap any benefits just because they were born here, is a real anger; you hear it often.

    There will always be "those people," but in order to have a healthy society, one where costs are contained by prevention (Obamacare), promoting healthy habits, along with supporting the EPA, which reduces respiratory problems in polluted cities, we must put accessible, cost effective health care for all as a priority.

    Lastly, our politicians, those with a real partisan agenda either against the president, or the democratic party, or, most likely, catering to their uninformed conservative base for the only reason, "job security," must be voted out and in their place lawmakers who have this country's future in their hands and heart.

  •  Neither chart.... (5+ / 0-)

    ...has an axis labelled 'Freedom'™.

    Put that in there, and you'd really see us shine!

    (Freedom™ is a registered trademark of the Republican National Committee. Used with permission. All rights reserved.)

    The superfluous goods of the rich are necessary to the poor, and when you possess the superfluous you possess what is not yours." St. Augustine

    by Davis X Machina on Sun Jun 22, 2014 at 01:36:34 PM PDT

  •  It also costs too much . . . (1+ / 0-)
    Recommended by:

    It also costs too much, Sen Johnson, to conduct an unnecessary war in the Mid-East, don't you think?

    My solution:  Fold the VA medical program into Medicare --
    just consolidate them. Every honorably discharged Vet and his family are members of Medicare at no cost.  How do you like that, Senator?   BTW, I hear you are retiring from Congress; what a good idea. Now you can go to work for private insurance companies.

  •  If those groups in the US with access and (0+ / 0-)

    financing to pay for this better healthcare are also not doing better, then the problem would seem not to be one that can be solved by changing the financing system.

  •  England (0+ / 0-)

    18 June 2014 Last updated at 03:25 ET
    NHS 'facing funding gap of up to £2bn' in England
    Senior health sources told the BBC growing costs would outstrip the money the NHS received from April 2015.

    Health Secretary Jeremy Hunt is involved in Whitehall talks on how to plug the gap.

    The Department of Health said it was "confident" it would "make the savings necessary to meet rising demand".

    So maybe their #1 rank is in some danger ? I hope not ,
    I enjoy that England is in 1st place .

    "please love deeply...openly and genuinely." A. M. H.

    by indycam on Sun Jun 22, 2014 at 01:54:10 PM PDT

  •  Serious (not rhetorical) question: (1+ / 0-)
    Recommended by:

    We spend the most on healthcare. Where is that money going? Who's counted as paying it, and who's counted as receiving it?

    I don't mean this as a rhetorical question. I'm quite curious. Is it going to our healthcare providers? Is it going to healthcare administration? Is it going to the bloodsucking insurance companies? If we want to start decreasing our costs, who's going to see fewer dollars flowing their way (and thus, most likely, start fighting back to keep them)?

    Always follow the money.

    by Zaq on Sun Jun 22, 2014 at 02:17:42 PM PDT

  •  you're looking at that chart wrong (2+ / 0-)
    Recommended by:
    GayHillbilly, qofdisks

    rotate it 90 degrees counter clockwise and look at it in a mirror.

    Oh- and let's label those axises a little differently.

    Rather than health care spending per capita that should be profit per customer per year or some such.

    And the other axis, life expectancy should be changed to something like average profit extraction window.

    So what if our consumers don't last as long if we clearly squeeze way more in terms of the absolute yield.

    With these simple adjustments it becomes clear that, yes, we are leading the world.

    Have a little empathy for the bottom line here, people.

  •  X & Y axis and R^2 have a well known liberal bias (1+ / 0-)

    -1.63/ -1.49 "Speaking truth to power" (with snark of course)! Follow on Twitter @dopper0189

    by dopper0189 on Sun Jun 22, 2014 at 02:55:30 PM PDT

  •  Our health care system gets blamed (0+ / 0-)

    For a lot, just like our schools. But frankly, I'm not sure you can blame the poor health of people who eat crap, refuse to exercise, smoke and abuse substances solely on our health care system.

  •  Our health care system gets blamed (0+ / 0-)

    For a lot, just like our schools. But frankly, I'm not sure you can blame the poor health of people who eat crap, refuse to exercise, smoke and abuse substances solely on our health care system.

  •  The government is happy with the LE data (0+ / 0-)

    Politicians and government accountants will never publicly admit it, but those numbers are good as it reduces Social Security and Medicare lifetime costs in their view.

    Hey, what's 4 years at the end of one's life, but that's a lot of Medicare and SS savings, am I right?

    I distrust those people who know so well what God wants them to do, because I notice it always coincides with their own desires. - Susan B. Anthony Everything good a man can be, a dog already is. - pajoly

    by pajoly on Sun Jun 22, 2014 at 04:24:06 PM PDT

  •  I love the graph at the top n/t (0+ / 0-)

    My invisible imaginary friend is the "true" creator

    by Mr Robert on Sun Jun 22, 2014 at 04:37:44 PM PDT

  •  Not news. My continued monotonous complaint (1+ / 0-)
    Recommended by:

    about ACA is not that it does nothing good.  Of course it does.
    It's that ACA, for as cumbersome and confusing and inefficient and frustrating as it can be, is not health care reform.  It is health insurance regulation with a subsidy program thrown in. It is the outer layer of a damned rotten onion.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sun Jun 22, 2014 at 05:52:21 PM PDT

  •  Here's the comeback to 'socialized medicine" and (0+ / 0-)

    "death panels".

    Compare US spending and results to spending and a results in a country with "socialized medicine".

    You're fighting for a system that will take two years off your life and charge $5000/yr more for the privilege, every year for the rest of your life.

    I've lost my faith in nihilism

    by grumpynerd on Mon Jun 23, 2014 at 05:45:46 AM PDT

  •  Please Help!! (0+ / 0-)

    Please help us and tell Governor (of Alabama) Bentley to expand Medicaid.  Here’s his contact number 334-242-7100 or fax 334-353-0004. (let him have it)       

    Please help us and tell Rep. Bradley Byrne (of Alabama) to support expanding Medicaid Please call Phone: (251) 690-2811 Phone: (251) 972-8545 phone: (202) 225-4931 fax: (202) 225-0562 (let him have it)   

  •  It's not crappy, it's... (0+ / 0-)

    ...profitable!  Isn't that the whole point of any human endeavor?  Sure seems so in this country and the corporations it is designed to serve.

    Today is the tomorrow we worried about yesterday.

    by Long Haul on Mon Jun 23, 2014 at 05:36:38 PM PDT

  •  As an example of this (0+ / 0-)

    I was booted off Medicaid for some reason, since my income isn't that high I really don't understand. I had scheduled and overdue colonoscopy to be done, then found out that the insurance I have on the exchange requires a $150 deductible, and I just don't have it now, so I had to cancel the scan. I need propane for the winter!

    If I was still on Medicaid, they would have covered the entire cost, and I would get it done. Well, except for the cost of the prep supplies, which I would also have to come up with.

    Hopefully there won't be any repercussions from this, but who knows?

    Women create the entire labor force.
    Sympathy is the strongest instinct in human nature. - Charles Darwin

    by splashy on Tue Jun 24, 2014 at 12:38:07 PM PDT

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