Which costs more: a more private, or a more public health care system?

[Mr Spinkles]

Let's try to look objectively at the data. I believe the following graph should help us answer this question. I made it using data from a World Health Organization 2010 report. The x-axis is government expenditure on health as a percentage of total health expenditure. The y-axis is total health expenditure, as a percentage of GDP. Keep in mind that 1% of GDP is an enormous amount of money. To give you an idea, the U.S. military budget is around 4% of GDP. So a few points up and down on this graph is extremely significant.

The countries shown are from the top 27 countries by GDP per capita, as of 2011. The data point representing the U.S. is highlighted by an orange diamond. The line is a linear fit to the data. Not shown are those outliers which spend less than 4% GDP on health in total: Singapore, and the Islamic/Arabic monarchies Qatar, Brunei, United Arab Emirates, and Kuwait. Also not shown are countries which receive external resources for health: Israel.

List of countries shown: Luxembourg, Norway, United States, Switzerland, Netherlands, Australia, Austria, Canada, Ireland, Sweden, Iceland, Denmark, Belgium, Germany, United Kingdom, Finland, France, Japan, Republic of Korea, Spain, Italy.

Hypothesis: Public health systems are expensive, and therefore, the U.S. cannot afford such a system.

Prediction: The above hypothesis predicts that the data in the graph below should be positively correlated, not negatively correlated.

Results:​

Conclusion: The best available evidence does not support the hypothesis. In fact, it supports the opposite.​

Please discuss.

 

[Pegg]

Money should not even factor into health.... it should be a human rights issue.

The right to access medical care should be the focus, not the cost.

 

[Mr Spinkles]

I agree with you Pegg but if it costs less to protect human rights more, then the issue is a no-brainer.
In the U.S. one argument against a more public system is that it costs more. This argument appears to have no basis in fact.
Nevertheless, many Americans believe it.

 

[MoonWater]

indeed. it is interesting to note that the graph shows a trend where the more the government covers the health care costs of it's citizens, the lower the overall cost of health care as a percentage of GDP becomes. the more i think about it the more it seems like arguments against universal health care are just as shaky, illogical, and outright based on falseties and fear mongering as arguments agains same sex marriage are.

 

[Alceste]

I sure wish this argument would work, but unfortunately I feel opposition in the US to universal health care is ideological rather than pragmatic. In other words, I expect opponents of universal health coverage don't care if it's cheaper or more effective. They only care about making sure nobody gets a "free ride", except the CEOs of massive, multi-billion dollar corporations.

 

[Kilgore Trout]

Facts, rational arguments, and sensical lines of reasoning don't work against people who are strongly ideologically indoctrinated. This includes those who have been indoctrainted to think that the vast majority of people are worthless slobs who sit around, living the good life, and doing nothing, while a few, hard-working wealhy, corporate scions of dedication and virtue selflessly keep everything running through genius, determination, and moral superiority.

 

[Terrywoodenpic]

Why would the health industry spend millions of dollars on lobbying and promotions against universal health care, if they thought it would cost more and put more profits into their members pockets.

They Know perfectly well they will have a harder time of it in a less costly universal health system.

 

[Terrywoodenpic]

The UK spends far less per person on total health care than the USA
However the present conservative UK government is trying to reduce the spend still further, by cutting services and staffing. It is reasonable to suppose that cuts will reduce the overall standard of care.

 

[Willamena]

I agree with you Pegg but if it costs less to protect human rights more, then the issue is a no-brainer.
In the U.S. one argument against a more public system is that it costs more. This argument appears to have no basis in fact.
Nevertheless, many Americans believe it.

I would think it depends on if the doctors are private. In our health care system, for instance, doctors, nurses and other health workers are on a public payroll. If the doctors are private, they set their own wages, which may drive the cost of the whole system up.

 

[jazzymom]

Facts, rational arguments, and sensical lines of reasoning don't work against people who are strongly ideologically indoctrinated. This includes those who have been indoctrainted to think that the vast majority of people are worthless slobs who sit around, living the good life, and doing nothing, while a few, hard-working wealhy, corporate scions of dedication and virtue selflessly keep everything running through genius, determination, and moral superiority.

I believe that another belief is at work too. That Americans are different and that America is better.

We don't have to learn anything from other countries.

We are isolationist in our views I believe.

The belief in individuality and pulling one up by his own bootstraps.

The community is not important but the individual.

 

[Jayhawker Soule]

The graph is suggestive, but I'm not sure that "health care" in country 'A' is equivalent to "health care" in country "B", nor does the graph factor in such things as population, etc., as far as I can determine.

 

[Mr Spinkles]

The graph is suggestive, but I'm not sure that "health care" in country 'A' is equivalent to "health care" in country "B", nor does the graph factor in such things as population, etc., as far as I can determine.

I tried to factor in those things to the greatest extent possible, by comparing the top wealthiest nations by GDP per capita, and excluding outliers (like Qatar and other tiny, wealthy monarchies). I think if you look at the list of countries you will find they are as comparable as possible in life expectancy, standard of care, type of government, etc. In fact most of the countries are in the European Union, so differences between them is about as controlled an experiment as we will find in human affairs.

Nevertheless, you are right that the comparison is, inevitably, imperfect. It is only (as far as I can determine) the best available evidence. The question is, why do so many Americans take it for granted that increasing public involvement in health care costs more, when that belief is at odds with the best available evidence?

 

[Jayhawker Soule]

The question is, why do so many Americans take it for granted that increasing public involvement in health care costs more, when that belief is at odds with the best available evidence?

I am not convinced that most Americans even ask that question.

 

[Alceste]

I tried to factor in those things to the greatest extent possible, by comparing the top wealthiest nations by GDP per capita, and excluding outliers (like Qatar and other tiny, wealthy monarchies). I think if you look at the list of countries you will find they are as comparable as possible in life expectancy, standard of care, type of government, etc. In fact most of the countries are in the European Union, so differences between them is about as controlled an experiment as we will find in human affairs.

Nevertheless, you are right that the comparison is, inevitably, imperfect. It is only (as far as I can determine) the best available evidence. The question is, why do so many Americans take it for granted that increasing public involvement in health care costs more, when that belief is at odds with the best available evidence?

Actually, it could hypothetically cost more if you botch it terribly. "increasing involvement" is a pretty broad term. I can see the US appointing a panel of pharmaceutical and insurance industry executives to create the fee schedule, for example.

If you carefully follow what has worked in other countries instead of trying to reinvent the wheel, you really can't go wrong. That "American exceptionalism" nonsense can be a real handicap for this sort of thing.

 

[Mr Spinkles]

I am not convinced that most Americans even ask that question.

I meant out of the subset of Americans who bother to even consider the health care issue. In my personal experience on RF and talking to people I know, I have yet to encounter an American who opposes a more public system, who does not also take it for granted that such a system will cost more (and therefore we cannot afford it).

 

[Kilgore Trout]

The question is, why do so many Americans take it for granted that increasing public involvement in health care costs more, when that belief is at odds with the best available evidence?

Because the argument that it will increase costs supports their position of being against any type of "socialized" medicine. Everyone wants to make their opinions sound rational and reasoned, even when they're not - and usually after the fact.

 

[Jayhawker Soule]

I meant out of the subset of Americans who bother to even consider the health care issue.

Fair enough.

Why do you think one would cost less (as opposed to "not cost me less") if the quantity and quality of the health care is the same?

 

[Alceste]

Fair enough.

Why do you think one would cost less (as opposed to "not cost me less") if the quantity and quality of the health care is the same?

We don't have to pay for a multi-billion dollar private health insurance industry. That's your biggest savings right there.

We can negotiate reasonable prices for drugs and medical equipment.

We can see a doctor any time without considering payment, so we catch illnesses before they become very expensive to treat.

 

[Jayhawker Soule]

We don't have to pay for a multi-billion dollar private health insurance industry. That's your biggest savings right there.

That's an excellent point. Now, forgive the naive question: do the health care costs found in the graph include health care insurance costs?

 

[Alceste]

That's an excellent point. Now, forgive the naive question: do the health care costs found in the graph include health care insurance costs?

I don't see how they could not. In the US, isn't the private insurance industry the gatekeeper, basically?

When I used to fool around with the interactive database on the WHO, health care spending was divided between public and private spending. The US spends the same per capita public portion (slightly more, actually) as the rest of us do, but then spend about as much again on private costs. I assume that means insurance, mostly, including deductibles and copays and so forth.

Anyway, the data is available and the data I've seen is consistent with the graph.