Interesting piece that challenges perceptions about healthcare spending.

From http://www.techcentralstation.com/050505C.html

By Arnold King

One of the most persistent myths about the U.S. health care system is that poor people lack access. While we allegedly provide luxury health care for the rich, we do much less than other countries for those in poverty. However, the data tell a different story.

The government's Medical Expenditure Panel Survey (MEPS) tabulates health care spending for a sample of over 35,000 Americans. One of the variables included in the survey is household income relative to the poverty line.

When the data for 2002 (the latest survey year available) are extrapolated to the full noninstitutional population, one obtains these results for persons below the poverty line:

Number of Persons: 35.6 million

Total Spending: $106.3 billion

Per Capita Spending: $2,986

Next, look at data on per capita spending on health care in various countries, as compiled by the OECD. In 2002, per capita spending in Canada was $2,931, in France it was $2,736, in Germany it was $2,817, and in the United Kingdom it was $2,160. The United States spends more on the average poor person than those countries spend on the average person.

In fact, the MEPS data understate spending in the United States, in part, as it is limited to the noninstitutional population. Therefore, it excludes nursing home expenditures. When those are added in, the per capita spending in the United States on those in poverty will turn out to be higher.

Still, people who are above the poverty line receive much more medical care in the United States, right? Wrong. In the MEPS data, the per capita spending rate for people above the poverty line is $2,789, essentially the same as the rate for poor people. (Again, the MEPS data excludes spending on nursing homes, research and development, and other categories that show up in countries' national income accounts.)

Questions

As with all aggregate health care data, these statistics were not designed to answer the most penetrating questions. Some issues that come to mind are:

1. Do other countries spend much more per capita on their poor than they do on the average person?

2. Do poor people in the United States consume too much of the "wrong" health care resources -- too much acute care and not enough preventive care?

3. Do poor people in other countries require less health care than poor people in America? Are they healthier to begin with?

I suspect that the answer to (1) is "no," but that the answers to (2) and (3) are "yes." People who tend to make bad choices about how to care for themselves and how to spend money also tend to be poor. Taking this propensity to make bad choices as given, the poor need to spend more to achieve a given level of health. I believe that this effect is stronger in the United States than it is in other countries.

I suspect that severe substance abuse plays a big role in poverty, poor health, and mortality. My guess is that if substance abusers were excluded from the international statistics on health outcomes, the standing of the United States would improve considerably. If this is true, it still begs the question of whether our public health policies are inferior to those of other countries in the area of substance abuse.

I think it would be foolish to conclude that the United States does as well or better than other countries in providing health care to the poor. What the data do suggest, however, is that poor people in America do not suffer from a lack of total health care resources.

No Easy Answers

If the United States does not lag in spending on health care for the poor, then this undermines one of the arguments for adopting a more European or Canadian style health care system. Our challenge is not to redirect resources toward the poor but to come up with better approaches for improving public health.

In Medicaid, we already have the sort of state-funded health care system for the poor that other countries provide for everyone. It is difficult to see how expanding that system to the middle class (as Howard Dean, among others, has proposed) will make the poor better off.

I believe that there are genuine problems with our health care system. Studies and anecdotal evidence suggest that the uninsured and the poor receive inferior care. But I do not believe that there are any easy answers. In particular, I fail to see how any fair-minded individual could conclude that we ought to increase government's role in health care finance. If the poor under Medicaid are not as well cared for as the rest of us under private systems, then government-funded health care would seem to be part of the problem, not the solution.

In many countries ,particularly in the Carribean and Latin America,even well heeled people cannot get basic Emergency room treatment at Hospitals.

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I always come back.

I just skimmed the article but it seemed pretty misleading. Why is the author focusing on the poor? I think this is one of the few groups in the US that does get automatic coverage. The bigger problem lies with the middle class and any companies that try to provide coverage for their middle class workers.

Also, why did the author compare dollar figures? Given that the biggest problem in the US seems to be that it is getting little health service bang for its buck, comparing money spent seems like the worst measure the author could have used. The fact that spending was even close is surprising. I had always assumed that since they're covered, health care provided to the poor in the US was comparable to that provided in other Western countries. But there is no way that $2,986 worth of healthcare in the US is comparable to $2,736 worth of healthcare in France. For the author to even suggest this is grossly misleading.

I would be very interested in seeing a study that compared services provided.

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The trouble with the rat race is that even if you win you're still a rat.
--Lilly Tomlin

Consider a few things : the population of the USA grew more durint the last US census, than the entire total population of Canada.

I would like to send the inner city poor of the USA ( noncompliant with healthcare advice, engage in high risk behavior ) and the illegal immigrant population of the Southern USA to
france
canada
sweden
UK

I don't have the data, but I bet southern california spends as much on healthcare for uninsured "undocumented" workers as is spent in Canada.

I'd REALLY love to see the effects on these uninsured masses on these so called utopian healthcare systems.

can you say FLAT BROKE? The USA system could stand to be improved

first: put all malpractice lawyers in orange jumpsuits. second, allow physicians to practice real medicine ( not defensive ** medicine )
third : make people pay 5 dollar copays to be seen in emergency rooms.
No money ? then no treatment for anything other than life threatening emergencies. This will stop some of the massive waste.
Finally, deport illegals that enter emergency rooms. fly all of them to Paris and Stockholm ( free of charge of course. )

Don't blame me I did not vote for Bush, I don't think Bush could have succeded in the election without the poor. So the American people are happy with the current health care sytem.

I think you're right; but I'm not sure what your point is. If you think that other countries in this list don't have similar immigration and social problems you're mistaken. You're probably right in thinking that Canada and Sweden have proportionally smaller levels of illegal immigration but the level in France is probably at least as high. On top of that, I think France may be dealing with some social problems that aren't an issue in the US. (Whether France is dealing with these issues well is another matter.)

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The trouble with the rat race is that even if you win you're still a rat.
--Lilly Tomlin

there are 20 million ( probably an underestimate ) illegal aliens in America.
The total population of Canada is 30 some million
France 60 million.



Side bar :

Yes, the French have your own problems with the influx of Islamofascism.
Good luck to you guys.

The Dutch figured it out too late. Took 30 some stab wounds in Theo Van Gogh to clue that country in. They are getting tough with the radicals, hopefully before it is too late

FLK's grandfather was an immigrant, unless native American is not ruled out. When the U.S. have problems they always blame illegal immigrant, while at the same time they vote for politicians who incourage...illegal immigration. The very conservatives who preach unti...illegal immigrant voted in mr Bush.

First, I am a native American as I was born in America....and a natve Texan. You have to be Texas born to understand that concept.

Second, my ancestors came to America LEGALLY. Then rather than go on welfare , and demanded a driving test in their languare ( Irish ) they learned the language ( English ) and got jobs.

They did not suck the resources out of preexisting Americans.

Finally, I an pretty disgusted with George Bush and his easy does it open door policy to law breakers.
I suppose Taliban and al-quaeda are sneaking in with the other illegals. I guess as long as the terrorists promise to vote for him, he'll give them amnesty too

The native Americans are not illegal or legal immigrants, they were here before the Europeans got here. I suppose in your definition of native American, my son was born in Philadelphia doe's that make him native American I don't know. When you talk of Islamic terrorist, you have to look at the root course.... of terrorism, Arab Israeli conflict, Oil, globalization, ignorance on both side.

Me my self I am an immigrant, though I was an illegal immigrant, now I am a citizen of the U.S. I did vote in the last election, though my guy lost the election. The only time I have taken well fair..... is my first six months, in this country. I went through community college, Temple University and now attending medical school. I lived in the center city of Philadelphia but I worked so hard, to pay rent and other bills, and go to college at the same time. All I am saying is there are some illegal immigrant who are working hard human beings, it's unfair to blame all the problems of health care and others on them.