Top of the Charts

November 2, 2009
Posted by Jay Livingston

In case you wondered about what we in the US pay for health care compared with those unfree unfortunates who suffer under various forms of socialized medicine, here are some graphs showing the advantages of what Republicans here tell us is “the best health care system in the world.”

The graphs are from the International Federation of Health Plans. I’ve selected only four – to show the relative costs* of
  • an office visit
  • a day in the hospital
  • a common procedure (childbirth without complications)
  • a widely used drug (Lipitor)
(Click on a chart to see a larger version.)

You can download all the charts here, but be warned: it gets boring. We’re number one in every chart, at least in this one category of how much we shell out.

Since we have the best health care in the world, this must mean that you get what you pay for. Our Lipitor must be four to ten times as good as the Lipitor that Canadians take.

*Udate: As Phenompbg says in his comment below, these amounts are what providers are paid by governments or other insurers, not what the patient pays, which in many Eurpean countries is essentially nothing. See the footnotes for the tables in the original document. Or look at the comments on this at Boing Boing, a discussion which is remarkably civil (do they monitor comments?).

Hat tip: Ezra Klein.


Man of Letters said...

That inclusion of US Medicare in the baby deliveries without complications seems a bit fishy to me.

As for the cost of drugs, what has been Canada's contribution to the availability of useful drug treatments? Among the other things drug companies do with the profits from their expensive American pills is reinvest in new and better treatments for the same or different ailments. America is the engine for drug development in the world, and its the big bad drug companies who are the primary reason.

Jay Livingston said...

Thanks for commenting, Man. But I'm skeptical. Maybe if their revenues were reduced, Big Pharma would cut down on marketing, which they spend much more on than they do on R&D. And many of their "new" drugs are just variants of older, and sometimes more effective, drugs.

Marcia Angell, former editor of the New England Journal of Medicine, published a book a few years ago, he Truth About the Drug Companies: How They Deceive Us and What to Do About It. The title subtly hints at her take on the subject. You can read a shorter version she did for the NY Review of Books.

Anonymous said...

That inclusion of US Medicare in the baby deliveries without complications seems a bit fishy to me.

It's not fishy if you remember that there are two groups of people who qualify for US medicare: retired people, and people of all ages with a qualifying disability.

Unknown said...

My issue with this data: many of these countries have government support that reduces health care payments. Regardless of how one feels about a national health care system, a payment of $100, when compared with a payment of $10 and $90 worth of government money should be compared on equitable grounds. $100 is $100, regardless of who is paying that $100.

The real problem with healthcare isn't that the government isn't paying for it: it's that it costs too damn much to begin with. The question shouldn't be, "Why am I paying $100?" but, "Why does it cost $100 at all?"

Adam said...

@Man of Letters:

What has Canada's contribution to the availability of useful drug treatments?

uhh what about:

Anonymous said...

Regardless of how one feels about a national health care system, a payment of $100, when compared with a payment of $10 and $90 worth of government money should be compared on equitable grounds. $100 is $100, regardless of who is paying that $100.

If you read the report, this isn't a comparison of the cost to the patient, this is a comparison of the total cost, regardless of who is paying or whether it's covered by insurance or not.

I live in Canada but as a not yet landed immigrant I am not currently covered by Medicare. So I know how much it costs to see a doctor in Toronto. Last month an office visit and a standard set of blood tests set me back only $100 for the tests and $40 for the office visit.

Unknown said...

Jay, cmon, put things into perspective. Also put up the charts of where are tax dollars go today, rather than paying for health care. This isnt apples to apples, and also the US offers some of the most advanced health care in the world, and unfortunately that comes at a cost. We need to question why we fund two wars, and spend trillions on building a global empire rather than building up our own country first. US companies spend a much larger fortune on R&D than any of these other countries do. They get the benefit of our up front costs and investments. Americans don't protest providing health care, they protest the fact that we can't have it all, we can't fund being the worlds police department, and health care on top of that. We have to make tough choices. I would much rather we have better health care than go in to protect cast areas of the world to protect US corporate interests abroad.

Jules said...

Here's your answer, Man of Letters:

Anonymous said...

As a Canadian (British Columbia -- each province manages it's own health system according to federal standards) I can confirm that I pay nothing when I go to the doctor for any normal treatment. We paid nothing for our children's births and all of the associated care. We did pay a small fee recently to get a fibreglass cast on my son's arm. The plaster cast would have been free. We pay nothing when we go to the emergency room or clinic. My wife paid nothing for her extensive treatment for lymphoma (cancer) which included, chemotherapy for six months, radiation therapy, CAT scans etc. I pay about $100 per month to the provincial health care plan (BC Medical Services Plan) for my family of four. Americans who worry about this really need to think carefully about what exactly they are afraid of.

Anonymous said...

In countries like Canada and Germany, when you visit the Doctor for a check-up, the cost is for the Doctor's time, and overhead for the office (admin assistant, heat, rent). In the US, you must add in the cost of the Doctor's lawyer, the accountants, the insurance reps, their accountants, the business manager, and their respective offices/overhead. That's a lot of extra salaries to pay. Are you getting value for your money when you have to pay their salaries too?

How much value does an accountant and multiple insurance reps add to your healthcare compared to the medical doctor? Are those people actually adding value to your healthcare dollar?

Anonymous said...

Mtn wrote: "US companies spend a much larger fortune on R&D than any of these other countries do" - where did you get this from - of course this is true only for the German companies ;-) And this is because we can do have the best health care in the world. C'mon - where are the facts?

Julien said...

@ Man of letters
If the biggest company is american (pfizer) the second largest is english (glaxosmithkline) and the third one is french (sanofisynthelabo).. so i'm asking you, who contributes more : USA or europe ?

I think you didn't quite understand the chart : it's not what the patient pays but what IT COSTS. So even if I paid for everything for a day in hospital it would cost me 12 700 dollars in the USA and 1000 dollars in France.

The most surprising thing is that so many people in the USA listen to stupid arguments like death panel and other lies and believe them... Come on guys, THINK ! the only winners are your insurance company and the physicians, and that's why they give so much money to lobbyists and lying republicans

Phenompbg said...


Save yourself a lot of dim comments and state explicitly in your above post that the amounts indicate actual cost, and not what the patient gets billed.

Anonymous said...

Call me naive but it seems that here in the US the prime directive overall is to make tons of money. We have seen how well this direction has worked in our financial markets. Now we see how well it works in our health care needs. We can argue over this and that but the same reality will exist. Some people want to make a hell of a killing and don't mind how they do it. I have worked many hard jobs over my life so far, working for other folks. My wife and I pay into a catastrophic insurance plan and we both hope to god to not use it for obvious reasons and also for the fact that we would pay out of pocket quite a bit of cash. Really frankly folks, the way I see it is the common working stiff gets screwed because somebody needs another McMansion. There are quite a few doctors and nurses who would like the insurance companies to take a hike. Huge profits and health. Great combination. Anybody who thinks that we have it the best is in La La Land. They will wake up in the end.

Anonymous said...

As an interesting additional tidbit: German economists estimate, that the is about 30% cost reduction potential in the german numbers.... Now talk about the efficiency of markets ;-)
To Man of Letters:
As long as the Marketing budget doubles the R&D budget in most drug companies I wouldn't shed a tear when drug prices are cut down to reasonable levels. Much of the basic research for drugs has been funded by the tax payer, not big pharma

Sandra said...

I lived in Canada in the 70's, and seem to remember that provincial taxes go to medical care and that they're higher than state taxes here. Maybe the current Canadians can comment.

However - even though this may make the cost to the patient seem lower than it actually is, once you go to the doctor it doesn't matter what your income is - everyone is covered equally.

Anonymous said...

A bit more clarifying statistic would be to compare the salaries of doctors and other high-ranking officials in medical industry to the cost of services, globally.