Print Story How much do Europeans save on healthcare by just letting people die?
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By nlscb (Tue May 06, 2008 at 07:48:08 PM EST) America, Europe, Health, Nationalization, freedom (all tags)
Everyone knows Americans pay too much for healthcare.  What many do not know is that, according to the neocons at the OECD, its governments (federal, state, local) spend more per capita on health care than any other country in the world except for Norway and Luxemborg. 

So, how does the rest of the world save so much money when we spend so much?



I figure the savings that nationalized healtcare provide come from the following areas:


1)  Not having a distorted tax structure.


American individuals cannot pay for healthcare with pretax dollars.  American corporations can.  This causes huge distortions, since people who have someone else paying for something have no incentive to seek lower costs.  At the same time, those who do not have employment through the proper corporation pay a fortune for healthcare


2)  Protecting doctors from outrageous frivolous lawsuits


Tort law in the United States is clearly abused.  No where does this come more apparent than healthcare.  American doctors perform plenty of marginally necessary tests, treatments, and surgeries just to make sure that they will not get sued in the 1 in a million chance that patient x actually needed whatever they just expensively provided.


3) Reduced paperwork and processing costs


Having everyone going through the same system means everyone uses the same paperwork.  A significant part of America's healthcare system is dedicated entirely to processing claims.


4)  Letting people just die


This is the rub.  It is often claimed that a large percentage of US healthcare spending is spent on the last year of life.  How much of Europe's is spend on that year?  Do Europeans just let the old croak?  I don't have a problem with this, but I think I deserve a fair answer before the US goes down the road of nationalization.  As well, what if a little kid gets lukemia or some other awful disease which has a very high treatment cost with at least a relatively low chance of survival.  At what point does a European government just go "to hell with it.  Let the brat die".  Again, I hate children and would throw most through a wood chipper if I had the chance, though feet first and just slowly enough to milk them for the maximum number of tears for my martinis, so I don't have a problem with this.


But unfortunately, one needs to have these answers at the ready if one is to advocate nationalized healthcare in the United States.  This issue will eventually come up, and I'm surprised no one seems to have addressed it.  What percentage of European savings on healthcare spending come from just letting people die instead of treating them? 

< Eight Years. | Ding, dong, the witch is dead. Which old witch? The wicked witch! >
How much do Europeans save on healthcare by just letting people die? | 42 comments (42 topical, 0 hidden) | Trackback
IHBT but just by R Mutt (4.00 / 4) #1 Tue May 06, 2008 at 11:19:28 PM EST
Look at the data.
In a Commonwealth Fund-supported study comparing preventable deaths in 19 industrialized countries, researchers found that the United States placed last.
...
Measuring the Health of Nations: Updating an Earlier Analysis"... compared international rates of "amenable mortality"- that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care. In addition to the U.S., the study included 14 Western European countries, Canada, Australia, New Zealand, and Japan. According to the authors, if the U.S. had been able reduce amenable mortality to the average rate achieved by the three top-performing countries, there would have been 101,000 fewer deaths annually by the end of the study period.
The question is: how much extra profit does the US healthcare industry generate by just letting people die? Human life only has a certain value, so it could well still be a the most cost-effective system.

Look at it this way by ObviousTroll (2.00 / 0) #5 Wed May 07, 2008 at 01:59:51 AM EST
we're doing our bit to hold back overpopulation - how about you?

--
Has anybody seen my clue? I know I had it when I came in here.
[ Parent ]
But how much did those deaths cost? by nlscb (2.00 / 0) #20 Wed May 07, 2008 at 06:19:31 AM EST
If they just died in there homes, than actually money was saved.   


There is little doubt that American hospitals will try to keep the elderly alive much longer than European ones will.  I know for a fact that that is EXACTLY what happens in Denmark, for example.  How much money do they save by doing this?  What % of the savings on healthcare that European countries enjoy over America come from letting people die?


My invective towards children and the elderly aside, the question not a troll.  If you do not think that this topic will not be brought up if America decides to nationalize its healtcare, then you really don't understand how the country works. 

[ Parent ]
That's not a fact by R Mutt (4.00 / 1) #23 Wed May 07, 2008 at 06:43:59 AM EST
As the earlier link shows, treatment is worse in the US than most of Europe. Life expectancy is also lower.

The US system both costs more and produces worse outcomes than an average European system. (Though they vary greatly between nations).

It's not a question of "you get what you pay for". Some systems are just plain inefficient: you can pay more and still get a worse outcome.

I think if the US had a true free-market system it probably would be more efficient, but it doesn't.

The US system skimps on preventative care, but pays a lot for "emergency" care.

Example: someone with high cholesterol and cardiovascular problems. but no insurance, will probably not receive statins, even though they're cheap. When he gets a heart attack though, he will receive a massively expensive heart bypass operation. While it bankrupts him, most of the cost will be borne by the hospital or the taxpayer.

Consequence: more expensive and worse outcome.

[ Parent ]
Stop dodging the question by nlscb (2.00 / 0) #27 Wed May 07, 2008 at 08:26:00 AM EST
Europeans let people die in order to save money on healthcare.  For example, the Danish government will not pay for Kidney Dialysis over the age of 65.  I happen to think that's pretty sensible.  But it does mean that they are letting people die in order to save money. 


How much of the savings that Europeans enjoy comes from that?  I'd be surprised if it's over 15%, but that's just a guess. 

[ Parent ]
As they say on Wikipedia by Herring (2.00 / 0) #29 Wed May 07, 2008 at 08:52:21 AM EST
Citation needed.

Sounds like the sort of stuff the republicans make up to scare people about the evils of "socialist medicine".

christ, we're all old now - StackyMcRacky

[ Parent ]
My cousin is a Danish Doctor by nlscb (2.00 / 0) #35 Thu May 08, 2008 at 03:14:17 AM EST
Admittedly I did not verify this, but I have no reason not to believe him - he certainly didn't seem to have any problem with the practice.  Sorry to break this to you, but denial of service to those with a low likelihood of survival is a tactic used by governments to save money on health spending.  The question stands: how much?  Maybe the US does it more.  Triage in a disaster situation is essentially a short term version of this. 

[ Parent ]
Well by Herring (2.00 / 0) #37 Thu May 08, 2008 at 03:27:52 AM EST
I googled on a few variations (denmark, ration, dialysis, elderly, 65 etc) and didn't find anything.

In the case of a very elderly patient getting, say, a hip replacement, if they are in such a poor state of health that they are unlikely to survive the anaesthetic then it's not exactly denial of treatment.

christ, we're all old now - StackyMcRacky

[ Parent ]
Not to those neocons you fear by nlscb (2.00 / 0) #41 Thu May 08, 2008 at 08:42:45 AM EST
While I don't enjoy people dying (well, most people), neocons do.  So they will use whatever scare tactic, including the one that is the subject of this diary, to prevent nationalized healthcare in the US. 

[ Parent ]
Healthcare is always rationed by Herring (2.00 / 0) #42 Thu May 08, 2008 at 09:11:37 AM EST
one way or another.

I find the attitude odd that it's bad to deprive people of treatment because they wont benefit but OK to deprive people of treatment because they can't afford it.

christ, we're all old now - StackyMcRacky

[ Parent ]
Stop dodging the answer by TheophileEscargot (2.00 / 0) #31 Wed May 07, 2008 at 09:16:46 AM EST
Americans let people die in order to spend more money on healthcare.
--
It is unlikely that the good of a snail should reside in its shell: so is it likely that the good of a man should?
[ Parent ]
You left out a big one by lm (4.00 / 1) #2 Wed May 07, 2008 at 12:26:54 AM EST
Negotiation.

For example in Japan, according to a bit on the PBS News Hour I watched about a month ago, the doctor's union and the government sit down and negotiate prices for every imaginable procedure. Since these prices will be applied to every procedure in the country, the government negotiating team has quite a bit of leverage. The US government does this to a limited extent with regards to people covered by some specific programs (e.g. Medicare/Medicaid) but law prevents it from doing it in other areas (e.g. Medicare's new prescription drug program).


There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
Medicare service prices are not negotiated by ad hoc (2.00 / 0) #16 Wed May 07, 2008 at 05:07:22 AM EST
I suppose, strictly speaking, that is true by lm (2.00 / 0) #18 Wed May 07, 2008 at 05:47:12 AM EST
But many people on Medicare are on HMOs which do negotiate prices. But some services, even when offered through such a plan, cannot be negotiated by law.

There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
[ Parent ]
Medicare does not negotiate prices. by ad hoc (2.00 / 0) #24 Wed May 07, 2008 at 06:52:33 AM EST
Period. Full stop. You take what they pay or don't accept Medicare at all. That's the way it works. HMOs negotiate with insurance companies, they do not negotiate with Medicare.
--
The three things that make a diamond also make a waffle.
[ Parent ]
So, those on Medicare HMOs aren't on Medicare? by lm (2.00 / 0) #30 Wed May 07, 2008 at 09:14:00 AM EST
I think that's twisting the English language.

There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
[ Parent ]
No by ks1178 (2.00 / 0) #32 Wed May 07, 2008 at 10:33:56 AM EST
What Ad Hoc is refering to is that Medicare does not negotiate their prices.

Instead they declare what they will pay for something that it covers.

Whoever performs the work will either decide to accept medicare patients at that price, or not, but there is no negotiation involved.

[ Parent ]
I understand that and have conceded the point by lm (4.00 / 1) #33 Wed May 07, 2008 at 10:57:26 AM EST
But the fact remains that those individuals who are on Medicare and have opted to take part in an HMO receive many services that have negotiated prices.

There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
[ Parent ]
Medicare HMOs are private insurance by ad hoc (2.00 / 0) #34 Wed May 07, 2008 at 12:31:13 PM EST
paid, in part, by the federal government by way of Medicare. The HMO (the private entity) may negotiate with doctors, etc, but the payment the HMO gets from Medicare is not negotiated.
--
The three things that make a diamond also make a waffle.
[ Parent ]
Right. We agree on all that. by lm (2.00 / 0) #36 Thu May 08, 2008 at 03:27:29 AM EST
Apparently where we disagree is whether Medicare HMOs are part of the Medicare program.

There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
[ Parent ]
It is not. by ad hoc (2.00 / 0) #38 Thu May 08, 2008 at 06:49:04 AM EST
It's no more part of Medicare than a doctor who accepts Medicare payments is "part" of Medicare. It's a private HMO (most every insurance carrier offers one) whose premiums are paid, in large part, by Medicare.
--
The three things that make a diamond also make a waffle.
[ Parent ]
Let me see if I correctly understand you by lm (2.00 / 0) #39 Thu May 08, 2008 at 07:17:46 AM EST
Private security forces in Iraq hired by the state department are not part of the US Iraq war effort. Correct?

There is no more degenerate kind of state than that in which the richest are supposed to be the best.
Cicero, The Republic
[ Parent ]
Now you're being stupid. by ad hoc (2.00 / 0) #40 Thu May 08, 2008 at 07:52:17 AM EST
A comparable analogy that you would be making is that private security systems are part of the state department. They are not. Hired by them, yes. Part of them, no. Both part of the war effort? Yes.

Are Medicare HMOs and Medicare part of the US Health Care system? Yes. Are insurance companies part of Medicare? No.
--
The three things that make a diamond also make a waffle.

[ Parent ]
You can't generalise across Europe by Rogerborg (2.00 / 0) #3 Wed May 07, 2008 at 12:58:24 AM EST
Some nations are much more efficient in their processing of the dying.

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Metus amatores matrum compescit, non clementia.
Delayed Care. by ObviousTroll (2.00 / 0) #4 Wed May 07, 2008 at 01:59:01 AM EST
I think a lot of American health spending is spent on chronic/quality-of-life things that other countries are famous for making people wait fore - hip replacements, for example.

Another issue is that we spend government health care dollars stupidly - dropping millions, for example, so a single illegal immigrant can receive 4 different transplants over the course of her life, while not properly funding clinics that would help hundreds of such immigrants.

--
Has anybody seen my clue? I know I had it when I came in here.

Yeah, my mother-in-law had hip replacements by georgeha (2.00 / 0) #6 Wed May 07, 2008 at 02:14:40 AM EST
she's 76, in a locked down unit of a nursing home she'll never leave. She has less pain now, but I'm not sure if it was worth it.


[ Parent ]
The quality of life issues are always by ObviousTroll (2.00 / 0) #9 Wed May 07, 2008 at 03:31:49 AM EST
a tough call. Another thing I've noticed is how often people are demanding MRIs instead of X-rays. At $1600 a pop, they ain't cheap.


--
Has anybody seen my clue? I know I had it when I came in here.
[ Parent ]
They're $200 in Mexico by theboz (2.00 / 0) #11 Wed May 07, 2008 at 04:14:27 AM EST
I imagine the $1600 a pop cost is only in the U.S. where all of our medical costs are ripoffs.  There's a reason we pay the most in the world but are only 37th in the quality of our healthcare.
- - - - -
That's what I always say about you, boz, you have a good memory for random facts about pussy. -- joh3n
[ Parent ]
Having worked for $BIGPHARMA for a while by ObviousTroll (2.00 / 0) #12 Wed May 07, 2008 at 04:20:39 AM EST
I'm actually a believer in the idea that the US subsidizes the R&D costs for a lot of the rest of the world.

Now, that said, it's also believable that price pressure in the US would force $BIGPHARMA to become more cost efficient in both operation and in the products they design.


--
Has anybody seen my clue? I know I had it when I came in here.

[ Parent ]
That's one way of saying it by Herring (2.00 / 0) #26 Wed May 07, 2008 at 07:06:42 AM EST
Another way is that the drug companies' business model is dependent upon being able to screw the US market. If Mr X pays $2 for an item but Mr Y is only prepared to pay $1, then is Mr X really subsidising Mr Y?

Also, the fact that big pharma spends more on marketing than on R&D kind of undermines the whole argument.

christ, we're all old now - StackyMcRacky

[ Parent ]
For $200 by Herring (2.00 / 0) #13 Wed May 07, 2008 at 04:34:40 AM EST
do they still check you've removed the Prince Albert?

christ, we're all old now - StackyMcRacky
[ Parent ]
I thought... by theboz (2.00 / 0) #14 Wed May 07, 2008 at 04:50:41 AM EST
I thought that having the piercing tear through the remaining flesh of your penis and spray blood everywhere was part of the fun?
- - - - -
That's what I always say about you, boz, you have a good memory for random facts about pussy. -- joh3n
[ Parent ]
Only if you're dressed by Herring (2.00 / 0) #15 Wed May 07, 2008 at 05:05:13 AM EST
as Bumblebee man.

christ, we're all old now - StackyMcRacky
[ Parent ]
Depends on the part of Europe by wiredog (2.00 / 0) #7 Wed May 07, 2008 at 02:41:08 AM EST
Apparently, in Ireland, the normal treatment for a heart attack is to let them die.

Earth First!
(We can strip mine the rest later.)

Only if they're old! by Merekat (4.00 / 1) #8 Wed May 07, 2008 at 03:13:42 AM EST
And in any case, I doubt the irish health system would manage to do so economically.

[ Parent ]
3) Reduced paperwork and processing costs by jayhawk88 (2.00 / 0) #10 Wed May 07, 2008 at 03:41:42 AM EST
I work for a smallish medical school. Our clinics are managed by a practice management department that is associated with the school, but not officially part of it in a weird kind of "Sometimes we're part of the school and sometimes we're our own private entity" arrangement.

Among this departments duties is to process prescription claims to insurance companies for doctors affiliated with us who see patients in our clinic. To do this through our practice management software requires at least 5 steps and 3 separate companies. Requests are put into the system and converted to a text file of some kind, then "faxed" to a third party processing company using some special piece of software. This company then passes it through a second processing company for reasons that no one is really quite sure of, who then passes it (we believe) to the actual insurance companies.

Now you might say "Well your practice management software sucks", and you'd be right, but apparently this kind of thing is not that uncommon. It's the second processing company that fascinates me the most. As far as we can tell their only function in life is to move text files from the original processing company to insurance companies. I mean it's literally Tom Smykoski from Office Space come to life.

This is what I never get about the whole "Oh the bureaucracy will be so horrible with national health care" argument. Could it really be that worse? Watching some of the insurance fights Jenn has had going through the infertility stuff the past few years; granted we were not dealing with life threatening stuff and you expect a little insurance flack for something like that but still.

I remember reading by Herring (2.00 / 0) #17 Wed May 07, 2008 at 05:36:37 AM EST
that prior to the Tories fucking about, admin costs in the NHS were reputed to be around 5%. Since all the fucking about with pretend markets to make it all leaner and more effecient, we're up to about 18% now. Still a long way off the USA though.

christ, we're all old now - StackyMcRacky
[ Parent ]
There is a flaw in your logic by Merekat (4.00 / 1) #19 Wed May 07, 2008 at 05:50:00 AM EST
And it has taken me a while to track it down. Since most expenses come in the last year of life, clearly instead of hastening death, immortality would be cheaper.

There is a flaw in your maths by Herring (2.00 / 0) #22 Wed May 07, 2008 at 06:34:00 AM EST
Because in each of these infinite years of life, medical costs would be smaller, but they would be non-zero. So summing the future costs and discounting to get present value, the ultimate cost is infinite (see PFI for more examples).

christ, we're all old now - StackyMcRacky
[ Parent ]
Just do what they do with PFI by hulver (2.00 / 0) #25 Wed May 07, 2008 at 07:06:22 AM EST
Keep it off the balance sheet.
--
Cheese is not a hat. - clock
[ Parent ]
present value of future money by gzt (2.00 / 0) #28 Wed May 07, 2008 at 08:29:41 AM EST
You have to apply the discount rate. You're interested in the present value of the stream of payments, not the total amount. Sure, the total amount is infinite, but that's not so important.

[ Parent ]
From the Canadian in New York perspective by Phil the Canuck (2.00 / 0) #21 Wed May 07, 2008 at 06:25:08 AM EST
American doctors are much more likely to dump someone on fifteen prescription drugs (that cost more than they do in Canada) where a Canadian doctor would tell you to use diet and exercise.

American doctors are more likely to be ruined by a lawsuit and so have to carry massive malpractice insurance, driving up costs.

For-profit healthcare drives up patient cost.

In Ontario, the government tells doctors how much they charge a patient for services.  Government control keeps costs low.

How much do Europeans save on healthcare by just letting people die? | 42 comments (42 topical, 0 hidden) | Trackback