Corrente

If you have "no place to go," come here!

Dunno where the heck Obama gets that $6000 from, but here are some good data sources

Some alphabet soup definitions

National Health Expenditure, or NHE. This is everything a country spends on health: care [doctors, hospitals, drugs, etc], research, infrastructure, public health.

Personal Health Care, or PHC. This is just the amount that's spent on health care: fees for doctors, hospitals, labs, clinics, etc and purchases of prescription drugs and medical equipment [like wheelchairs].

CMS is the Center for Medicare and Medicaid Services, and it's part of HHS, Health and Human Services.

OECD is the Organisation for Economic Co-operation and Development, comprising 30 countries in the [more or less] developed world.

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What we spend our health care dollars on

My favorite source of US NHE data is this collection of tables [PDF] from CMS [data from 1960 through 2007].

The first table is the one with the most-often-referenced numbers: in 2007, the total NHE was $2,241.2 billion [that's $2.24 trillion], there were 302 million of us, making the per capita NHE $7,421 [$2.24 trillion divided by 302 million people]. Total GDP was $13,808 billion [or $13.8 trillion], so the NHE was 16% of GDP [or 16% of the economy, since GDP is often used interchangeably with 'the economy'].

Personal health care [PHC] can be found in table 2. For 2007, total PHC was $1,878.3 billion [or $1.88 trillion], which is about 84% of NHE -- the other 16% of the 2007 national health expenditure went to research, administration, public health, infrastructure, etc. I include this just as a reference, because sometimes people [or organizations] use PHC spending instead of NHE.

Table 4 breaks out all this spending down to the level of doctors, hospitals, drugs, etc, and by payer: Medicare, Medicaid, private health insurance, out-of-pocket for the years 2002-2007. For instance, from this table you can see that private health insurance spending totaled $775.0 billion, of which $680.3 billion went to pay for actual care. Dividing that $775 billion by the total NHE, we find that, in 2007, private health insurance spending was responsible for about 35% of the total national health expenditure. And if you want to know what percentage of PHC was covered by PHI, divide $680.3 billion by $1,878.3 billion = about 36% of health care was paid for by private insurance.

Ok, now that your eyes are glazed over, I'll leave you to wade through [or not] all 13 tables on your own.

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How we compare to the rest of the world

Next up is the OECD data, where we find out how the US stacks up against the rest of the world in both % of GDP spent on health care and per capita spending. This is typically calculated as national health expenditures, rather than personal health care, but be forewarned: OECD calculates NHE slightly differently from the way CMS does, so the numbers will vary a bit [by about 2% for 2007].

The OECD likes to sell their compilations of data, so you can't get lots of lovely tables to pore through like you can from CMS [I know, this breaks your heart], but they have summary fact sheets for each of the 30 countries in the organization. The first page of each country's summary shows the same 2 bar charts: % of GDP spent on health care in all 30 countries, and per capita spending on health care in all 30 countries. Here's the one for the US for 2007 [the latest year available]. According to the OECD, we spent 16% of our GDP on health spending, or $7290 per capita [compare this to the $7421 per capita according to CMS, not a huge difference].

Unfortunately, they don't provide nice little tables, so if you want to do any math, you have to read the numbers off the charts and punch them into the calculator of your choice.

If you don't believe me that all the front pages look the same, here's Greece, just for comparison.

Some factoids from the US data sheet:

Most OECD countries have enjoyed large gains in life expectancy over the past decades. In the United States, life expectancy at birth increased by 8.2 years between 1960 and 2006, which is less than the increase of almost 15 years in Japan, or 9.4 years in Canada. In 2006, life expectancy in the United States stood at 78.1 years, almost one year below the OECD average of 79.0 years. Japan, Switzerland and Australia were the three countries with the highest life expectancy.

Infant mortality rates in the United States have fallen greatly over the past few decades, but not as much as in most other OECD countries. It stood at 6.7 deaths per 1 000 live births in 2006, above the OECD average of 4.9. Among OECD countries, infant mortality is the lowest in some of the Nordic countries (Iceland, Sweden and Finland), Luxembourg and Japan, with rates between 2 and 3 deaths per 1 000 live births.

Sad, innit?

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So, a general rule of thumb --

- If you're going to compare US spending to US spending, either over time or between sectors, the CMS is your best bet.

- If you're going to compare countries to countries, the OECD is a better source.

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Can't get enough? Want more?

Here's the US PHC spending by age, for selected years from 1987-2004.

Here are projections for US NHE for 2008-2018, an update for 2010-2019, and some notes on the accuracy of projections.

Just to make you jealous that we don't have Medicare for everybody, here's a starting point for Canada's CIHI, their Medicare database. See how easy it would be to figure out how well our health care system were performing if we had all this data in one [transparent!] place?

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Two of my other favorite sources, for general data...

The CIA World Factbook: population, geography, economy, all kinds of good overview stuff, for every country in the world. They update it every year, and if they're keeping archived data from years past, I haven't found it yet [annoying if you link to one of their pages]. Just for fun, here's the European Union.

The US Census Bureau: I love their Quickfacts pages, for the US, and for comparing states, counties, and cities. And what was the population every year from 1900-1999?

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Last, but not least when we're talking about single payer: how the $350 billion [$400 billion] savings is calculated.

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UPDATE 8-15-09: If you like searchable databases [and I do] CMike in comments has provided a link to the World Health Organization [WHO, more alphabet soup!] . Great stuff.

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Submitted by jawbone on

See chart.

Using UNHDR data, I can't get the Obama figure, which FactCheck was told represents a sample family and is reached by multiplying the per capita cost by 3.3. Can't do it with the UNHDR figures (altho' closer); way, way off with the OECD figures: US higher by $8339 based on 2007 figures. (Norway: individual--$4763, family--$15718; US: individual--$7290, family--$24,057.) Obama may have figures from 2008?

We can't afford to NOT have single payer.

I did note that the increase in costs went up slightly less in 2007, which was prior to the Big Meltdown so that was not a factor. Slight decreases seem to happen prior to big eletions where health care reform is a big issue in the campaign. The BHIP tend to make up the difference in later years....

Medicare for All...with a Robust Private Option

Submitted by hipparchia on

i'd forgotten how to get to the human development report.

'health expenditures' and 'purchasing power parity' are both somewhat nebulous. there is no hard and fast rule for calculating either one, though there are some broadly-agreed-upon principles.

it looks like possibly the unhdp might not be counting items such as research in their numbers, and might instead be limiting their numbers to more direct provision of health care, such as public health activities and phc. this is just a guess on my part, based on the description at the link -- after all, how much health research is sierra leone going to be able to invest in? for purposes of measuring human development across countries with widely varying economies, limiting the measure to direct spending makes sense.

but for purposes of using other economies in the 'developed' world as benchmarks for what we should be spending on all health-related stuff, it makes sense to include not just the direct spending, but more indirect items like research, since most of these other economies have enough money to spend on things like research too.

also, while 'households' are relatively easy to count, at least here in the us -- the census bureau basically counts everyone living at an address as a household -- deciding what constitutes a 'family' is more difficult.

not all that long ago, everybody was citing 2004 numbers [or 2003 or 2005], especially for international comparisons, because that was the latest year for which all the data was available. entirely possible that obama is using older numbers, not that we can blame him for that, single payer advocates are still using $350 billion for the most part.

the real problem is not the exact number, but the complete lack of context. for all his vaunted oratorical skills, obama is a maddeningly imprecise speaker when it comes to a lot of things. part of it is his conciliatory method of dealing with people, but part of it is that his extemporaneous speaking skills, while better than bush's, are still only so-so.

then there's that whole govt can't solve everything / i believe in markets thing. hard to speak authoritatively from that viewpoint in the face of the reality we've got right now, but it's what he campaigned on.

CMike's picture
Submitted by CMike on

Wikipedia uses World Health Organization numbers. You start here, pick (1) the countries you want and (2) the indicator(s), for our purposes "per capita total expenditures on health (PPP int. $)." Then choose your (3) the time period. The safe play for the time period is to go with the "latest available," which turns out to be 2006 info in this instance. At that point the site will spit out the data in a table or a bar graph.

Greg Palast provides some interesting perspective on the president's behind the scenes negotiations. (I think he boo-booed in his "alert," in the box to the side of his post, by using a $26 trillion figure for hospital expenditures. Maybe I'm wrong though I went ahead and pointed out the error in his comments. Looks to me like 2007 U.S. hospital expenditures came in at under $700 billion. Adding $6 Trillion to a $7 Trillion baseline would give you $13 Trillion in anticipated hospital expenditures for the coming decade and the $155 billion savings the president has negotiated is 1.2% of that total.)

>>>Late edit-- I should have said "savings the president allegedly has negotiated."

Submitted by hipparchia on

hit the wrong button on the calculator?

using the numbers in table 2, i come up with ~$3.3 trillion total drug spending for 2009-2018, which is close to the $3.6 trillion that he cites, so we're in the same ballpark on drugs.

using the same table, i get ~$10.5 trillion in total hospital spending for 2009-2018, and $155,000,000 is about 2.5% of that total.

too bad he didn't link to his data source. ;)

CMike's picture
Submitted by CMike on

I'll have to get your data sources in my health care bookmark folder and start using them. (typo alert - at a glance, we know $155,000,000,000 is ~1.5% of $10,500,000,000,000 [1.476%])

Submitted by hipparchia on

total projected hospital spending for 2009-2018 = approx $10.5 trillion

promise of savings that obama/white house/somebody squeezed out of the hospital industry lobbyists = $155 billion

10.5 trillion = 10,500,000,000,000
155 billion = 155,000,000,000

155,000,000,000 divided by 10,500,000,000,000 = 0.01476, or 1.476%, which would be 1.5% if you round off.

yay! i hit all the right keys and got the right number of 0s in everywhere! of course, this assumes that i hit all the right keys when i originally added up the 10 years' worth of projected hospital spending to get 10.5 trillion. :)

[i really can do math, honest, just give me a pencil and some paper, or chalk and chalkboard, preferably one of the black ones]

basically, palast is correct, the lobbyists have promised to be 2% less evil over the next 10 years. did anybody check to see if they had their fingers crossed behinds their backs when they promised this?

meanwhile, the $80 billion in savings on drugs + the $155 billion in savings on hospital costs = $235 billion. total. over 10 years. whereas hr 676 would save us $400 billion in just the first year. and that's what they really don't want you to look at.

Submitted by hipparchia on

thanks for that link. i'm adding it to the arsenal.

i found the same oecd summary for the us, but for 2004 spending, and checked it against the who database for 2004 for some of the oecd countries -- looks like the oecd estimates are running 1%-3% higher than the who estimates [i checked turkey, mexico, the us, netherlands, switzerland, coupla others] looks like who and oecd are probably using roughly the same data and calculations.

nice to have an alternate source, and really, really nice to have one where you can pick out exactly what you want to look at like that.

CMike's picture
Submitted by CMike on

This site is tough to keep up with. I just posted a link to that pdf with the OECD chart for 2007 health care per capita expenditures in an old thread here before I saw your post.

Submitted by hipparchia on

which is what prompted me to put together, all in one place, a list of the sources i use most often.

and yes, tough to keep up with this crowd. [nice to know we've got so many people who are on their toes too] i still haven't made it all the way through reading that thread.

TreeHugger's picture
Submitted by TreeHugger on

a paucity of attention to it by journalists and pundits who are the reducing valves at-large for reporting and providing context on health care for the public. (And were it not for the econoblogs, much of the financial thuggery still rampant would also be ignored.)

Thanks for your detailed posts. My problem always seems to be how best to condense the most salient data into an accurate but short post, usually leavened with humor, that can persuade my friends ...both the Obama worshippers and the Obama haters.

Submitted by hipparchia on

as you can see, i have trouble with it too! :)

a paucity of information and a surfeit of noise, i would have said. journalists and pundits have always been paid to whip up interest and put out propaganda. real information, investigation, and analysis is expensive, difficult, and requires the application of lots and lots of critical thinking skills. it's dull and boring to do, as well as dull and boring to read/hear about. fluff has always subsidized substantive reporting. the trouble is that media moguls have decided to wring a few more percent profit out of the cash cow, and keep sloughing off more and more of the dull, boring, expensive, but useful-to-humanity stuff.

And were it not for the econoblogs, much of the financial thuggery still rampant would also be ignored.

isn't that the truth.

Valley Girl's picture
Submitted by Valley Girl on

from a post at FDL from markfromireland- discusses a JAMA article- and other good resources in the thread- very much worth reading- some good talking points there.

http://seminal.firedoglake.com/diary/7220

quote from mfi:
~~The thing that leaps out from the pages of the study isn't just that the desperately underfunded and understaffed NHS outperforms the American health sector on most health outcomes although that is made eminently clear. No, what leaps from the pages is the way in which the American system betrays the overwhelming majority of the American population in the interests of making profits. The ever increasingly bizarre campaign to persuade Americans to keep their current rates of death, misery, and despair is being waged by a pack of parasites interested in one thing and one thing only. Money.~~

Submitted by hipparchia on

that's my favorite line, with the 'pack of parasites' running a very close second. it truly is an ever-increasingly bizarre campaign the purported progressives are waging against their own. and they're the ones who so dismissively mock the 'rubes' for voting against their own economic interests when they vote republican.

sigh...

i'd seen the conclusion from that jama article quoted before, that the highest socio-economic class here is worse off, healthwise, than the lowest class in the uk. nice to have a link to it, complete with pointed commentary from someone who has lived it.

Submitted by regulararmyfool on

hipparchia

You do a great job. I simply cannot wade through the nonsense without losing the track.

You are doing what I thought would happen on the internets when I first hooked up.

Thank you.

Submitted by hipparchia on

always nice to hear that i've done something helpful.

You are doing what I thought would happen on the internets when I first hooked up.

there are others out there on the interwebz doing the same thing [and not just on health care], but just like in real life, there's often a lot to wade through to get to them.

Jess Fiedorowicz's picture
Submitted by Jess Fiedorowicz on

Yes, great work, hipparchia. Thanks for posting.

Submitted by hipparchia on

i was very lucky to have found pnhp early in the process when i first started blogging about this a couple of years ago. the entire organization has my undying gratitude.