The Scope of the Problem

You have probably been annoyed by how expensive and frustrating it can be to get health care. But you may also, like many people, assume that’s the way health care has to be. But as Ezra Klein points out in an invaluable post today, health care in United States costs much, much more than it does anywhere else in the world—and we have less to show for it. Most people realize it’s more expensive here, but as Klein says, most people don’t realize just how much more expensive it is. It’s too unbelievable.

Klein draws our attention to a National Geographic graph, which powerfully illustrates just how enormous the gap is. The first thing you notice is that not only do we spend more on health care than other country, but that it’s not even close. In 2007, we spent $7,290/person, fully 65% more than Switzerland, the next highest-spending country. The difference is so dramatic that, as Klein points out, if we were just able to limit our costs to what they spend in Canada—which has universal health care—it would eliminate the deficit entirely. Nor do we have that much to show for the enormous sums we spend on health care. Not only do we visit the doctor fewer times a year per than most other countries, but our 78-year average life expectancy is actually a little below average. They Portuguese live longer than we do, and spend less than a third as much on health care. And compare our life expectancy to the almost 83 years the Japanese live on average. Imagine what it might be worth to you to live an extra five years.

Now a lot of other things—what chemicals we’re exposed to, how much we exercise, how well we eat, and so on—influence how long we live beside the quality of our medical care. It may be that the best way to extend the length and quality of our lives is to think of how we live as an extension of health care. Nevertheless it’s hard to believe that life is the United States is so much more unhealthy or expensive than in Canada or France or England that it could explain such a huge disparity in outcomes. A more likely explanation is that our fee-for-service system creates an incentive for health care professionals to order expensive tests and treatments we don’t really need, while at the same time creating little incentive for them to improve the actual quality of care.

Of course, another part of the explanation is that the rest of the first world provides universal health care coverage, meaning that almost no one goes without some minimum level of care. The painful irony here, as David Leonhardt points out, is that our government spent about $1.35 trillion on health care in 2008, which is about $4,500/person—and more than just about any other country spends on health care. Our government, in other words, already spends more on health care than do the governments of Canada, the U.K., and France, all of which actually provide public health care. And as individuals we still end up paying thousands of dollars out of our own pockets every year on top of what the government spends. That’s why the most important parts of the health care bill are the parts aimed at controlling health care costs—if we don’t get them under control soon, they will bankrupt us.