Health Care, Part Two: Crisis of Abundance

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In 1980, U.S. health care spending took up 8.7 percent of GDP. Other industrial countries were in the 6 to 9 percent range.

In 2002, U.S. was at 14.6 percent of GDP (over 15 percent today), and other countries were in the 8 to 11 percent range.

Today, U.S. spends about $5000 per person per year on health care, compared with $3000 per person per year in other countries

Impact: Medicare and Medicaid budgets strained; employer-provided health insurance deteriorating; millions uninsured

Common Scapegoats (not really the problem, but people like to blame):

--drug companies; but drug company profits are less than 3 percent of total health care spending

malpractice insurance; also small relative to health care spending

--insurance companies; but overhead is less than 8 percent of health care spending

--spending on the last year of life; only 7 percent of total health care spending;

Premium Medicine

Increase in Physicians, by specialty, in the U.S., 1975-2002 (overall population rose 35 %)

SpecialtyPercent Increase
All Physicians111 %
General Practice55 %
General Surgery26 %
Internal Medicine242 %
Pediatrics228 %
Cardiovascular237 %
Gastroenterology433 %
Pulmonary472 %
Neurology385 %
Diagnostic Radiology704 %

In 1980, 3.6 million CT scans. In 2003, 50.1 million

In 1980, 0 MRI's. In 2003, 24.2 million

Medical technology constantly changing--a doctor's office looks very different today than in 1970's

Are we better off?

Over time, we have seen longevity increase, improved health among the elderly, and reduced chronic illness across the population

Some specific treatments are proven successes: beta blockers, for example

Anecdotes of successful interventions

Comparisons of populations receiving more or less premium medicine show no difference

Some evidence that medical services determined by supply, not proven value

Other countries control spending through reduced availability, different cultural expectations

summary: U.S. spends much more than we did 25 years ago on health care; spends more than other countries; evidence is mixed on whether we are getting our money's worth; main cause is the capital-intensive mix of health care services;