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Sunday, May 20, 2018

Today Weekend Reader brings you The American Health Care Paradox: Why Spending More Is Getting Us Lessby public health Yale professor Dr. Elizabeth H. Bradley and Lauren Taylor, a presidential scholar at the Harvard Divinity School studying public health and medical ethics. In The American Health Care Paradox, which is set for release on November 5,  Bradley and Taylor assert that the U.S. should refocus health spending on social services, like many other countries around the world. Their study describes the ways in which our current system is broken, and explains why reforms like Obamacare fall short of solving issues facing health and social services. For the percentage of GDP that the U.S. spends on health services, Americans are generally an unhealthy population compared to many other countries around the world. Why is this? Making affordable health care accessible to all is only half the battle; a complete overhaul of the American health care system and the way we look at social services — as a necessity instead of an entitlement — could not only cut costs but create a far healthier society. 

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In spite of the clear and recent data, the United States stumbles when addressing these social determinants of health. Although Americans do not like being mediocre in national health outcomes, they have been even less enthusiastic about facing the complex web of social conditions that produce and reinforce these outcomes. They continue to pay top dollar for hospitals, physicians, medications, and diagnostic testing yet skimp in broad areas that are central to health, such as housing, clean water, safe food, education, and other social services. It may even be that Americans are spending large sums for health care to compensate for what they are not paying in social services—and the trade-off is not good or the country’s health.

Roughly five years ago we started thinking that there might be a connection between soaring health costs and meager social service spending, when we were musing about theoretical roots to the so-called health care paradox in the United States. To explore whether our hypothesis would hold up, we examined ten years of spending and health outcome data from thirty OECD countries that collected data using comparable methodologies. The results confirmed our suspicions.

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Our comparative study, published in the academic literature in 2010, broadened the scope of inquiry about health and health spending to include spending on social services as a potential determinant of population-level health outcomes. For the purposes of our study, social services expenditures included public and private spending on old-age pension and support services for older adults, survivors benefits, disability and sickness cash benefits, family supports, employment programs (e.g., public employment services and employment training, unemployment benefits, supportive housing and rent subsidies), and other social services that exclude health expenditures. Health expenditures included public and private spending on curative care, rehabilitative care, long-term care, laboratory and diagnostic services, outpatient and preventive care, and public health services.

The study found that if we counted countries’ combined investment in health care and in social services, the United States was no longer spending the largest percentage of GDP—far from it. In 2007, for example, the United States devoted only 25 percent of gross domestic product to health and social services combined, while such countries as Sweden, France, Austria, Switzerland, and Denmark dedicated about 30 to 33 percent of their respective GDP to the combination. In 2007, while the United States ranked highest in health spending, it ranked only thirteenth in spending on health services and social services combined (see Figure 1.4).

Moreover, the study revealed that America was one of only three industrialized countries (the other two were Korea and Mexico) to spend the majority of its total health and social services budget on health care. On average in the OECD countries other than the United States, for every dollar spent on health care, an additional two dollars was spent on social services. Yet in the United States, for every dollar spent on health care, less than sixty cents was spent on social services. Most important, we found that less spending on social services relative to spending on health services was statistically

American Healthcare Paradox Chart

associated with poorer health outcomes in key measures, such as infant mortality and life expectancy, and this result held even when the United States was removed from the analysis.

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22 Responses to Weekend Reader:The American Health Care Paradox: Why Spending More Is Getting Us Less

  1. No one has to spend more money on making the population more aware of social practices, that impact negatively on health outcomes. Avoid eating toooooo many Twinkies, some are ok. Avoid having 2 babies before you are 15, with no reliable /supportable way of caring for them. Emphasize a disciplined family life style with oversight from elders till there is a modicum of civilitystandards/ education imparted to everyone. These are personal mission statements that be easily achieved by all with out costs. Or we can send everyone to summer camp for journalism at Harvard to see how setting loftier goals can have positive outcomes as it did for Bill O’Reilly or Lauren Taylor.

    • i agree with your post up until the comment about oreilly and taylor. what do they have to do with the rest of your post? don’t know about taylor but oreilly paid his own way through school and gives a lot of $$$ to charity. Some people might have a problem with you telling them when they can have kids and whether they should worry about how they are going to support them. We know that too many twinkies are not good for you, but you can’t tell people what food to purchase even if it is the taxpayer’s $$$ paying for it. As for disciplined family lifestyle , this admin does nothing to promote it. Noone wants to be accountable for their own actions these days from the president on down. It’s always someone else’s fault for the position these “victims” find themselves in.

      • I agree, which is dangerous here. Pointing out that O’ Reilly got advantages by attending Harvard and used the outcome differently than Ms. Lauren Taylor, who tends to be very liberal and expects everyone to be admonished /helped by social programs for living their life style. I am one certainly that says, you reap what you sow, do not expect me to pay for your bad judgements from obesity to pregnancy, contraception, or bad rearing. Also if you do not take advantage of what is around you than that is your outcome. No mercy from me.

  2. wait till “other people’s money” runs out and the gimme my free obama swag and cash people start getting less. That’s when the real fun begins. you koolaid drinking sheep types are about to reap what you have sown.. too bad you had to take the rest of America with you.

    • Someone made an interesting observation that the Dem Senate will also lose many seats due to Un Affordable Careless Act. It seems this project had little input from users, professionals except for legal types, who wrote obfuscating CYA promulgations for this unreadable Bill. They were so cunning that they created themselves a massive lie and are now trapped by the consequences.
      It could have been so simple to just add onto the existing Medicare Program for administering to the Un insured. Of course Medicare is paid for by the one Percenters and other Working tax payers. Everyone should be made to contribute in a like manner from their earliest mature years as contributors to the system fairly. That is why the working , middle class are ticked off. They do not want to pay for non contributors , and rightfully ticked off…not because Obama is Black and therefore that they hate the ACA, AS SOME LIBERALS LIKE Chris Matthews spout.

    • Looks like to me it’s the Right wingers like yourself, are the ones having fun.
      Oh, yes you are. With you snarky little bumper sticker slogans. Meaningless
      claptrap, better suited for a beer hall putsch. Made up of malcontents, and
      dimwits, who never admit there is a problem that couldn’t solved by, one
      doing nothing, or two, denying the problem even exists. That way they
      never have to do any of the hard work of learning the problem, or working
      with others who may have different ideas toward solving the problem.
      So, in that respect, you may not always get everything you want. And,
      adults know this going in. So, when this happens, they don’t take their ball,
      and go home, they compromise. And real problem solvers must be brave.
      Because it takes courage to be for something. Then one runs the risk their ideas may be adopted, and fail. And, find themselves in the unfortunate position of actually having to take responsibility for something. But, it looks
      like to me, for all the talk about how all those other people should go to
      work, and quit living off the public’s money. That’s exactly what the Right
      Wingers themselves are doing. Getting a paycheck they have done
      absolutely nothing to earn. Unless, jerking off, and throwing spitballs
      fills the requirements nowadays. Reread your comments here. You and
      your pal, IE. A lot a yada yada, woulda coulda shoulda. Saying nothing.

      • We had a good system that served 85% satisfactorily. All that was needed was a minors fix. The two best points were pre-existing conditions were covered and no bankruptcies allowed due to catastrophic bills. These should be actuarially a part of everyone’s premiums.

        • I don’t disagree with you about having a good system for
          many years. But things change. The economy changed.
          Medical science changed. Bankruptcy laws were tightened.
          When a husband, or wife had a serious medical problem,
          without insurance, the remedy used to be divorce. This,
          loophole if you will, was closed. The family’s savings, and
          in some States, their homes were liquidated to pay the bills. Others, like FL. protects that asset. Coincidently the reason
          O.J. Simpson moved to FL. after losing the civil lawsuit.
          As to the present system, the one we’ve all gotten used to,
          was/is imploding due to the fact healthcare costs have been
          rising unabated, for the last 20 years. My insurance premium
          rose 500% between 1995, and 2010. While out of pocket
          costs doubled. My case is not unusual. But better than
          in some parts of the Country. And all the while employers
          were struggling with the same problem. Then, maybe a bad
          year, fuel prices went up, profits went down, and another
          20/30 people became uninsured. This put the load on those
          that still had insurance. And more money from the government, to reimburse hospitals, so they didn’t go belly up, and bring the entire system down, when the uninsured, without assets, couldn’t pay. And the hospitals charged more for services to the insured, to fill the gap, exacerbating the original problem of cost containment. But the simple fix, the
          one a lot of people were hoping for, turned out to be impossible. Why? Politics of course. Lobbies, they all have
          them. And money in politics speaks louder than common
          sense. Truthfully, as to whether this health reform law will
          eventually work, I haven’t got a clue. But, I do know we had
          to do something. Hell we’ve got all these old farts getting old
          all at once. (And I’m one of them.)

          • All great facts that affect medical care. The technology growth and diagnostic capabilities are great for defining problems. They are costly along with the huge physical plants that house these services. .the regulations cost dearly to provide comfortable hotel services, and error free…almost …..distribution of medical services. I work in the system….the CYA,legal, regulatory stuff and insurancees is ridiculous and certainly adds a large portion to the cost. Many discussions on this and the use of electronic medical records , with medical peers and we think that these regulations and IT costs have not added on Iota to better healthcare outcomes. A question never answered is what is the morbidity , mortality rate of 30 years ago and today. I say not much difference. One favorite story is that in the 1970s approx. there was a strike by medical staff in Britain for several months….there was a study that found that the number of deaths decreased 15% in the kingdom during this period. …….go figger.
            The health care system in US can be fixed if all PACs and congress were excluded from negotiations and a professional non political panel set up including public users to define a workable system.

          • I really appreciate your insight on this. Yes, I understand the
            reference to hotel service. Healthcare is unlike any other
            service. In that, there is no acceptable grade B choice.
            Not like choosing a car. A short trip? We’ll take the little
            compact job. My wife’s gall bladder needs to come out?
            I’ll take the Caddie please. Nothing but the best when it
            comes to her health! Then, we find out, as to outcomes,
            we don’t actually do all that well, for what it costs us.
            Hilarious story on the Brits! I had not heard that. But it’s
            worth repeating. And I couldn’t agree with you more on
            tossing the special interests, and back room deals out.
            And letting the professionals set up a system. I don’t
            ever recall seeing anything like the mess exposed by
            politicians trying to do something to improve the number
            of insured. While taking care of every lobbyist in the
            Country. Just so people with a chronic problem, like my daughter, with type one diabetes, since the age of 12,
            won’t need to worry about not having health insurance.

          • I have the the same problem with a type 1 since age 16…..a surprising ,sobering realization of human vulnerabilities? The present ACA attempt to administer health system is overly concerned with SELF INTERESTS and only results in animosity, …….probably designed to do so.
            The existing healthcare system can be fixed, yes, even using the fine administrative structure already built into current insurance suppliers……., do not have to create a mega bureaucracy . Universal coverage with no exclusions can be achieved for all and a seamless contribution structure for everyone. I am sure the the two of us can get it done. We all discuss better plans than ACA around a burger and beer. We all do a little tweaking of each other on this forum but this is a serious issue that needs simpler minds. E ven the likes of all of us, here on this site…Infadelicious, and of course Obozomustgo…satirical at times……all want similar outcomes for all to be achieved in a fair manner.

      • Kinda hard to compromise when the potus says ” we will NOT negotiate ” with Americans but bends over backwards to appease and arm countries that openly declare us enemies and their intention to wipe out out allies Yoy know nothing about where I get my paycheque. You want to see what exchanging democratic votes for freebies does to a city look at what the dems did to Detroit . If anyone is in denial it is you and other leftist freaks who defend this lying incompetent , incoherent without a TelePrompter, petulant president even after all the ” made up scandals” some with not do made up American deaths with no explanations and the ongoing lies. You are sheep taking us all to a nasty place. Wake the ***** up

        • Why do you insist on being such a stooge? And what makes
          you think the President of the United States, owes the T-Party
          a fucking negotiation, for shutting down the government, and
          threatening the economy? Screw the T-Party, and the gutless dimwits that allowed such a festering pus filled cancer to inflict
          themselves on the Country in the first place. As far as I’m concerned, if they’d brought over a bunch of terrorist scum from Somalia, and put them in the Government, it’d be an
          improvement over the T-Party.

          • The president works for the American people , all of them. He had only represented his buddies and sheep so far. The Petulant piece of democrat barracaded the veterans memorial That idiot could pull one of his executive orders any time he wanted to. So dont blame republicans. That’s what we get when a community organizer/race pimp is voted in to office. You are obviously so koolaid drunk blindly obedient to the messiah you go into an fbomb filled defence of him even as he blatantly lies and leads you over the cliff. This time with ACA it’s going to affect even the gimme free **** that I am entitled to crowd and not just the taxpayers working to support the freeloaders. Then we’ll see the rats fleeing the obozo fail boat in droves

          • Surprise! Who knew the Federal Government managed the
            National Parks? I guess you didn’t get it the first time. The T-Party stupidly shut down the Government. And the President
            of the U.S. had absolutely no obligation, to follow them around,
            and clean up the God Damned mess they insisted on making.
            I guess these stupid M Fers had this plan, they were going to
            make life as miserable for as many people as possible. Cost the
            Country as much money as possible, while the ignorant yahoos
            back in Bum Fuck Georgia pissed their overalls, while Obama begged a bunch of inbred Ass Wipes to please open up the Government! How did all that work out? I’ll bet, they know If
            they want the Parks open so much, they won’t close them
            in the first place.

          • THIS fed gov’t runs whatever the hell it wants as evidenced by the latest fiasco of ACA. So nice try but no cigar Obozo said he’d clean up the mess 5 long years ago. He has made things worse as well as made us the laughing stock of the world. He is a useful idiot to the muslim brotherhood to boot Sorry for all of America that your messiah is an empty suit -community organizer should have been the clue as he has never had A real job You need to deal with it. Go take your fbomb laced obozo zombie rant somewhere else

          • Alright then, we’ll just go with what your guys purposed.
            Let’s see. What was it they suggested exactly? To get the
            unemployed back to work, they said, what? Turn around a near dead economy, or prevent the things that flat lined the economy, from flat lining it again? The GOP said what needs to be done is? Well, they didn’t purpose anything. What they did decide to do, was exactly what you do every time you come on here. Namely trash talk whatever the other side does. Even if it’s something your guys had done in the past.
            Like government spending to stimulate the economy. Now
            is officially, spending us into oblivion Even if a bill has a lot things in it, like an across the board tax cut, they said they’d support if that were left in there. They didn’t. It’s just all
            one big game of screw the Democrat. Whatever Obama purposes, becomes the most evil destructive plan in the universe. Then, just to top it all off, we’ll make a lot of idiotic
            and baseless accusations, which our dumb as the day is
            long base out there will really enjoy. They don’t have to
            have anything to do with anything. Or have any truth to
            them. We’re mostly entertaining here anyway. Tell Obama
            to put down his Koran, and get off his knees! Sure it’s all
            shit, but who cares? We’re not here to do any real work anyway. So until we’re actually in charge, who gives a rat’s ass? Truth be told, we’re a lot more interested in China’s
            economy, than here. Because, here there is always these
            Constitutional Rights. And, environmental, regulations.
            Over there, the government don’t give a shit, if we work ’em
            round the clock. In fact, it turns out Communism can be a
            very good thing. But, back to the Socialist in Chief, taking away freedom, and liberty! That pretty much covers the
            general plan of the nut jobs you’re so fond of.

  3. Classic!!!

    Tennessee State Sen. Brian Kelsey gave Health and Human Services Secretary Kathleen Sebelius a book that he thought she might need… “Web Sites for Dummies”
    Check out the look on disgusting face….

    bwwwaaaaaaaaaaaahahahahahahahahahahahahahahahaha!!!!!

    ROFLMAO!!!!!!

  4. Some of this thesis is starting to be accepted. You can see it in the models being rolled out in NYS, for example. Cost containment efforts are being focused on hospital care. To make it work, NYS has introduced care management for vulnerable populations–seniors, dually diagnosed, mentally ill, etc. Care managers support consumers through coordination, monitoring, linkage, transportation support, etc. Just getting implemented. Will be interesting to see how it works out.

  5. Since the results of our own use of liberty cannot be predicted, questions regarding the “justice” of resulting incomes are meaningless.

  6. To thrive over time, we should adhere to the moral standards and practices upon which the oaks of liberty grew strong in the first place.

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