No ignoring averages is dumb. Only a tiny percent of the population in any nation pay for their health care directly - we depend either on public insurance, private insurance or a national health system - all which hae costs to users based on average costs. Canadian health care on average is less expensive than U.S. health care - both per person and as a percent of GDP. Does this mean something for most Canadians and most USAians? Well both Canadian and USAian health care is overwhelmingly financed by regressive means - taxes that roughly translate into per capita taxation, and (in the U.S. case) employer and individual health insurance. Also there is direct payment for a portion of health care (but not the majority). Under those circumstances something very odd would have to be going for higher average U.S. costs not to translate into higher health care cost for most Americans. I note that your example of Tenncare: A) had no comparison to other nations (including Canada) so there is no way to tell if this accounts for any of difference between Canadian costs and U.S. B) was referring to a plan specifically for the poorest of the poor. Which means it is not necessarily reflective of costs for the majority who are not the poorest of the poor..
In general you seem to answer statistical arguments that point to a difference between U.S.. and Canadian costs with anecdotes and small data subsets that don't to reflect light one way or the other.
And the thing is you can speculate all you want about causes at the margins. But we know where most of the higher costs come from:
1) The U.S. spends about 31% of it's health care dollar on administriation as opposed to Canada which spends about 17% for the same purpose. http://content.nejm.org/cgi/content/abstract/349/8/768 Note that this excludes insurance company profits, which from the point of view of a consumer I think can be counted as an administrative cost if you don't consider it straight out theft. 2) The Use spends about 40% more than Canada for the same pharmaceuticals. http://www.pc.gov.au/study/pbsprices/finalreport/pbsprices.pdf.
These two factor alone account for the overwhelming majority of the diffence between U.S. and Canadian spending. And single buyer leverage would give us better ability to deal with other problems as well.
> >
> > /jordan
>
> I agree: we should look at total cost to society, not the "average"
> consumer. There is a mountain of data that demonstrates the massive
> cost/benefit ratio of preventative care (e.g., prenatal care,
> hypertension screening, cancer screening). Given that most
> uninsured people do not receive this preventative care, and only
> go to the emergency room when they are extremely ill, health care
> costs for our society as a whole are substantially higher than for
> any other industrialized nation.
>
> --I think this is perhaps the greatest threat to public health
> in the U. S.: because health is a commodity, we only buy it if we
> think we "need" it. However, few of us have the expertise to
> determine, based on scientific research, whether or not we need
> (say) a prostate exam at age 50. The advantage of universal
> health care is that people are more likely to take advantage of
> preventative care that improves their health and lowers overall
> health care costs.
>
> Miles
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>
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