>Cass calls this calculation the Cost-of-Thriving Index. It measures the median male annual salary against four major household expenditures:
> • Housing, defined as the annual rent for a three-bedroom house in the 40th percentile of the local housing market.
> • Health care, defined as the annual premium on a typical family health insurance policy.
> • Transportation, defined as the average cost of owning and operating a car driven 15,000 miles per year.
> • Education, defined as the average cost of tuition, fees, and room and board at a four-year public college.
Why is education being overweight by a factor of several times? The other items are the annual cost of expenses that you incur annually. But education is only incurred 4 years out of the 80 years you're alive. Giving them the same weight as the other items is ridiculously misleading.
quoting from paper:
Basket Component: One Semester of Public College
Source: The COTI uses the federal National Center for Education Statistics estimate for total tuition, fees, room, and board at a four-year public institution. 67
Rationale: Two children pursuing four-year degrees would require a combined 16 semesters of college, so a household preparing for those costs would need to save roughly one semester’s worth of cost per year before the children reached college age. (While the savings might ideally earn a positive return in the interim, that return would need to be quite strong just to keep pace with the rate of increase in tuition over the same period.)
The one-semester estimate may overstate costs in some respects—for instance, a family would likely have 20 or more years between the birth of a first child and the college graduation of a second. And in practice, many children do not ultimately attend college (though a small and, it seems likely in recent decades, declining share has chosen from a young age not to consider that path). But it also understates costs by considering only public college costs; private college costs are more than twice as high.68 Note also that the cost of public college tuition already incorporates the substantial public subsidy provided by the state government.
> What is education being overweight by a factor of several times? The other items are the annual cost of expenses that you incur every year. But education is only incurred 4 years out of the 80 years you're alive. Giving them the same weight as the other items is ridiculously misleading.
That is strange. Education is also an oddly priced expenditure because the nameplate tuition is not the price paid by most students. It would be a lot better to use the the net price, which is much lower, but is harder to collect.
In the Roman Empire, people lived 30 years and died. Most were illiterate. As a society develops, and has more excess resources, allocating more and more of those resources on keeping people alive, healthy, and educated seems reasonable.
What's missing from the charts is quality. We spend a lot on healthcare, but we also now have multi-million-dollar MRIs machines and similar magic.
Germans must do without those fancy MRI machines after all... oh wait they have those two. So what’s the catch? Maybe they have fewer people covered? No, not that either:
> Despite spending less per capita, Germany still manages to cover 100% of its population. In the United States, about 8.8% of the population remains uninsured, which equates to about 28 million people. Even more people are underinsured.
What they have less off is overhead. They do have a shortage of doctors, but not due to costs of becoming one - education is either free or nearly free (especially by US standards).
> Tuition loans of over $200,000 are not uncommon for students in the US after graduating from medical schools, which are often private institutions. In Germany, however, the vast majority of medical universities are tax-funded and, for this reason, free of tuition. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617919/
So we probably have more than enough money in the system already to treat every single one of US citizen, maintain great care and not close local hospitals, but we are too busy allowing profits and helping doctors pay back mega education loans.
People in Roman empire lived until 90 just like us. For example Seneca de Elder was 92 when he died.
The reason why "life expectance" was 30 years was because child deaths, since that number is just an average.
If you have 2 people living in a country, one is 100, and the other is 0, and the child dies, life expectancy is 50.
not too bad.
Do you factor in:
- Famines?
- Wars?
- Being killed by bandits?
- Are you talking about the city of Rome? Italy? Gaul?
- Just rich people, or do you include folks like slaves?
- Etc.
If you're going to accuse me of giving bad information, you'll need to provide better information. And from there, you need to count on dubious records. I took my number from Crash Course history (the unit on the middle ages), but it meets what I'd previously read across multiple credible sources.
https://en.wikipedia.org/wiki/Demography_of_the_Roman_Empire....
This article is a summary of one random historian, Frier.
Probably better summary of evidence:
https://archive.org/details/demographyromans0000park/page/20...
"We have a single papyrus record of 122 individuals listed in a register of taxes. Of these 122, 85 have ages extant. ... only 8 are over the age of 49 years, and only 2 of those are over 54"
"average life expectance at age 15 range from 8.3 to 15.4 years."
Etc. There's a broad set of estimates, but the estimate of 50 years is simply not plausible, unless you're talking about the wealthy elite. Being poor in Rome sucked.
And with Rome, I guess that's usually the case.
I'll mention: For all the talk of infant mortality, most infant deaths in history weren't recorded. The figure everyone tosses around -- 28 years -- sort of already takes that into account.
I've given up on editing bad Wikipedia pages a long time ago.
The difference was that a random cut could turn into an infection and kill you. Hannibal lost vision in one eye due to an infection. Prior to antibiotics, you never knew if an infection would:
- Pass;
- Disable you; or
- Kill you
Same thing for a lot of other medical issues, as well as non-medical ones (such as a famine, bandits, or a random army passing through).
hmm I wonder if there might be a connection there... as other nation implement price controls a larger part of the R&D and the costs associated with that are born by the US
Further Medicare / medicaid price controls to keep the cost of the entitlement program from going bankrupt has transferred the cost to patients not on those programs
Third leg of this stool is standard of care, American patients have a high exception for standard of care then in "most other developed" nations where waiting months for a specialist is accepted as normal, or having ward style hospital rooms is normal as well. Where the US we expect must faster treatment times, and semiprivate rooms normally with no more than 2 people to a room, though 4 to a room has become more popular in some regions. This increases costs
Hospitals complain that Medicare and Medicaid underpay, but it's a modest amount, not something that explains the very high costs for other patients: https://www.aha.org/fact-sheets/2020-01-07-fact-sheet-underp...
Also in the Hospital context there are other factors that drive up the costs. Keep in mind that about 70-80% of all US Hospitals are non-profit
Which are these developed nations? Because to give my annecdotal perspective it isn't the case in Belgium or others that i know of (With minor exceptions like recently where orthodontists couldn't handle anyone but the most urgent due to covid measures and now have a backlog of patients.)
>and semiprivate rooms normally with no more than 2 people to a room, though 4 to a room has become more popular in some regions.
Every bedroom in every hospital i've been to has been double or single though i have no experience on that front in surrounding countries. Most are double with the single ones being for special cases or people willing to dish out or with great insurance.
If you are a white-collar worker you'll usually have a private health insurance so that you won't have to wait in line for public care.
1. Is that it is just out of control in the US, but there are also some valid reasons, like,
2. Aging population. As people get older, they need more medical care, so an aging population will have higher average healthcare spend than a young population.
3. Advances in healthcare tech. We can treat more things, so there are more things to receive healthcare services for. And we can also treat things for longer, at great expense. Something along the line of: 10 years ago you could live with disease A for 10 years at a cost X. Now you can live for 20 years at cost X^2.
The more likely issue are lack of competition and high cost of entry (regulatory and educational). Regulatory you can’t really loosen, as that’s a direct protection for patients. Educational costs for doctors we can absolutely fix.
The lack of competition probably cannot be fixed with the normal “market” approaches because you are not dealing with a rational consumer behavior - when people are sick they are anything but rational. This is where something like a public option health care plan could come in with a strong negotiating position. Unfortunately, there is a good chance politics would prevent that from negotiating as well…
I assume you have data for this? Something more than the flawed infant mortality rate that is often cited but is a very poor judge of a health system in reality?
Something like 5 year cancer survival rates. Time a person waits on Specialist Wait List, the time it takes a person to get a replacement Hip, MIR, or Heart Stent. All of which I believe the US is very high or at the top of those statistics
If you only let half of your population on the list in the first place, I don't think it's overly shocking that metrics across the board would appear better.
I'd be interested to know the percentage of people in each country that require hip replacements, MIR's or Heart Stents but have no effective chance at even seeking out the preliminary care that would lead to them.
Even the most aggressive numbers on uninsured in the use put it about 15% to 20% of the population, no where near the 50% you are claiming in your comment
There was a time in my 20's where I did not have insurance, I still had (and got) care when I needed it. Sure it was expensive but I was never denied services.
Yes you can find stories of people that do not have access to care, and we should do what we can to eliminate those edge cases where there are clearly gaps in the system but paint these edge cases as the rule is just disingenuous at best
That was an example, simplified so as to make the impact more obvious. Take any country on the planet, and look at their healthcare figures - now exclude the poorest 50% of people from accessing the medical system in those countries. Bet the numbers look better now.
> There was a time in my 20's where I did not have insurance, I still had (and got) care when I needed it. Sure it was expensive but I was never denied services.
I'm not sure how relevant personal anecdotes are when you're talking about the healthcare of an entire population. But hey - good work mate.
Edit: Took me a bit but I tracked down the article that my recollections are based on: https://news.ycombinator.com/item?id=21737795
I disagree, we have a free society, and one of my concerns about a government run health care system is that it would allow encroachments upon that freedom. I do not need or want a parent via the government. I neither need nor want the government passing laws to control what food I eat, how much food I eat, or what health choices I make
The questions comes down at that point to if you desire a collectivist authoritarian government, one that "the greater good" (which is subjectively defined) always over rules the individuals rights, or do you want individualism and individual rights to reign supreme over the collective
I support individualism
Approximately none of your screed had anything whatsofuckingever to do with reality.
200 to 300 thousand travel to the US for healthcare every year. That's with population of ~30 million. Extremely common.
Which begs the question, why do they travel to the terrible USA, when wonderful social care in Canada is so amazing on paper, with wait lists measured in years?
As a Canadian however, it would not surprise me if most of the people traveling were upper class people trying to bypass the waiting lists.
You have to understand that this is inevitable as long as our systems don't have the same level of fairness and people are allowed to "choose" their system. Of course privileged people will choose the system that they can benefit from most, whereas unprivileged people cannot afford to choose.
This is not to say that our Canadian healthcare systems are perfect (far from it), but rather that some of them attempt to promote fairness (in service quality and rapidity), thereby negating the greater privilege of wealth relative to less fair systems such as yours.
This practice of healthcare tourism does of course take some pressure off the system for unprivileged people, so it's hard to say it's all bad on the whole. But don't expect the situation to change regardless, as we are also ruled by the wealthy, and they do so like to have freedom of choice.
By the way, the position on the waiting list is often adjusted according to the urgency of one's situation, so people who travel to reduce waiting time would not have been in critical condition on average, not to mention they may simply be traveling to get services that are legislated differently in Canada (as I believe cosmetic surgery can be, depending on the province).
This is only technically true, and ignores the fact that many medical procedures that are done when something is not critical means making a full and complete recovery with no life long effects but delaying the treatment while sitting on a wait list until the issue becomes "critical" means the problem may only be able to be partially rectified and the person may suffer from life long effects due to the delay in treatment
At the end of the day government run health systems control costs by limiting the supply and ignoring the demand. This creates an untenable system that can never be "fair" to anyone.
College, transportation and housing are all pretty high overall, but the healthcare share is just stunning. If we were looking at dramatically better outcomes or services, fine. Unfortunately, doctors get to see patients for less and less time, billing is going up and you don’t really see anything in return. Most other developed nations put a stop to this a long time ago…