The Administration's Health Care Plan--Posner

It is understandable why there is widespread concern with the American system of health care. The nation spends about 15 percent of its very large Gross Domestic Product on health care, which is almost twice as much per capita as the nations that we consider our peers spend, yet outcomes, at least as measured by longevity, are no better in the United States than in those other nations, or for that matter in many much less wealthy nations. We provide much greater health care to elderly people at the end of their life than other nations do, though without much to show for it in increased longevity. Some 45 million people--15 percent of the population--have no health insurance, either private or public. They are either charity patients, or pay the full price of any medical treatment they receive--or at least are charged the full price, for a common sequel to an expensive medical procedure for an uninsured patient is the patient's declaring bankruptcy in order to wipe out his medical debt. The Administration wants every American to have medical insurance. The details are unclear, but the thrust of the Administration's plan is those who can afford to buy medical insurance, either directly or through their employer, would be required to do so and that those who cannot would have their insurance subsidized. The cost to the government alone of the Administration's program is estimated by the Administration itself to be $120 billion a year. How it will be financed remains up in the air, along with many other crucial details. Probably part of the cost will be defrayed by limiting the tax deductibiliy of employer-provided health insurance. But most of it, at least in the short run, will simply be added to the government's huge budget deficit--so huge that amounts like $120 billion are beginning to seem like small change. The Administration claims that in the long run the aggregate cost of health care will actually fall. Indeed, the hope is that the $120 billion annual cost will not have to be funded at all, but instead will be offset by various reforms that the Administration proposes, including digitization of health records, allocation of greater resources to preventive care, and evaluating the performance of hospitals and other medical providers more carefully, to determine which medical procedures are really useful, and limiting reimbursement to providers accordingly. I don't think the program makes fiscal sense. If enacted in anything like the form that the Administration is urging on Congress, it would be immensely costly and would thus add significantly to our national debt, which is already growing at a fast clip because of the decline of tax revenues as a result of the current depression and the immense government expenditures on trying to speed economic recovery. Ignored in estimates of the cost of the health care program is the effect of insurance on the demand for medical services. When people, because they lack health insurance, have to pay for medical services or encounter long queues in hospital emergency rooms, they have an incentive to economize on medical treatment. If they have health insurance, the marginal cost of treatment in excellent medical facilities falls to the cost of a deductible or copayment; and it is the marginal cost that the insured consumer of medical services confronts--the cost of the health insurance premium itself is a fixed cost, which is not affected by how much treatment the insured receives. Because the supply of medical services is not highly elastic, an increase in the demand for those services will increase average as well as total cost. I would not object if a program of universal health insurance could be financed by reducing or eliminating the tax deductibility of health insurance. But only a modest reduction, if that, in its deductibility is politically feasible. The reforms that the Administration contends will not only pay for the program but also reduce the aggregate costs of health care in the United States are probably pie in the sky. Digitization of medical records does increase efficiency: it makes it easier to change doctors, track health histories, and coordinate medical services. But the net savings are likely to be modest or even negative, because anything that lowers the average cost of a given quality of health care increases demand, just as broadening insurance coverage does. Preventive care--another efficiency measure touted by health-care reformers--is potentially very costly, because by definition it provides health services to people who are not yet ill. Advances in preventive care are not limited to telling people to exercise and eat healthful foods, but increasingly are dominated by massive and costly programs of screening and follow-up. Such programs, and the treatments that ensue for persons found to have a treatable condition, may extend life, but often this means keeping alive very sick people who will require expensive care for the remainder of their prolonged life. An effort to create a form of benchmark competition between hospitals and between doctors, by careful evaluation of outcomes and by using the results of the evaluation to calibrate reimbursement by insurers so that the best-performing health-care providers will be rewarded and the worst punished, is likely to founder on the difficulty of adjusting for differences in outcomes that are not attributable to the efficiency of the health-care provider. In addition, efforts to limit treatment by limiting reimbursement, especially efforts by government to do so, are deeply unpalatable both to patients and to doctors and hospitals. A patient convinced by his doctor that a particular treatment is his only hope for continued life will not be reassured to be told that in the opinion of the government's experts, the treatment would not be cost-justified because it is very costly and is unlikely to be successful. Insurers, and employer health-benefits plans, try to do this kind of financial triage now, but their lack of success is reflected in the enormous annual cost of American health care. A deep problem is the replacement, in the medical profession as in the legal profession, of a professional model of service with a business model. In the professional model, the service provider is assured a good but not extravagant income by limitations on competition, and in exchange he is expected to avoid exploiting the ignorance of patients as he could do by performing unnecessary or low-value procedures. In the business model, the service provider endeavors to maximize his net revenues. In the case of medicine, the disparity of knowledge between provider and patient, coupled with the fear and desperation that serious illness (or just the possibility of it) engenders, enables the profit-maximizing provider often to convince the patient to undergo costly low-value treatments. Certainly the profit-maximizing health-care provider will be very relucant to refuse to provide a treatment that the patient insists upon, his insistence being made convincing by the fact that insurance will pay all or most of the cost. Insurers do try to limit their costs by refusing to approve low-value procedures--but in the face of combined pressure by provider and patient, the insurer is often forced to back down. To return to the initial puzzle of why our peer nations are able to provide what seems, judging by outcomes, a level of health equal or superior to that of Americans at far lower cost, the only convincing answer is that the health-care providers in those nations limit treatment. I am not sure of the explanation, but the possibilities include: the professional model is more tenacious in societies less committed to free markets and a commercial culture than the United States; more of their hospitals are public and more of their doctors are public employees, who are therefore salaried rather than entrepreneurial; and Americans, being less fatalistic than most other peoples, have a more intense demand for life-extending procedures. These are reasons why a national health plan modeled, as the Administration's appears to be, on the health plans of peer nations with much lower aggregate health costs is unlikely to work well, or at least to generate net cost savings. Of course if people value extension of life very highly--and there is evidence that, in the United States at least, most people do--a very costly health care system may be cost-justified, in the sense that the benefits exceed the costs. Yet the benefits seem rather illusory, since the extra money we spend on health care does not seem to produce better outcomes. But international comparisons of health that are limited as they largely are to differences in longevity are crude. They ignore health benefits unrelated to longevity, such as the benefits conferred by cosmetic surgery and the possibility that the additional costs of health care in the United States enable people to live more dangerous, strenuous, or self-indulgent lives and by doing so confer utility.

Comments

[Anonymous]

Jack,

Do you propose a sort of indentured servitude or slavery system for providers?

Jim

[Anonymous]

One graph you should look at-
average spending on health care vs. GDP per capita for the developed countries. There is a near linear relationship. In fact, so much of the variation of spending on health care is accounted for by GDP per capita, that there is no relationship between health care and any other factor.

This suggests that health care is a luxury good and the reason we spend so much money on health care is because we have so much money.

[Anonymous]

"Insurers do try to limit their costs by refusing to approve low-value procedures--but in the face of combined pressure by provider and patient, the insurer is often forced to back down."

is this a reference to specific research or conjecture?

[Anonymous]

Jim?? What would cause you to ask such a question?

......... and Anon 9:48........ I'll take your word, perhaps, for the spending slope paralleling GDP.......... but! as is widely reported the US spends 15% (as reported here and perhaps higher) while other developed nations are spending from half as much to 10 or 12%.

15% of our $14 trillion economy is $2 trillion or something on the order of $21,000/ household, which is growing at some 3 times the rate of inflation while not serving everyone. Think there might be some potential here for a different model? Like NOT leaving some 40 million to showing up half-dead at the ER for the most expensive and least efficient means of H/C?

If wiser policy in the US were to save even 5% of GDP that would add to $700 billion/year or $7,000 per household. I don't expect any such savings to occur, but surely we can shoot for slowing the rise, hopefully before H/C consumes an even higher percentage of our household budgets.

And.......... a question: With soaring H/C costs gobbling away at median incomes that have been flat for all too long, and with energy nibbling away as well, how exactly can we expect a demand driven recovery with folks returning to retailers, the remaining auto dealers, or perhaps even to purchase a bit of our housing inventory?

Jack

[Anonymous]

For following piece was written by Leo A. Gordon, M.D. of Los Angeles, California. It was published in the Journal of the American Medical Association on February 24, 1984. It is pretty much what you can expect from health care in the future.

"I saw your ad on television and came over here this morning to talk to you about my gallbladder."
"Yes. I'll remove your gallbladder for $529.69 with no extras. I'll do it next Tuesday in under an hour, you can go home the next day. You can pay cash, in which case they will be a 10% discount, or you can use your credit card, in which case the will be a 10% processing fee by my office. Any questions?"
"Yes. Could you tell me a little bit about the procedure?"
"What's to tell? You saw the ad, and I just told you what it meant. Gallbladder removal for $529.69, no extras."
"Yes, I know that, but what about the medical aspects of my case?"
"Oh, a wiseguy! You get the price, now you want the extras!"
"I thought extras meant hidden costs in other charges"
"well, you were wrong."
"Let me get this straight. You're low price is just for the isolated act of removing my gallbladder? What about information, kindness, rapport, compassion, all the things doctors are supposed to be involved with?"
"Ah, the unending desire for a superior product and a low price. Listen, you brought this on yourself"
"what do you mean?"
"Remember about 10 years ago, when competition and consumerism began to govern medical practice? Remember when the government began contracting, regulating and consumerizing medicine. Remember when they equated gallbladder removal with ball- bearing production? Well, those actions caused two things to happen. First, it lowered the cost of medicine for the consumer. Second, it allowed me, through marketing and sales analysis to become the premier biliary surgeon in the United States. My landmark bill, SB 980867 'Limited Partnership Cholecystectomy For the Public,' which, by the way, was a rider on AB 78956 'Pollution Standards in Henry County,' sailed through Congress and became law. The public demanded it and the public got it. I'm franchised in 30 states now!"
"You mean for your price, all I get is a mass-produced product?"
"Look, you want talk, understanding, rapport, information? Those are personally demanding things. Go to the professors up the street. But don't expect a price like mine!"
"I'm shocked. Are all doctors like you?"
"Who said I'm a doctor?"
"What? How can you remove gallbladderand not be a doctor?"
"Economics, my friend, economics. The government found it increasingly easier to deal with operating room technicians than with doctors. It set up technical schools for these people and taught them to perform cholecystectomies, then legislated medical licenses for them. I employ over 200 of them. It makes economic sense."
"But does it make medical sense?"
"Medical sense became subordinated to economic sense in the late 1980s. Medical sense will forever be subordinated to economic sense, if I have anything to say about it. I have a smooth operation here, no pun intended"
"I'm uncomfortable with your setup. I don't mind paying a little extra for the things you've discounted from your operation. I had no idea that those aspects of medicine cost money."
"Listen, let me level with you. A lot of people don't think of it this way, but when you go to a surgeon, you are purchasing a 'share', as it were, of his expertise. It is helpful to think of it here as being analogous to a product. It is precisely because the share is not a physical entity that people have racked their brains trying to assess its worth. Surgeons naturally feel that a share is quite valuable and that it can be judged in terms of its visible results and its life-saving capacities. Medical consumerism, in seeking lower-cost shares, overlooked one important fact, that such shares or products are the basis for the free enterprise system. A durable master-crafted product commands a greater price than a poorly made mass-produced one. And so it is with medical shares. I sell cheaper ones, because I find it easier to do so and rely on volume and speed to make a profit. Those selling higher-priced shares must become involved in individual commitment, understanding, allegiance, technical excellence and rapport. I have no margin for them in my setup. What I have created is the logical medical extension of free enterprise marketing. Some shares are just plain worth more than others."
"I really don't know what to make of this."
"Make of this what you will, but remember one thing and one thing only -- $529.69, no extras. Nobody can beat that!"

END OF ARTICLE

My advice Don't get sick.

Jim

[Anonymous]

For following piece was written by Leo A. Gordon, M.D. of Los Angeles, California. It was published in the Journal of the American Medical Association on February 24, 1984. It is pretty much what you can expect from health care in the future.

"I saw your ad on television and came over here this morning to talk to you about my gallbladder."
"Yes. I'll remove your gallbladder for $529.69 with no extras. I'll do it next Tuesday in under an hour, you can go home the next day. You can pay cash, in which case they will be a 10% discount, or you can use your credit card, in which case the will be a 10% processing fee by my office. Any questions?"
"Yes. Could you tell me a little bit about the procedure?"
"What's to tell? You saw the ad, and I just told you what it meant. Gallbladder removal for $529.69, no extras."
"Yes, I know that, but what about the medical aspects of my case?"
"Oh, a wiseguy! You get the price, now you want the extras!"
"I thought extras meant hidden costs in other charges"
"well, you were wrong."
"Let me get this straight. You're low price is just for the isolated act of removing my gallbladder? What about information, kindness, rapport, compassion, all the things doctors are supposed to be involved with?"
"Ah, the unending desire for a superior product and a low price. Listen, you brought this on yourself"
"what do you mean?"
"Remember about 10 years ago, when competition and consumerism began to govern medical practice? Remember when the government began contracting, regulating and consumerizing medicine. Remember when they equated gallbladder removal with ball- bearing production? Well, those actions caused two things to happen. First, it lowered the cost of medicine for the consumer. Second, it allowed me, through marketing and sales analysis to become the premier biliary surgeon in the United States. My landmark bill, SB 980867 'Limited Partnership Cholecystectomy For the Public,' which, by the way, was a rider on AB 78956 'Pollution Standards in Henry County,' sailed through Congress and became law. The public demanded it and the public got it. I'm franchised in 30 states now!"
"You mean for your price, all I get is a mass-produced product?"
"Look, you want talk, understanding, rapport, information? Those are personally demanding things. Go to the professors up the street. But don't expect a price like mine!"
"I'm shocked. Are all doctors like you?"
"Who said I'm a doctor?"
"What? How can you remove gallbladderand not be a doctor?"
"Economics, my friend, economics. The government found it increasingly easier to deal with operating room technicians than with doctors. It set up technical schools for these people and taught them to perform cholecystectomies, then legislated medical licenses for them. I employ over 200 of them. It makes economic sense."
"But does it make medical sense?"
"Medical sense became subordinated to economic sense in the late 1980s. Medical sense will forever be subordinated to economic sense, if I have anything to say about it. I have a smooth operation here, no pun intended"
"I'm uncomfortable with your setup. I don't mind paying a little extra for the things you've discounted from your operation. I had no idea that those aspects of medicine cost money."
"Listen, let me level with you. A lot of people don't think of it this way, but when you go to a surgeon, you are purchasing a 'share', as it were, of his expertise. It is helpful to think of it here as being analogous to a product. It is precisely because the share is not a physical entity that people have racked their brains trying to assess its worth. Surgeons naturally feel that a share is quite valuable and that it can be judged in terms of its visible results and its life-saving capacities. Medical consumerism, in seeking lower-cost shares, overlooked one important fact, that such shares or products are the basis for the free enterprise system. A durable master-crafted product commands a greater price than a poorly made mass-produced one. And so it is with medical shares. I sell cheaper ones, because I find it easier to do so and rely on volume and speed to make a profit. Those selling higher-priced shares must become involved in individual commitment, understanding, allegiance, technical excellence and rapport. I have no margin for them in my setup. What I have created is the logical medical extension of free enterprise marketing. Some shares are just plain worth more than others."
"I really don't know what to make of this."
"Make of this what you will, but remember one thing and one thing only -- $529.69, no extras. Nobody can beat that!"

END OF ARTICLE

My advice Don't get sick.

Jim

[Anonymous]

very good

[Anonymous]

This is too big a question to be tackled from just one side.

[Anonymous]

Judge Posner,

A very interesting recent article in the New Yorker discussed some of the concerns you outlined, including the replacement of the professional model with the business model and rational limitations on treatment, which the author views as intimately interrelated. I think your cultural explanation and suggestion that what works for Europeans won't work here is intriguing, but another way of saying Americans are less fatalistic is that they have a strange (to me) fixation with prolonging quantity of life regardless of the quality attached to such extension, and a somewhat primitive view that more consumption of a good thing (especially when they do not directly face the marginal cost of that consumption, as you point out) always bears a direct relationship to the value obtained by that consumption. Indeed, the culture may have local variations on this point and on professional v. business models (though the latter seems not to be quite a binary choice so much as a spectrum with many variations) as the author of the New Yorker piece suggests.

David Lundeen

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

[Anonymous]

When you think about it, it makes MORE than fiscal sense to find that kind of money in the budget. You could stop doing so many things--overseas aid, special interest funding, etc.

I am of the opinion that it is immoral to not provide health care to many more people and don't mind paying my share. But then, these plans always make sense in the short term, but such a large budget increase in the long term will probably turn out to be unwise and perhaps cause even more damage, not to be too utilitarian. Maybe if destruction of the entire system is inevitable, it's better to have many people benefit now, and fewer in the future rather than nobody, ever.

[Anonymous]

Interesting how "globalism" works; Not subject to international pricing pressures are drug companies, docs, lawyers, politicians, CEOs, seemingly Wall Streeters, and perhaps oil companies who benefit from cartel pricing.

[Anonymous]

Listen, let me level with you. A lot of people don't think of it this way.

[Anonymous]

What do they think? And what type are they?

Jack

[Anonymous]

I caught Prof Posner on Charlie Rose last night and it was quite good; Rose seemed to draw a lot out of him and it was more interesting than his essays.

I've not read his "Failure of Capitalism" and probably will not for the reason that I so completely agreed with him that A. We (the world) are in a depression and a downward spiral that will be VERY tough, perhaps even impossible to pull out of, and that B "economists" including bankers, Wall Streeters and academics did a POOR job of forecasting and that those (and I think there were many) who warned that the sky was falling, were so universally ignored.

In past recessions (but not depressions) it's been housing and autos that have pulled the cart out of the ditch, today what I see of housing is the Catch 22 that housing will not rebound until housing rebounds, and about the same for the auto biz. With credit cards maxxed out that leaves the small stuff we pay cash for to haul the cart and it's not enough, not nearly enough.

As Posner mentioned on Rose, we've the double whammy of being left with a huge and growing debt and the deficits of the last eight years that were also not creating a strong economy and growing job market, so now the massive spurring needed IS going to sink us in levels of Debt/GDP we've not seen since WWII.

Posner, wisely, I thought, separated beneficial make work projects that we could do now with existing tech, such as going through our homes and buildings to make them far more energy efficient from "new tech" which may well be beneficial in 5 years or longer but will do little to spur this ailing economy in the near term.

Posner seems to be, mostly, on the same page as the President and admin but criticized them for not coming with an agreed upon plan of action and beginning to implement it Jan 21. But, with the clumsy bank bailouts, the auto mess, and a couple of intractable wars to continue or end, I thought that a bit much to expect as the politics of change are much harder to implement than an academic opining "shoulda, coulda, woulda". But in short Posner seems to agree this is one tough mess to clean up.

[Anonymous]

Price and Wage controls? Is "Triage" a Health Care Concept WHO's time has come? Shall it be setup along the lines of "need" or "ability to pay" or perhaps the elimination of "non-necessary" services and procedures and the concentration of efforts and resources on more "basic" medical care.

neilehat

[Anonymous]

As a Swede I must say that I´m pleased that I´m living in Sweden. Okey, our taxes are rather high, but we can relay om our healtcare when we get sick, no matter if you are rich or poor. Admit, this is rather humanly!

D

[Anonymous]

Three elements to help manage health care expenses?
1) How can life span be seriously considered a metric for the U.S. health care system when the population does such a pathetic job of taking care of themselves? Individual accountability for one's choices (diet, exercise, etc) seems a significant contributor to any cost containing solution.
2) Dividends distributed by publicly traded health insurance companies also seem a huge siphon of health care dollars away from care needs.
3) While very tough to organize, the level of care provided to one in their final stages should correlate with their existing quality of life. Dignity and comfort for the patient would remain huge priorities.

[Anonymous]

Anon 10:49,

I have personally witnessed the following in emergency rooms and the full and expensive resources of the system were focused on the problems:

"I swallowed my gum"

"my husband forgot our anniversary"

"My son is leaving for camp tomorrow and needs a physical exam and a note or he can't go"

A coke bottle up the rear and "I have no idea how it got there"

A key chain in the bladder and "I have no idea how it got there"

Drug dealers who jumped out of a 5th floor window with bed sheets as a parachute (it didn't work) to escape cops who were breaking in the door.

Countless drug and alcohol induced injuries and overdoses.

"I fell two years ago and my ankle hurts"

And on and on and on.

[Anonymous]

jack,

this is anom at 9:48

I got the graph from Dr. Phelps (U. of Rochester), Healthcare Economics.
I think you're missing the point of a luxury good. If an item is a luxury good, a consumer substitutes luxury goods for other goods as he gets more wealth. Additionally, the more "excess wealth" (money left over from food and other necessities) a consumer has, the more he can spend on luxury goods. Therefore, it can be expected that more wealth can lead to a greater percentage of money spent on health care.

[Anonymous]

Anon 9:48: I have the concept and markets are often "very curious", and different for different folks.

"We" (some of us) are wealthy enough to support the arts and gambling, "luxury goods" I suppose though often it's poorer folk who gamble and spend more on lottery tickets than those who can more easily afford to do so.

But more to your point, in terms of "markets" our H/C system is a kluge that seems to have been designed to combine the worst aspects of socialism with virtually none of the good aspects of capitalism.

Sooooooooo, we've surely a split "market" with those with the better grades of insurance -- which goes up to some VERY premium levels -- spending as if the most luxurious of benefits had zero costs or a cost so minimal as to amount to zero. In that sector I see virtually NO cost containment aspects, so, I look further for some cost containment effects, but where?

It appears that those coming in paying cash have no opp to dicker and instead are charged MORE than what the "insurance" company pays for the same treatment. Medicare? a clumsy attempt to put downward pressure on fee for service that clearly shorts your primary GP while often over-rewarding specialists. Those "not covered" and falling into the ER half-dead for the priciest care on the face of the earth? They may see the "luxury pricing" but if they weren't able to pay for "insurance" they're likely not able to pay ER bills either.

So......... back to the "dilemma" of why the US pays $150% of what other nations pay and leaves 50 million out. I don't see the cost inflation being driven by "wealthy" consumers, but by the fact of there being "cost containment" aspects ranging from none to clumsy and ineffective that would clearly give little incentive toward increased efficiency and LOTS of opportunity for individual Doc-shops to charge much more than similarly skilled scientists in other areas could earn.

This part is not quite right:

Additionally, the more "excess wealth" (money left over from food and other necessities) a consumer has, the more he can spend on luxury goods.

Jjjjjj: The ONLY sector that has gotten wealthier during these last three decades of tremendous increases in med care costs, has been those in the top quintile with the lower quints actually becoming poorer as a flat median wage is nibbled to death by H/C and energy costs. So there is no surplus of dollars rushing to bid up prices for "scarce?" medical care.

Therefore, it can be expected that more wealth can lead to a greater percentage of money spent on health care.

Jjjjj: Well, this doesn't work too well either, as the US continues to spend an even higher PERCENTAGE of its (nearly the largest) GDP per capita than do those where, ha! "medical bankruptcies" are virtually unknown instead of being the #1 cause as is the case in the US.

Ha! Perhaps just for fun here, we could see if we could employ known economic principles to design a H/C system substantially WORSE than that of the US! This could be a real challenge!

And, Ha! Ha! while WE might not be able to do worse, and Congress "loses it's nerve" (translation is too beholden to self dealing H/C interests, perhaps they could invent something worse!

I see only two possible schemes: One would be similar to Canada -- and expanded Medicare with government trying to figure out the "right price" and stumbling along with some form of fee for service with "procedures" trumping wholistic care and all of today's squabbling over the price being wrong or outdated.

Or, something like an improved version of HMO's and provider networks seeking subscribers and their voucher with service above that mandated by a patient bill of rights.

Of the two the second should have incentives to seek efficiencies and contain costs while providing their best service in order to gain more subscribers.

Obama tack seems to be to push us all into "insurance" companies and leaving for later the obvious conclusion that once we're all in the pool who needs or would want insurance companies at the party????

Jack

[Anonymous]

Great! Thank you!

[Anonymous]

great post sir..
thanks for sharing. really helped a lot here.
-------------
Tiffanys

[Anonymous]

I'm going to focus on the Judge's last paragraph. It seems that we want to have our cake and eat it, too.

We want longer lives, but we don't want to make the personal efforts (such as exercising and reducing our caloric intake) that might help. Instead, we want pills and heroic treatments. This is why some critics have used the term "sick care" to describe the US system rather than "health care."

The rise of Type II diabetes testifies to the problem we've run into. A friend of mine managed to drop 70# and no longer needs medication. Most similarly situated people will just take the pills.

A system of regular health *maintenance*, combined with some personal responsibility, would likely prove to be far cheaper than only fixing things when they're seriously damaged.

[Anonymous]

"But international comparisons of health that are limited as they largely are to differences in longevity are crude."

Straw man alert! As I commented in the other thread, researchers have tried to make more careful comparisons to compute Potential Years of Life Lost (PYLL) by country and found that the US healthcare produces among the worst results in the OECD despite tremendous expenditure. (The only countries that are worse are in Eastern Europe.)

Link for download:
http://www.oecd.org/LongAbstract/0,3425,en_2649_34631_16361641_1_1_1_1,00.html

[Anonymous]

We're becoming fatter and fatter, with several hours sitting down. It's just a trend.

-- a reader in tiffanys