17 Examples of America's Broken Health Care System

Regardless of how you feel about last week's Supreme Court ruling upholding most of Obamacare, one thing is clear: America's health care system is broken, unsustainably expensive, and often embarrassing compared with the systems of other developed nations.

Here are 17 charts showing why.

For more on health care, check out:

Fool contributor Morgan Housel doesn't own shares in any of the companies mentioned in this article. Follow him on Twitter @TMFHousel. The Motley Fool has a disclosure policy. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. Try any of our Foolish newsletter services free for 30 days.

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  • Report this Comment On July 10, 2012, at 11:07 AM, setht23 wrote:

    I'm getting an error on the slides webpage. Could be on my end though.

  • Report this Comment On July 10, 2012, at 4:23 PM, Squirespeaks wrote:

    To sum up all the charts - Americans are fat, they pay more for less access to worse care, and they are most likely to go poor because of health problems, and medical costs will bankrupt the U.S. Great.

  • Report this Comment On July 10, 2012, at 4:31 PM, Tomohawk52 wrote:

    Wow, fantastic presentation. I understand the American desire to not have the government micromanage every aspect of your care, but I just don't see the fairness in someone having a child with medical problems then basically going bankrupt paying for it. Surely there has to be some happy medium between government providing cradle-to-grave micromanaged care (with the user taking no responsibility for their health choices) and people going bankrupt for conditions or loved-ones conditions that were entirely unavoidable.

  • Report this Comment On July 10, 2012, at 4:57 PM, slickandjake wrote:

    Tomohawk52: Here is how I would approach this issue if I were in the Government. First, the major problem is healthcare costs rising at a much faster rate than inflation, period. When this happens in a "free market", then typically there is either a monopoly, collusion, or fraud. So I believe it is the Government's job to find out if any or all of these exist and fix it with the justice system. Once a free market has competition and relatively low fraud, the healthcare costs will come back to its "natural" price where people will be able to afford it. Until they fix the skyrocketing costs no law or system will work.

  • Report this Comment On July 10, 2012, at 5:01 PM, mdk0611 wrote:

    Excellent summary of the problem. What needs to be fleshed out are the causes of the problem. Too much specialization? Difference in "end of life" care? Difference in malpractice/litigation statutes? Difference in compensation for care providers?

    These also need to be examined.

  • Report this Comment On July 10, 2012, at 5:04 PM, dsmathguy wrote:

    There is no free market in health care. A few years ago, my daughter needed to have her tonsils removed. I called around to various hospitals/surgery centers to ask how much it would cost. Nobody could tell me. It all depends on who the doctor is who your insurance provider is, etc. If there were a free market, we, the consumers, would be allowed to make choices based on pricing information.

  • Report this Comment On July 10, 2012, at 5:08 PM, KingOfPizza wrote:

    You can't have a truly free-market system with a captive audience. Everyone is going to need health care at some point, and people who try to avoid using it will end up using it more in the long run.

    Nobody is going to say, "That's too much money for [procedure x], I'd rather save my money and die 5 years prematurely." They're going to have the procedure regardless of the cost and regardless of their ability to pay. This causes prices to climb to compensate for the non-payers; it's a positive-feedback loop.

  • Report this Comment On July 10, 2012, at 5:14 PM, KingOfPizza wrote:

    Also of note is that consumers of health care generally aren't rational and informed, which makes economic modeling difficult. For most, health care decisions are based on what the doctor says and emotional responses.

  • Report this Comment On July 10, 2012, at 5:19 PM, wan2bretired wrote: is the Government's job to find out if any or all of these exist and fix it with the justice system...

    The biggest misnomer is that this AHA brings the government into the health care management for the first time. The Government has been in control since the late 50's and early 60's. The Government determines how many doctors and of those specialists are produced every year. The Government sets the reimbursement rates for xrays, procedures, hospital visits etc through medicare and medicaid, and insurers follow there lead. The current iv drug shortage is due to the Government and not the evil drug companies. We are in the 8th month without proper sedatives, and are using anesthesiologists, which have increased cost. The Government sets regulations which require money be spent to comply, without evidence base data to support improved outcomes. Small groups have to hire IT people to manage the mandated EMR. Hospitals have more nurses caring clip boards then caring for patients, to insure compliance with new cshs mandates. I could go on and on. The hospital employ more people to manage the bureaucracy of mandates than care for patients. The more mandates, the more money that goes to non-patient care but increases costs. The AHA is full of these mandates. The dollar that takes care of the pt is shrinking as the bureaucracy grows.

    We have had government control of medicine, and they are the reason why the cost has gone up. The AHA is doubling down on this, so dont expect cost or care to improve.

  • Report this Comment On July 10, 2012, at 5:44 PM, slickandjake wrote:

    dsmathguy, you are correct, the healthcare system is not treated as a free market right now. It should be a free market, but the reigns have to be let go by the Government. If I were in Government, I would see my purpose as prosecuting collusion and fraud and making sure there is not a monopoly situation, not enacting a law or system to fix the symptoms of escalating healthcare costs. wan2bretired's comments are exactly correct. The Government has been in the system for decades, which means it has not been a free market.

    KingofPizza, it is not a captive audience if there is healthy competition in the market. The insurance companies are there to help with the "major" items such as heart surgery or cancer treatments. The problem is that health insurance is unaffordable because healthcare costs are too high and rising too quick. Get a handle on the rising costs of healthcare, ensure competition between insurance companies, and healthcare as well as insurance becomes affordable. After all, affordable healthcare is the goal, right?

    One thing about graph #5 hit me. Even though the U.S. is spending much more in per capita spending, the rest of the World is also starting to exponentially grow in per capita spending starting around 2000. There is no other data, but it appears that the rest of the World's healthcare costs are beginning to rise at a greater rate as well.

  • Report this Comment On July 10, 2012, at 5:50 PM, Zombie111 wrote:

    I too could not view the presentation, will try another computer later, but in response to slickandjake, there are other really important factors impacting on health costs that complicate the model you propose. The main 3 that I can think of are:

    1. The "Silver Tsunami" of aging baby boomers.

    2. The huge and increasing educational and insurance costs for medical professionals especially specialists in O&G or surgery.

    3. The technological advances that will make possible procedures that are not currently feasible (brain transplant anyone?).

    4. Advances that have already happened that keep alive people who would have died previoulsy (accident victims, very premature babies), which can create huge future costs if these people are to have a decent quality of life.

    These factors will tend to increase overall costs in even the fairest, non-corrupt and competitive model. I haven't read much about how they are going to be addressed.

  • Report this Comment On July 10, 2012, at 5:57 PM, thedoge wrote:

    The second slide shows the real culprit: health care-related costs began to accelerate when health insurance and hospitals became for-profit, corporate entities. As a result, what we have now is not a health care delivery system, it's an insurance company profits delivery system. That's why it does the former so badly and the latter so well.

    There are market-based solutions to all this. Here's one that hasn't gotten the attention that it should:

  • Report this Comment On July 10, 2012, at 6:13 PM, xetn wrote:

    Almost all of the cost increases for medical care has been:

    AMA: limiting the number of medical schools so we always have less doctors (limiting competition).

    Licensing: It is a cost and a limiter. It does not prove that a licensed doctor is competent; only that he/she can pass a test.

    50 different state insurance departments that "control" all insurance and each insurance company must get permission to sell within each separate state.

    Government regulations on medical practice and new drug approvals.

    The insurance company/government partnerships (most of Obamacare was written by the insurance industry.)

    The Fed's constant devaluing the dollar which also result in price increases.

    High cost of liability insurance for doctors (in many cases several hundred thousand dollars per year).

  • Report this Comment On July 10, 2012, at 8:14 PM, manleymike wrote:

    My question is: How does the free market, in health care, provide for the poor?

  • Report this Comment On July 10, 2012, at 9:38 PM, truman1987 wrote:

    Healthcare doesn't work in the classic free market. In economics textbooks healthcare is the always used as an example of inelastic demand. Even if the price goes up the demand will be unchanged. You will pay whatever it costs to save your life. In addition, there is no way you can negotiate costs on any medical procedure. Imagine breaking your ankle and calling around to find the cheapest doctor.

    The only answer is a single payer system that negotiates pricing up front and makes everyone pay what they can afford. There is no getting around it. Might as well just get it over with. I'm not sure how people can look at the results of our system and then the results of the European single payer systems and conclude, "nope, don't want that, twice the care at half the cost."

  • Report this Comment On July 10, 2012, at 10:01 PM, PaintItBlue wrote:

    I didn't see anything about an additional problem. Money is not the only thing that makes it difficult for people without insurance to get care. Some providers will not even make an appointment for a person who has no insurance. The last time I was turned away like this, I could not get a referral either. BTW I was working, but had no benefits at the time. I had been a patient there in the past. Was stuck trying home remedies.

  • Report this Comment On July 11, 2012, at 12:22 AM, clydejazz wrote:

    As investors, we evaluate investments based on the numbers--profits, free cash flow, projected earnings, p/e ratio, etc.

    How can we ignore the basic facts? Single-payer systems deliver as-good or better results for half the cost.

  • Report this Comment On July 11, 2012, at 1:39 AM, grusilag wrote:

    Healthcare costs are going up but it seems that these charts could just as easily represent the cost of education, housing or other things that we feel are necessities.

    The question then is this - why are costs of basic things going up without a commensurate increase in our pay? Labor, afterall, is supposed to be the number one cost of doing business. If the cost of healthcare is going up, does that mean nurses, paramedics, or doctors are getting paid more? If the cost of education is going up, does that mean teachers are getting paid more?

    The answer unfortunately is no. The cost of labor, our wages, have not gone up in decades, but the cost of everything we make and provide, has. So the question is, where is the money going? If labor is not the culprit, then what is the hidden cost in everything. Afterall, the money must be going somewhere??

  • Report this Comment On July 11, 2012, at 9:40 AM, ty46mf wrote:

    A recent article in The Journal Of The American Medical Association made several suggestions as to how to improve the american health care system. One suggestion was to study what other coutries have tried and learn from their experience what works and doesn't. What another writer alluded to is the fact that the medical system can now treat many conditions that were recently fatal but we still can't cure these conditions and the cost for treating these conditions will continue to rise until we accect the truth that we will have to put legal limits on the now almost unlimited health benefits that are provided .Who gets organ transplants and how many times do you get tranplants? Is there an age limit on getting kidney dialysis? If you have dementia do you get a knee replacement? Other countries have wrestled with these delimmas ;we need to try to learn from others

  • Report this Comment On July 11, 2012, at 9:57 AM, CluckChicken wrote:

    "The current iv drug shortage is due to the Government and not the evil drug companies."

    The shortage is not due to the government, it is do the is very small margins on these drugs and the fact that fewer drug companies want to make small margin drugs. This isn't an evil move by the drug companies it is them working in a free market. You also notice large shortages of Flu shots in years the flu season starts early, because the drug companies guess as to what demand will be, they over estimate then they eat the costs. In the EU they never have a shortage of flu shots because the governments guarantee a percentage of units based off of population and the companies produce to that level, if the people do not use all the shots the drug companies do not take a hit.

    "Government regulations on medical practice and new drug approvals."

    Yes the US has more regulations to get through in order to get a drug to market even though these have been greatly reduced in the 90s. Sadly we are now seeing the effects of these weaker regulations in far more deaths caused by poor quality drugs. I honestly do not understand why people want a more lax drug approval system, do we really need to have another Thalidomide in our lifetime? I cannot imagine what it must be like to hear that some major health issue was caused by a supposide cure and then to hear that it could have been avioded if we had kept the old testing standards.

  • Report this Comment On July 11, 2012, at 10:23 AM, TMFBreakerForce wrote:

    Hi Morgan,

    Terrific presentation. Thanks for trying to raise awareness. The whole situation is really quite troubling and depressing. The great majority of us know plenty of family members, friends, etc who are suffering due to these out of control costs...



  • Report this Comment On July 11, 2012, at 10:36 AM, RenegadeIAm wrote:

    Interesting selective use of statistics.

    Note how there was a chart for the average wait time "to see" a "nurse or doctor." Note how there was no chart for the average wait time to GET TREATED. People have been known to die of cancer waiting to actually get treated in Canada and Europe. Some conditions wait YEARS for treatments. Sure, they "see" a "nurse" quickly, but that's about it.

    Note also that costs skyrocket when government funding is introduced. Given infinite demand for medical care, as long as it's free, people will get as much as they want. That causes costs to go up and then rationing for others deemed less worthy for treatment.

    Yes--that could be you. 130,000 elderly were euthanized in Great Britain last year thanks to the NHS. They were just too much trouble to take care of over the holidays and such, so they were left to DIE.

    The government manages and restricts medial care in this country already--that's a large cause of the cost problem. Hospitals are so micromanaged that a group of doctors cannot open a small one in a rural area.

    We all want better healthcare. Other nations are waking up to the disaster that socialized medicine has caused them. I hope we don't have to.

  • Report this Comment On July 11, 2012, at 11:00 AM, CluckChicken wrote:

    "Yes--that could be you. 130,000 elderly were euthanized in Great Britain last year thanks to the NHS. They were just too much trouble to take care of over the holidays and such, so they were left to DIE."

    Can you provide a source for this? All I can find is an article from the DailyMail (which is less then a respected news source) that has a single professor (note that not even a doctor) making the claim that the NHS euthanizes 130,000 people a year. Given that they published that news 4 weeks ago I would have thought somebody else would have looked into it. I have found that the CMF debunked the claim the professor made.

  • Report this Comment On July 11, 2012, at 11:20 AM, wan2bretired wrote:


    The gov sets the margin in medicaid and medicare as to what they will pay for generics. As manufacturing costs go up, the gov is slow to respond on price adjustments. Yes it is a free market on the manufacturing side, they choose not to sell for a loss or a slim margin set by the Government.

    Since you are so big on Gov Regulations ... why doesnt the FDA stand behind the drug companies when they get sued for a "bad drug" when used for the approved FDA indications? The studies to get drugs to the market are rigorous and despite that drugs will always have side effects, some not so pleasant. We live in a society for zero tolerance for bad outcomes. No drug is without risk or side effect. Some excellent medications have been taken off the market due to threat of law suits and the FDA. So for some conditions no drugs are available. Risks and benefits in any treatment need to be weighed. Nothing in medicine is without risk or the potential for a bad outcome.

  • Report this Comment On July 11, 2012, at 11:52 AM, CluckChicken wrote:

    "Note how there was a chart for the average wait time "to see" a "nurse or doctor." Note how there was no chart for the average wait time to GET TREATED."

    I do not think anybody actually tracks 'GET TREATED' because I am not sure anybody has defined it.

    Lets say that you go to the doctor with chest pain. You wait 2 hours to see the doctor. Now does the 'get treated' clock start when the doctor sees you or after they identify the cause or after they suggest the cure? Now lets say they identify the cause as being heartburn does that mean telling you to get some heartburn meds stops the 'get treated' clock or is it when you get the meds or when the meds work? Now lets say that the doctor isn't sure so he sends you to get some scans and bloodwork done, a week later the results of those tests are not clear, so you are reffered to a specialist, after another months of tests it is found that the pain is caused by anxiety. At what point does the clock start and stop? Lets say it was something that required surgery, does the clock stop with the final stitch, after PT, a year later or when you die because heart surgery is then a life long condition. In another case what if the treatment requires some pill and PT and it takes you twice as long as normal to heal does that mean you waited twice as long to 'get treated' as the normal person?

    I know people like to always bring up heart operations when they compare wait times in the US vs Canada. Though this is an old article (from 1991) a number of things in it are still true today: Do people get surgery because it will truely help them (deaths while waiting vs deaths due to surgery)? Does Canada have skewed medical numbers because doctors can earn 5 times as much in the US? For as much as Canadians complain about their health system why do they vastly prefer it to what we have in the US?

  • Report this Comment On July 11, 2012, at 12:18 PM, wan2bretired wrote:


    “Father” of Canadian Health Care Admits its a Failure

    Just Google it for all the articles.

    I practice near the Canadian boarder. So why do they still come to the US. Event the Canadian politicians, including the Canadian PM, "my heart my choice"

  • Report this Comment On July 11, 2012, at 1:20 PM, ravensmaniac1968 wrote:

    Chart 2 - What happened in the early 1980's that caused the cost of health care to begin increasing so much more than the overall cpi?

  • Report this Comment On July 11, 2012, at 3:07 PM, slickandjake wrote:

    Wow, great comments and debates on both sides. I cannot help but comment that the system is so complex, so regulated, and so difficult that I would argue nobody has a firm grasp of the problem. In additional, moral questions are all wrapped up in the issue which need to be fleshed out.

    As an example, Manleymmike asked "My question is: How does the free market, in health care, provide for the poor?" I would contend that what we Americans do today is argue the issues but never the principles. In our economic system money significantly represents an individual's contribution to society. Now that is not entirely true, I will give you, but the majority of people in America work, earn money for it, and spend it on what they need and then the luxeries they want. Before I go further and hit the question about the poor I think we need to answer what should healthcare be like? Should everyone be covered for everything? This is where the debate needs to be. In essence, there is a price on life. We actually unconscieously put a price on our own lives. For example, if you drive a vehicle you are adding risk to injuring or killing yourself. So why do people do it? Because they are willing to take the slight increase of risk for the large gain in quality of life. To take another example, I read there are 400-500 men who die of breast cancer each year. If that is the case, why aren't all men getting mammograms or a similar diagnostic test? The simple answer is that it is not cost justified similar to the car example. If we as a society are spending an extra $X a year for male mammograms, we are sacrificing a significant amount of quality of life (i.e. the money could be used on other "luxuries") for a slight decrease in risk. If fires still kill people, why don't we put fire houses on the corner of every American street? because it is not cost justified. Plain and simple, people put a price on life, even their own. But there is gray area as to where to draw the line because each person's price on life, whether conscious or not, is different. So how can we determine what should be covered and what should be paid out of someone's own pocket. The whole idea of health insurance is that people pool their money together so that when someone has a significant medical bill there is money out there to pay for it. The only problem is, what are the rules for coverage that everyone int he group can agree to? If someone who is 100 years old has a hip replacement, should that be covered? If, as one person put it, someone has dementia should they also get a knee replacement? It is these moral questions that need to be answered and agreed upon. I would suggest that if something is life-threatening, then the person should get the treatment to help them. However, if it is something that improves quality of life then a significant portion should be paid by the individual unless they have an alternate form of health insurance whereby the premium is higher but also covers quality of life improvement procedures. In other words, money being used as an indicator of a person's contribution to society, those who contribute more should be able to pay for the service of a luxury medical procedure. This is how I see treatment for the poor, that they should be allowed to get treatment for life-threatening issues, but perhaps need to pass on the luxuries. It sounds cold, I know, but in order to get better quality of life, you need to contribute more to society. Now you can bring up the issue of unfair wages and pay or what about children in a poor family, and this is where it gets complicated and really indicates that money may not be the best indicator for contribution to society, or in the case of children the potential contribution to society. I think overall, however, we need to recognize that everyone cannot get unlimited free treatment for whatever they want, otherwise we will find that we will be trading off significant quality of life of the entire society for slightly better overall healthcare which likely will lead to less people being able to afford healthcare because we are all paying for everyone else's unnecessary diagnostics, surgeries, medication, etc. It is a cold way to look at it, but we need to agree upon the rules of the game or suffer in the overall society's quality of life.

    This is also why I think that you cannot solve 40-50 million Americans not having insurance until you can figure out why costs are going so high so quickly. I have numerous examples of what I have seen, heard, and read that contribute to increased healthcare costs. But I have never seen an overall, unbiased report which took an in-depth look at it. You have presented graphs and data, but who has dug into the causes of these? Is there an unbiased publication that dives into the causes of the high costs????

  • Report this Comment On July 12, 2012, at 12:08 PM, slpmn wrote:

    slickandjake - I like the honesty of your commentary. Though I disagree with the notion that a person's contribution to society is measured by their income (if only it were that easy), I agree that dealing with the rising costs is critical, and it's not clear at all how national health care would do that.

    I also applaud that you're willing to come right out and admit that, to you, it's a straight up cost/benefit issue. I think a lot of people feel that way, but prefer to hide behind the "freedom" position.

    Personally, I think we're already covering the costs of $30 million uninsured, though it's difficult to measure directly. While I have a real problem with the notion of providing anything to the millions of lazy slobs who will benefit from Obamacare, I feel better about it when I consider that it will also undoubtedly benefit millions of kids whose poverty is no fault of their own, and perhaps hundreds of thousands or millions of low income families that have parents working hard to make ends meet, and would no longer have to worry about financial ruin caused by medical costs.

  • Report this Comment On July 12, 2012, at 4:48 PM, slickandjake wrote:

    slpmn, thanks for your comments. I did not make myself totally clear. I do not necessarily believe money is an indicator of contribution to society, however many people see it that way and I do believe it is how the economic system is mostly made up. In other words, if you want luxuries you have to have money under most circumstances. Therefore under this model money is an indicator of contribution to society and therefore the more contributions you make the more luxuries you can purchase. I am lucky, I live in a rural area where we tend to treat each other well and share many things where money is not necessarily as important. I call that a community, and a tight-knit one at that, and people know you well enough to determine whether you contribute to the community or do nothing.

    I would be a proponent of a measure of societal contribution in combination with potential societal contribution (in the case of children) which is not money. This measure then gives access to people the things they need no matter their financial standing. This is difficult to do, however, because getting 315 million people to agree on the ground rules of this measurement is nearly impossible. This is where we need to debate principles and come up with ground rules, not enact laws to treat symptoms of the true problems. And the way I see it, and it looks like you do too, everything is a cost/benefit analysis considering our economic systems. I mean, we could solve the high cost of healthcare immediately if doctors worked for free, medicines were free, hospital personnel worked for free, medical equipment and diagnostic tools were free, etc. But if this were the case, there would be very few doctors, very few medicines, very few hospitals, etc. Our healthcare would go back hundreds of years. So we need to find the "natural price" whereby risks are which lead to a number of deaths and even mistakes that are acceptable so the people who treat patients and create the equipment and medicines can also profit from their work, as well as provide R&D to consistently, albeit likely more slowly, improve our healthcare tools and medicines. Most people think those statements are cold, and I understand why they feel as such because if it were my family member or child, or even myself, I would want the best healthcare for them, but we need to accept those rules and risks or else our nation's healthcare and quality of life will continue to erode.

  • Report this Comment On July 13, 2012, at 10:19 AM, slpmn wrote:

    ^ I agree that is the discussion that needs to be had. Unfortunately, the political environment is not conducive to rational discourse. So the provisions in Obamacare that attempt to address the issue of whether it might not make sense to provide care in some instances gets labeled "death panels" and "rationing".

    That is not meant as a slam on Republicans because had Obamacare been "Reagancare" or "Nixoncare", the Democrats would have attacked the same provisions in the same fashion. At the political level, it's no longer about solving problems, its about winning elections.

  • Report this Comment On July 13, 2012, at 11:57 AM, tylee100 wrote:


    My web browser fliter blocks this link. In the future can you provide charts in the body of the article? Thank you.

  • Report this Comment On July 13, 2012, at 12:01 PM, craigwprice wrote:


    I have always wondered about the AMA limiting the number of doctors--

    How do they do this?

    What effect does that have on competition and pricing, etc?

    Also, why do we seem to have so many foreign born doctors?

    Here in Houston it seems 1/2 are foreign born-(I assume due to their strong accents).

    Being a doctor is one of the best paying professions, so why do we import people to be our doctors?

    slickandjake--thoughtful stuff.

    As to costs and competition-(only way to keep any cost down is competition, of course),-I, being self employed, would love to have a policy where I pay , say, the first $5,000 per year and the insurance kicks in after that.

    Lot less paperwork for my doctors and hospitals ans I would ,as a consumer, be very conscious of the cost of, say a doctor visit or a simple emergency room visit-stitches,as an example.

    One of my guys had to go and get 5 stitches for a simple cut and the bill was $650!! Actual doctor time was about 5 minutes. Nurse time, cleaning the cut and prepping for the work to be done, about 10 minutes.

    Broken system.

    The idea behind insurance should be to keep you from going broke, not cover every little expense!

    Too much paperwork with that and no incentive for anyone to keep costs in control.

  • Report this Comment On July 13, 2012, at 1:12 PM, MajorBob04 wrote:

    Great analysis and comparison of the state of health and healthcare spending in the US compared to other countries.

    What's not clear to me is what piece of healthcare spending is driving the cost increase. I think there are several factors:

    1) Increasing cost of drugs, compared to what people in other countries typically pay.

    2) Increasing lawsuits that lead to increasing awards thus driving demand for additional, often unneeded, tests. And new testing that is more accurate, but also more expensive.

    3) Increasingly fragmented and smaller families, thus making "end of life" decisions even harder. I saw one study that indicated that a large portion of healthcare spend is in the last year of life. The issue is that many times people are incapacitated or affected by their illness, thus if there are no clear "living wills", the decisions are even more difficult.

    4) In many other smaller countries the family members are at most an hour airplane ride from home, or they live close enough to drive, take a train, etc. In this country there are many people who live several hours away from family members, thus the ability to closely monitor and manage healthcare for elders is significantly reduced.

    Great article, though looking forward to further analysis and understanding.

  • Report this Comment On July 13, 2012, at 2:14 PM, whitewolf60 wrote:

    Insurance is not the solution. I'm not a Harvard Economist, but...

    Let's say the concept of "insurance" (a form of gambling) had never been invented and that the annual cost of health care for Americans totaled 1 trillion dollars.

    Now invent and force everyone to purchase health insurance. Total annual health care "costs" would likely now total 1 trillion + 200 billion dollars, as those "costs" would now include yachts and castles for insurance company execs, high-rise insurance company office buildings, salaries of thousands of insurance company paper-shufflers etc. etc.

    Note that NONE of the 200 billion-dollar increase would go towards actual HEALTH CARE!

    And don't give me that crap about the benefits derived from the ability of the insurance companies to negotiate quantity discounts on heart attacks and the like!

    It appears that the health care and health insurance industries are in cahoots to inflate prices as a scare tactic against consumers ("You had better get insurance! Band-Aids are 50 bucks in the hospital!"), then revert to a more realistic figure when the insurance company actually pays the provider.

  • Report this Comment On July 13, 2012, at 7:38 PM, roblorane wrote:

    The problem with the System is simply that the Insurance Cos are making enormous profits while denying benefits and coverage . One Ins Co alone ( Blue Cross ) has Billions in reserve over and above any possible liability . Blue Cross of Oregon has Millions in reserve again beyond any possible pay out scenario The insurance Industry is unregulated and pays a lot of money to Congress to remain so . These Cos are making this level of profit while their CEOs CFOs COOs are all in the 1% club . A low salary for a Health Ins exec is $ 4 million , others have been known to have an annual salary of $ 180 million , plus stock options . Google Health Ins exec compensation for more mind boggling info. Start adding up just the major insurers profits and it doesn't take long to figure out where the problem actually lays , everything else is smoke and mirrors .

  • Report this Comment On July 13, 2012, at 7:46 PM, 1owenj wrote:

    The basic problem in healthcare is overlooked. We now produce more healthcare than we can afford. Healthcare needs to be rationed - either by individuals or by the state.

    Rationing by individuals is best done by personal, catastrophic insurance - not employer provided insurance. State rationing which most countries use is fraught with all the typical socialist, statist problems of politicisation, waste, poor incentives etc.

    The advantage of personal insurance is that it can be customised to influence behaviour - smokers get higher premiums, skydivers pay more etc.

    The disadvantage is that some people will not buy cover. Do we let them die in the streets? The simple answer is to require everyone to have catastrophic, transferable cover but the libertarians won't have that. Pity. Its a smart cost effective answer with strong incentives.

    Non- catastrophic care is paid for directly by individuals - a much more effective method.

    However while America lets lawyers dominate law making and bureaucrats make process the goal - not outcomes, healthcare will continue to be troublesome.

  • Report this Comment On July 14, 2012, at 12:16 AM, 1owenj wrote:

    Insurance has been misrepresented. Health problems are a classic insurable risk. They are lumpy events and costs that are best covered by regular spread premiums.

    In effect in socialised medicine countries consumers pay "premiums" in the form of taxation.

    The form of insurance in the USA is hopeless in that it does not create incentives for individuals to look after their health. The value of personal insurance is that premiums can reflect the actuarial requirement so behaviour can be influenced.

  • Report this Comment On July 14, 2012, at 12:37 AM, JTAMES wrote:

    Mr. Housel has written a very good set of articles on the American healthcare system, my only criticism is that it is even worse than he describes. As a physician in a community health center providing for the underserved, I am in a position to know.

    The only way to get a grip on public expenditures for healthcare is to budget prospectively: decide at the beginning of the year how much we are going to spend on public healthcare. This system works for education, fire protection, and virtually everything else governments do.

    There should remain a free and lightly regulated market for private healthcare, in which rising costs are not a source of distress: after all, I have no right to restrain how much of your money you spend on your healthcare, nor any reason to be distressed when you purchase foolish healthcare products. It's your money, and none of my business.

  • Report this Comment On July 14, 2012, at 8:23 PM, ChrisBern wrote:

    Make no mistake, healthcare prior to Obamacare is not a free market. How do I know? Because 50% of healthcare spending is ALREADY from the government (primarily Medicare/Medicaid). That's not even counting the distortions that things like allowing employers to deduct healthcare expenses from their corporate tax returns has on the "healthcare market".

    Obamacare just takes that 50% and ratchets it up even more. But it's not a free market today, for sure.

  • Report this Comment On July 15, 2012, at 2:39 PM, billyjoeh2000 wrote:

    If "the powers that be" really wanted to cut health care costs they could do a lot better job of educating the people in ways to stay healthy and PREVENT many diseases.

    How about legalizing Naturopathic MD's in all 50 states (they are legal in only 15 states) ?

    How about using some Alternative Medicine treatments for some conditions and chronic diseases ? In Germany anyone who has a stroke can get up to three weeks of hyperbaric ovygen chamber treatments and many are "fully or partially cured" of the physical and mental disabilities that in this country make many people invalids for the rest of their lives.

    I gave my daughter (a type 2 diabetic) a book titled Reverse Diabetes Naturally. She went to her Dr. and talked to him about it and he told her

    "you're doing fine, just keep taking your medication and you won't have any problem".

    There are things like vitamins, good nutritition and lifestyle changes that could help people stay healthy for most of their life.

    There are Alternative Medicine treatments like accupuncture (from a GOOD practicioner) and Cold Laser therapy on accupuncture points that have a much greater sucess rate of helping people stop smoking, but the "medical establishment" doesn't believe in Alternative Medicine. The insurance co.'s won't pay for most Alternative Medicine and Medicare won't either.


    which isn't all bad.

    It makes many doctors wealthy.

    It makes the stockholders of Medical Ins. Co's happy.

    It makes drug co."s stockholders rich.

    Lots of good paying jobs in the entire medical field


  • Report this Comment On July 15, 2012, at 3:50 PM, Morgana wrote:

    Cost of Healthcare: When you pay $7 for an aspirin BECAUSE it is given to you in the hospital, BECAUSE you just had surgery or whatever, you begin to realize healthcare costs soo o ooo much BECAUSE THEY can charge whatever they want and no one stops them. This is our fault, those who do not get involved in politics or . . . yes . . . those people who invest in companies that pay their CEO OBSCENE amounts of money but want to make a profit, and includes the imbeciles who can't fathom logic and say, "Keep government out of my healthcare" while walking with a sign "Don't touch my medicare." DUH.

    (Sorry, I just got a bill for health insurance membership: 20% of my retirement pension, a pension which will never see a COLA. Yes, I rejected the expensive insurance and went elsewhere. OH, and I have no major illness!!!!)

    Also, with universal healthcare/single payer, whatever the tag name is, preventative medicine will become more important and inevitable. Maybe we do need intervention to stop us from the excesses which are killing us. We are not really a culture that elevates health. We are a culture that worships the illusion of health: facelifts, buff bodies with heart attack personalities . . . . Ok Ok I will stop my rant.

  • Report this Comment On July 16, 2012, at 12:59 PM, slickandjake wrote:

    Interesting thoughts. Some of mine:

    MajorBob04, I think there are a lot more than 4 factors driving costs up. You mention some good ones, but I am curious as to the number of prescriptions per person written in the U.S. versus abroad. The cost of technology advancements. The number of preventative testing per person versus other countries. And this is only a few, I have many more things I think at least contribute. Many people have posted that it is one thing or another, and they are all different. Again, I think the problem is much larger than what any one person knows. We need an in-depth unbiased investigation.

    Whitewolf 60, insurance is not gambling. Insurance is pooling people together so that if a member of the group has an issue that costs a lot of money, the group helps pay for it. This requires management of funds and ground rules for the group on what the insurance pays. What alternative is there, a Federal healthcare system? You will find the same added cost, or perhaps more, for the Government to do the same management. The key, in my opinion, is competition within the insurance business and the Government finding and prosecuting fraud.

    Roblorane, what you mentioned is due to either a monopoly situation or fraud, or perhaps both. Without competition prices will increase because the executives can line their pockets more and more. I hear the Democrats talk a lot about "distribution of wealth" and trying to re-distribute wealth with the tax system by taxing the rich more. This will never work. If you want to "distribute" wealth, then this is a statistical term and therefore compensation within a corporation should have a bell curve to it. This may allow people who work for a whole corporation to line their pockets, however it will likely reduce the total amount since the executives cannot benefit as much. Again, get competition and that means less money to line pockets because they HAVE to invest in their company.

  • Report this Comment On July 16, 2012, at 4:33 PM, SpaceVegetable wrote:

    Healthcare is such a complex issue, it's no wonder we find it difficult to fix it. People's opinions are (quite naturally) colored by their own health situations. Someone who's fit and healthy and who takes good care of his or her health may feel that catastrophic-onoy insurance is all that's needed. WHile someone like me, with a chronic, "high-maintenance" condition (rtheumatoid arthritis since age 16) through no fault of my own has a vastly different view. We are all so different and have such different needs from our health care sistem that one-size-fits-all isn't going to work.

    I buy my own insurance through my own business, since I work as a consultant and can't be changing insurance every few months depending on what my current staffing agency offers or what waiting periods they might have. I need my medications to simply be able to get out of bed every morning, so continuity of care is vital. I pay high premiums for very good coverage because it actually costs less than lower-premium/high-deductible plans, given my heavy usage. I have no problem paying more for better care, given that I need it and simply use more services than most.

    Unfortunately, Obamacare doesn't take this into account and will tax me for having "too good" of a plan, despite the fact that it's the best coverage for my needs. And a lower-premium plan will cost me even more, due to deductibles and co-insurance. Likewise, new taxes on drug companies and medical equipment, coupled with lower FSA and higher tax deduction thresholds do nothing but raise costs for people like me, who already spend disproportionately on health care. There is nothing remotely "affordable" in Obamacare. Making health care more expensive won't cure the underlying condition.

    I do understand that, perhaps, making it cost more will reduce the abuse and frivolous health care visits that are unnecessary - people going to the ER for a simple cold, for example. It may even encourage people to live healthier lifestyles. But for those of us with chronic conditions - especially when they aren't lifestyle-related - all it does is make things more expensive and further limit our options.

    I'm fortunate I can afford the health care I need (for now). Without it, I'd be on SSDI, so my health care spending is a true investment in my career and ability to make a decent living. It just seems counter-productive to me for Obamacare to be heaping costs on those already spending the most and then penalizing them for being responsible and paying more for the more comprehensive level of coverage they need. I suppose the rationale behind it is that only those nasty evil rich people have "good" insurance like that and they have to be penalized. That's theonly reason I can think of as to why something like that penalty tax would be implemented. And that's not health care, it's pure politics (I won't even discuss the financial income taxes being added to the wealthier folks).

    I don't have the answers, but I know Obamacare isn't it. My own solutions is to buy the best coverage I can get, save every penny I have, and hope Obamacare gets overturned before I have to cough up even more money, come tax time.

  • Report this Comment On July 19, 2012, at 2:00 AM, DJDynamicNC wrote:

    @wan2bretired: You said that the "Father” of Canadian Health Care Admits its a Failure."

    Are you talking about Tommy Douglas, the guy who got Canadian medicare passed, who never said any such thing, and who was recently voted "Greatest Canadian" in a poll of Canadian citizens?

    Because that's not generally how I see failure.

    I did find an article on a right wing blog about a guy from Quebec who was involved in the process saying that the system is in crisis and needs to be changed, but that's not at all what you tried to convey.

  • Report this Comment On July 21, 2012, at 5:01 AM, Zombie111 wrote:

    Good article and debate. Ty46mf: Agree about the factors you mentioned, also new technological advances will increase overall costs (brain transplants currently are free as they don't exist, but maybe one day they will).

    The aging population is a huge demographic factor, with Baby Boomers in developed countries creating a huge demand/ need that will have to be managed somehow. A generation or 2 ago people with dementia were often cared for at home (mainly by women) but now it is seen more as a health care issue. Probably no country has a system that is equipped to handle it, but I can't ever see a health insurance company wanting to take on people over the age of 65, unless they can afford massive premiums.

  • Report this Comment On January 13, 2013, at 11:36 AM, 9drydock wrote:

    Long ago, as a child growing up most of us had no health insurance. My father was a PCP, had no insurance and was diabetic. He died at 54. Today most of us are living longer and I attribute that to a combination of better health habits and amazing medical technology. (When I was a kid, if you had cancer you got surgery, radiation and morphine!)

    Then the HMOs showed up. I remember Kaiser as one of the first. Non-profits like Kaiser and Blue Cross/Blue Shield were very popular and costs were very reasonable. Then for-profit companies got into the market providing superior services, etc. So, clearly anything to do with our health is profitable and I think that is the bottom line for us here in the US. Everybody needs healthcare, so how can there be "competition" to control costs? People want to live, regardless of the costs. The only competition is time and there is precious little if that when you're sick - you want instant satisfaction.

    Well, we fund healthcare with government taxes and fees, employer/employee contributions, we have huge HMOs, we could totally socialize it, but it makes no difference. Costs will continue to go up, unless one thing takes place to control the medical industry costs. Regulation. I'm not talking about death panels. That would only slow down access to healthcare that is inevitable for all of us. Costs would remain unchecked. No. Unless some entity in the US, a department, committee, medical tzar or something, establishes regulated medical costs for services, facilities, technologies, etc. we will continue to pay more and more until the cost of our health absorbs all of our discretionary income. At some point people will just have to suffer and die at a younger age(like we did back in the 50's), because the cost will just be out of site for all but the wealthiest individuals.

  • Report this Comment On March 23, 2013, at 2:33 PM, mudslinger777 wrote:

    All the info can't be on one page?

  • Report this Comment On July 11, 2013, at 3:43 PM, MotleyFoolStinks wrote:

    So how come many people come to the USA for treatment? Should they be goign to UK or Canada for their "socialized medicine"?

    Yes, it could be better, but 2000+ pages of laws is not what's going to do it.

    And motley fool's cheerleading for obama isn't going to do it either.

  • Report this Comment On July 11, 2013, at 3:55 PM, doco177 wrote:

    1. Millions are losing the insurance Obama promised they could keep. Because ObamaCare forces employers to offer expensive Cadillac plans but also offers the option of paying a fine for not providing health insurance that can be cheaper than providing it, between seven and twenty million Americans are likely to lose their health insurance coverage according to the Congressional Budget Office. The original estimate was closer to four million.

    2. The cost of healthcare premiums is about to further skyrocket. Premium costs have already exploded, but that is a slow-motion explosion. In the near future, we could see costs double or worse. Naturally, these costs will hit an already burdened middle class hardest.

    3. Lost jobs. Lost jobs.

    The Federal Reserve's March beige book on economic activity noted that businesses "cited the unknown effects of the Affordable Care Act as reasons for planned layoffs and reluctance to hire more staff."

    Human resources consulting firm Adecco found that half of the small businesses it surveyed in January either plan to cut their workforce, not hire new workers, or shift to part-time or temporary help because of ObamaCare.

    4. Potential doctor shortages that will mean rationing: The healthcare industry is already a bureaucratic quagmire. ObamaCare is about to add steroids. As the profession becomes tyrannized by government, the talented people currently practicing medicine plan to get out sooner than expected. Who knows how many will choose not to get in. Doctor shortages are what lead to the nightmare known as rationed care.

    5. Somewhere around $800 billion in tax increases will hit America's middle class. This added burden will not only further oppress a middle class already reeling from a drop in wages over the last few years, but could damage the overall economy.

    6. Inflation, the cruelest tax on the poor. When businesses get socked with added costs brought about by higher taxes and burdensome government mandates, they pass those cost along to the consumer in the form of higher prices.

    7. Added bureaucracy. Even those Obama lapdogs over at the Washington Post's Wonk Blog are admitting that applying for health care is about to get more burdensome than the byzantine paperwork involved in buying a home.

    8. To cut costs or to avoid having to provide insurance, workers on the economic margins are already losing hours, which means a lower paycheck. There are a million sad stories in ObamaVille; here are just a few of them.

    9. ObamaCare is projected to add $6.2 TRILLION to a deficit the GAO has already declared "unsustainable." That's "trillion" with a "t".

    10. More taxes than currently estimated are likely to hit because of situations like this one.

    11.Muslims, Amish, Native Americans, Congress are exempt from mandate and penalties under Obamacare that the rest of us have to pay.

    The govt becoming more involved in health care is the reason the costs have increased. So Govt creates a crisis, then provides a solution that comes at the expense of liberty and freedom, costs trillions, and by most accounts won't solve the problem but in fact make it far worse.Corruption, incompetence, disregard of the Constitution, and lying are integral to the way that this country is being run.

    Three years ago, Obama, Democrats, and his media lied to us about cutting the cost of health care, being able to keep our insurance, and not taxing the middle class.

    Today, those lies and what ObamaCare is and will do to the working and middle class are the biggest untold story in America.

    Just refuse obamacare..REFUSE..If only a mere 20% of the over 300 million population of the USA refuse Obamacare the government would be overwhelmed to even think they could penalize or mandate every citizen that refused to participate in the most corrupt and unlawful ways which it was passed that circumvented the constitution of the United States.

  • Report this Comment On July 11, 2013, at 4:11 PM, mccarthy68 wrote:

    What's truly mindboggling is to read some of these comments from people claiming that the reason the healthcare system is "broken" is because it's not a free-market system. Clearly our worst enemy is illiteracy and ignorance. If you read the slides and look at the data comparing us to other industrialized nations, not one of which has a free-market system and most of whom have systems far more regulated than ours, you can surmise that a lack of free-market influence is not the problem. The problems with our health system are multiple and complex but if one had to sum them up in a word for those who like nice, simple answers it would have to be greed. Drug companies want to rake in the cash with no restraints, insurance companies want people to pay into the system and get much less out of it, professional medical unions want fat salaries with massive benefits but protection from litigation and liability, trial laywers want massive payouts for bad outcomes that are simply a part of life, and perhaps worst of all... many Americans want everything for nothing... not just the best healthcare in the world for free but they want to eat and drink with reckless abandon and then never develop diabetes or heart disease or cancer.

  • Report this Comment On July 11, 2013, at 5:58 PM, goodforamerica wrote:

    The problem with arguing the broad cost of healthcare over a period of time is that it is an apples to oranges comparison. People are less healthy than they used to be, so there is a greater requirement for healthcare and this separates us from other countries as well. Compare the cost of taking out a gall bladder today to 20 years ago. Minimally invasive surgery, in and out of the hospital vs big time surgery. What was the procedure for HIV patients in the early 70's, make you as comfortable as possible until you died. Now it is tens of thousands of dollars in medications and treatments. Many cancers are the same thing.

    The "greedy" pharmaceutical companies some mention put hundred of millions of dollars into developing medications. Many never make it to market. They still have those costs even though they will never make a dime of the product. I know I want them working on new medications that will help me down the road and I know they have to make enough money on the products they do take to market to cover the cost of products that fail in development. I also know that other companies get lower cost for medications because of their laws concerning patents and generic drugs. However, these laws discourage new medications from being developed. Finally, torte law is a killer for medical costs in the US. In addition to malpractice rates, extra test and procedures to cover their butts is a hige burden on the US healthcare system. However, trial lawyers are a huge contributor to the Democrat party, so you did not see torte reform as part of obamacare.

  • Report this Comment On July 12, 2013, at 10:37 AM, wgcross2 wrote:

    A lot of good comments. One I would like to challenge is Tort reform. In Texas we've had the most extensive Tort reform in the nation. That was done under then Governor Bush with broad support in the community. However, this many years later, our medical costs continue to soar well above the cost of living increases. In otherwords, the consumers in Texas have seen no measurable benefits. How could this be if Tort was such a big issue?

    I also question the talking point that people are flocking to this country for medical care. Come on.

    Insurance companies don't pay for this sort of thing and neither do their country's socialized medicine. The costs associated with this would be prohibitive to a majority of people. The weathly go where they go. Surprisingly, many well off individuals here in the US seek medical care in other countries because (1) they can afford to shell out the total costs and (2) other nations can have better medical options. The US does not unilaterally dominate the medical field. That is a myth.

    One observation I have made in all my years, looking back, is that healthcare seemed to take off in costs when Wall Street got their hands into hospitals. Turning what is really a humane institution into an investment vehicle. Costs have continued to soar since. I know this cannot be the only reason, but it's impact had to be substantial.

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