US Government Already Pays More Than Other Countries’ Single-Payer Systems

I blogged about this before, but I thought it was relevant to cover again after reading Paul Krugman’s brief post and listening to all the controversy (fear) on a single-payer system (please see the definition if you are not familiar – essentially single-payer means the government becomes the insurer, i.e. it pays the health care professionals).  Lost in all the arguments is how the government is already picking up nearly half the cost of health care already (46%), more than what insurers pay (41%).  Sure this is substantially less than most other countries, but it’s still relevant as part of the conversation.

Take a look at the two graphs below (I’m taking the top 22 countries by population that spend at least $1,000 per capita on health expenditures, which excludes BRIC and developing countries).  The first one compares (as a percentage) where the money for health expenditures comes from – government, out-of-pocket, or private/insurance.  The US clearly has the largest percentage coming from private/insurers.

The second graph looks at raw expenditures per capita.  The US doubles nearly all other countries in spending, as we all know (this is slightly self-selected as I only chose countries with over $1,000 in spending, see my earlier post for a more complete picture).  Yet it’s clear that the US government spends nearly as much or more than other countries spend combined (government, out of pocket, and private/insurers).   Correlation does not mean causation, but clearly the intricacies of our current employee/insurance-based model adds significant overhead to the overall system.  But are there other inefficiencies in the system that lead to the high costs?

Opponents of single-payer argue that our quality of care will be poor if we move that way, but what is the evidence of that?  Our health care as currently setup is not the best in the world (perhaps it’s in the conversation).  But only two countries listed here have insurer’s paying over 15% (US insurers pay 41%).

My personal hope is that we slowly begin to move away from our overly complicated system and begin to adopt a system that resembles other countries’ (albeit better).  This won’t happen quickly- half the “stakeholders” (or special interests) in these negotiations would be severely hurt by reducing costs, as inefficiencies to us mean profit to them.  The Obama administration is making progress (I would rather we do it right slowly than rush into a poor solution) but we must all continue to educate ourselves, keep an open mind, and avoid the knee-jerk reactions from phrases that opponents throw out to impede potential improvements.


Health Expenditure Split (by % overall)

Health Spending Overall

Health Expenditures Overall

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