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Comment by kongolongo | Hacker News Reader

Every time this stat is brought up I always think it doesn't convey the full context. Even though its in terms of per capita, it's still an absolute amount, I think a better data point to illustrate if the US was overspending compared to outcomes would be what % of disposable income is spent on healthcare vs outcomes.

For example, let's say the US spent 2x on healthcare as some country, but had 4x the disposable income, would this still be overspending or would it be more efficient given the amount relative to income? The closest I can find is health spending as % of GDP but that doesn't capture what a person's income, since it includes government spending too, so it obfuscates whether or not the inefficiency (if any) lies in private or public healthcare in the US.

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Why would that even matter?

Things cost more in some places so you need to account for that variation. A million could pay for 3 / 4 doctors in the US or 30 / 40 in Africa.

You say this like the profit seeking in the US is some sort of natural phenomenon that we can't avoid. We can adjust costs based in cost of living and local currency, profiteering is what sucks resources out of the system

Physicians in the US are protected, there's only a limited number of slots every year in med schools. This is fake scarcity

Let's say the US spent 2x on healthcare as some country, but had 4x the disposable income, would this still be overspending or would it be more efficient given the amount relative to income?

Healthcare spending in $ per capita doesn't capture how much people earn in that country or how much of a burden it is relative to their income so its kinda meaningless without more context. It's like saying the US economy is better than 85% of the OECD because its in the top 5 gdp per capita.

"Disposable income" is undefined, its super vague and we can't determine anything with that phrase

Most people in the US don't have "disposable income" from my perspective

There's a very consistent definition for what that means with plenty of papers and institutions that use use roughly the same definition. Here's one phrasing of it by the OECD[1]. Basically it's just income minus taxes, what part of that is remotely vague?

Discretionary income might be an even better measure but that has more wiggle room on defining what is a necessity and not.

https://data.oecd.org/hha/household-disposable-income.htm [1]

I still don't see how that's a good metric, in any way, for judging health care costs. "Disposable income" takes nothing else into account such as other costs or predatory behaviors in the healthcare system

Its literally just money after taxes, and most people are living paycheck to paycheck

You can't judge how much of a burden healthcare costs are unless you account for how much of a person's income or some proxy of it healthcare is. Just saying that the US spends more per capita than other OECD countries doesn't say anything without more context. IF you want to show that the healthcare spending isn't efficient in the US you have to at least show that it's not just because everything costs more there or that everyone earns more in the US (gdp/capita is higher than ~85% of OECD in US).

It spends more per capita with worse outcomes

That's the point, where is that extra spending going? What good is it doing? Why is any other question the topic of discussion?

You haven't shown its extra spending with just that one stat. Does $50 USD buy you the same things in the US as $50 USD in Venezuela?

That's exactly what I'm talking about, it doesn't. Why not?

Does Venezuela have a bunch of leeching middlemen at every possible point in their systems due to the massive push for privatization?

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