Comment by smallmancontrov | Hacker News Reader

Comment by smallmancontrov | Hacker News Reader

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smallmancontrov

No, this absolutely does not explain the US's wildly off-base per-capita expenditure because uninsured people still go in the denominator of the per-capita figure! I'm sure the per-insured-capita figure is worse but that's not what we are comparing!

Americans are constantly trying to exclude uninsured people from their statistics (and, worse, from the care itself) but the comparable countries don't do this so it is utterly ridiculous to propose that the correct statistical comparison is one in which the US excludes the undesirables while other countries don't.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

    Total health spending per capita in PPP$
    
                    2024    2023    2022
    United States   14,885  13,818  12,898
    Switzerland      9,963   9,301   9,089
    Norway           9,393   8,909   8,533
    Germany          9,365   8,503   8,652
    Netherlands      8,436   7,615   7,517
    Austria          8,401   7,697   7,700
    Luxembourg       8,087   7,173   6,854
    Sweden           7,871   7,364   6,977
    Ireland          7,813   7,027   6,748
    Belgium          7,750   7,178   6,906
    Australia        7,469   7,015   6,907

The fun part is when you break those numbers down between government and non-government expenditure. You’ll find that US governmental spending on health care per capita is higher than every other country’s entire (gov and non-gov) spending per capita.

https://www.oecd.org/en/publications/health-at-a-glance-2025...

That number seems hard to believe? Specifically that non government spending would be this low. Presumably "compulsory" includes way more than direct government spending.

https://data.worldbank.org/indicator/SH.XPD.GHED.PP.CD?locat...

According to the world bank it's closer to 40:60 (government spending still being the majority). So that puts it behind Switzerland but still more than combined spending in just about any other country.

In that link, government/compulsory for the United States seems to indicate times when an insurance company covered it. Voluntary/Out of Pocket is when insurance company wasn't required to cover and did or person paid out of pocket.

Even if it's US Government only per capita with people the government insures, it makes sense it would be so high because only people on government insurance are the poor/disabled AND old. Two groups that have extremely high utilization.

That interpretation would require me to believe that a Canadian pays, on average, only 12% less out of pocket than an American. $2483/yr vs $2186/yr.

Could this be because US gov healthcare spending takes place mostly via Medicare, which is specifically for people 65+?

The spending per capita, unless I’m mistaken, is just “per person in the country” not “per person insured by the government”.

That means that even though government insurance in the US only covers a relatively small percent of the population, we pay more than other countries that cover the whole population.

Close to the same percent that doesn’t have employer coverage, they’re saying, those too old or ill to work fulltime.

I say convert SSA to UBI, set a floor, and let the price of things find a new level with more people in the marketplace:

Per capita stats are computed based on population, not per treatment or per person eligible for treatment. The US spends more per head on giving only a fraction of them subsidised healthcare than other nations manage on universal health, [more years of] education, [more generous] welfare payments etc. Some of that is down to medical professional salary discrepancies, but some of it is down to a terrible system...

>"Per capita stats are computed based on population, not per treatment or per person eligible for treatment. "

Your point is correct, but since the majority of healthcare spending occurs in the last 18 months of life, and the vast majority are on either Medicare or Medicaid during that time of their life (either due to age or ailment-related incapacity), it doesn't make a huge difference.

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