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There are two manner ins which I could have spent two times as much on doughnuts. I could have bought twice as lots of doughnutsI might have bought the same number of doughnuts however got actually expensive ones and paid twice as much, or some combination thereof. Right? If we're investing twice as much as other high-income countries, we're accomplishing that by either doing two times as much health care, paying two times as much for the same quantity of health care, or some mix.

Total costs is amount times rate. This concept that we're overusing healthcare, that we're doing so much to our patients, we're delivering so much health care, that's why we invest a lot. All the policy things has to do with trying to decrease that overuse, our culture of overuse. I would say that much of the policy focus has actually been on the quantity side of things.

Let's have a look at the data. One hypothesis I frequently hear is, as an American culture, we are fast to go the doctorat the drop of the hat, I get a little discomfort, Americans are off to see the medical professional. We initially ask the question, let's take a look at doctor gos to per capita (how much is health care per month).

This is doctor visits per capita in a given year: The mean is about 6. 6, and the United States is about 4. By the method, in Japan, the mean is 13. The average Japanese sees their doctor more than as soon as a month. For each 24-year-old Drug Detox who hasn't entered 4 years, there are people who are going every other Addiction Treatment Center week.

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6 and we're an excellent bit listed below that. We're not seeing the physician as much as these other countries. Then people take a look at that and state, "Ah, maybe the problem is not enough. Insufficient avoidance, inadequate medical care, and it's all leading to too lots of hospitalizations. The problem is overuse of medical facilities.

We said, let's take a look at healthcare facility discharges per population. And here is the mean, right, 149 per thousand population. And here is the United States: a bit below par. Surprisingly, Germany seems like a Drug Rehab little bit of the outlier, where hospitalizations per population are much, much higher. The other thingso this is just hospitalizations, right? Health center discharges per populationanybody have a sense of how our lengths of stay compare to those of other countries, these other nations? We're method shorter, method much shorter.

is? Yeah, 3. In the Medicare population it resembles 4, 4 and a half, because they're a bit older, however in the three to 4 days. In Japan, about 14. Right? I was in Japan a few years ago checking out a neighborhood medical facility. It was impressive to me. There were patients sitting around playing cards around a table.

Right? It's like they got the 4 days of IV, then they switched to the oral, and now we're simply observing them two days post-oral prescription antibiotics, simply making certain they're great. It's fascinating in terms of, if you believe about it: less hospitalizations, much shorter lengths of stay. And what you understand is we spend far fewer days in the healthcare facility than any other high-income nation.

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The 3rd, on this overutilization bit is that, the problem is we do too lots of tests and procedures. I put a little asterisk therein to advise myself to make a point, which is, naturally, when you speak about we do too lots of tests and treatments, a huge part of that hypothesisa big part of the driving consider the policy world, and I more than happy to enter into more on thisis the sense that the issue is that the doctors in Americawe're simply out there overtesting, overprocedurizing, fee for service.

So, let's take a look at some empirical information, and there's a bit of support for a few of this and not a lot for others, however let's take a look at the data. MRIs. MRIs, we are high. Sure, we have more MRIs per population than typical, however not some insane outlier. Knee replacements, here we really are number one.

We have more obesity than almost all of these nations, in fact, than any of these countries, so it's not a total surprise that we're going to get more knee replacements. Hip replacements, I expected equivalent numbers on hip replacements. I stated, "Oh, our knee replacements are high, our hip replacements are going to be high." Surprisingly, not a lot.

Meaning, once again, we see Germany appearing near the top, however we're in fact a little below average. Coronary angioplasty, a treatment that has actually gotten a great deal of attention for concerns about overuse. Sure enough, we're a little bit on the high side, and here's Germany once again ... Once again, what we see is we're a little high up on some things but not necessarily others, and here's Germany on coronary angioplasty.

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health care expense is primarily about providing excessive care, about overutilization. Right? I don't see it. We have fewer hospitalizations, less physician check outs - how much is health care per month. Tests and procedures, I view as a variety. Right? We do more MRIs, and knee replacements, and angioplasties. We do fewer hip replacements. The way I think of it is, when it comes to usage of health care services, we're above average on some things, we're second-rate on other things, and usually, we're pretty averageon usage.

Another fast one, I'm going to just reveal you this information and after that keep going. Actually, this is one I have actually even stated publiclywithout information and it turns out I was wrongthe one concept that has actually turned up over and over again is that all these countries are mainly medical care, we're mostly professionals, which the specialist-primary care doctor mix is off.

Then the very first time my colleaguesI remember they entered my office and they said here's the data on specialized mixand the information was that here was the mean across these countries, and here was the U.S., right in the middle. I didn't believe it. I simply believed this can't be right.

The proportion of doctors who are medical care, and on the right is Sweden and Denmark, where it's only 2233% in France, 54% of medical professionals are main carethe biggest obstacle with this figure is everybody calls it all different terms. Is it family doctors? Is it generalists? Is it main care medical professionals? What we did was we said, we don't care what you call it, let's discuss what people are in fact performing in the workplace.

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And then we went to both national data offices of each of these countries in addition to 3 to five specialists from each nation, and we showed them their data (how does universal health care work). I keep in mind talking to the people from Switzerland and stating, "Hey, we discover that 48% of your doctors are medical care, based on this meaning.

The 43% for the U.S. comes from the Kaiser Household Foundation, which is an outstanding source of data, using the AMA Masterfile national service. There are other studies and data from the U.S. that put the number a little lower. We can have a debate about which number is best, but this is our best at doing an apples-to-apples contrast. why doesn't the united states have universal health care.