Tuesday, September 8, 2009

Without Further Comment

As an addition to yesterday's post on healthcare spending and related jobs in the United States, I offer the charts below. No further comment from me.
  • Obesity.
Data: OECD Health Data

Note: BMI: Body Mass Index = weight in kg/height in meters squared. For example, if you are 1.85 meters tall and weigh 110 kg ----> BMI = 110/1.85/1.85 = 32.14
  • Public expenditure on health as a percentage of total expenditure on health.

  • Spending-adjusted index for Potential Years of Life Lost (PYLL) for males age 0-69, all causes.

The index is constructed by multiplying the number of potential years of life lost from all causes for males 0-69 years old (PYLL), by healthcare spending as a percentage of GDP and then dividing by 1,000. PYLL is in years per 100,000 individuals and is considered a measure of premature mortality. My indexing it to healthcare spending is designed to give a more comprehensive "bang-for buck" measure than the infant mortality chart in the previous post.


  1. For info, it LOOKS to me like France's obesity rate is going up steadily. Logical. We always copy American trends twenty years later...
    Too bad you don't make a further comment on this issue, as obesity is just one (small) part of a constellation of takes on the problem, which all hang together : sedentarity, one individual=one car (ties into your preoccupation with alternative energy), eating habits (ties into the agrobusiness industry, and its abuse of the environment).
    I know you know all of this. But I still believe that ONE graph does not do justice to ANY problem, as tempting as it may seem.
    (Yeah yeah, I know, I lack humor. ;-) )

  2. Dear Debra,

    There is a wealth of health related data in the OECD database, conveniently in Excel form. It spans the gamut from spending on health and number of doctors, to the incidence of myocardial infarctions.

    Google OECD Health Data...

    ..and knock yourself out ;)


  3. Thanks, Hell. I count on YOU for my data. I am a lazy lout, and don't want to suffer from too many consequences of my internet addiction. :-)

  4. Thanks for fleshing out the data on the poor healthcare outcomes, Hell. It wasn't that I disagreed with you, it's just that the infant mortality rate isn't relevant to our Medicare problem.

  5. And that graph isn't even including the "sub-obese, but still overweight" group of BMI >25-<30. I believe that the US tops 70% if you include them. Spectacular!

    Hospitals have to use special "people cranes" so that the nurses don't wrench their backs when treating these patients.

    Really, the US ought to have a special math holiday where all the citizens have to calculate calorie intake of what they eat and then spend an hour walking to see how slowly those calories actually burn off. Even the most oblivious among us would then have to admit that its easier to just not put the treats in your face than to try to lose them later.

  6. I heard Naomi Wolf the writer of the Beauty Myth say that women are so busy running around the track to manage their weight that they don't have the time to vote or cause trouble. Our modern idea of what is beauty comes from the aristocrats of Europe. Thin and pale. The rest of us don't have the time to keep up.

  7. Thin and pale in what time frame ?
    Last time I checked those Rubens, Rembrandt and Titien nudes were pretty fleshy.
    Yeah, I know that was a long time ago, but it just goes to show that thin and pale have not always been in style.

  8. Nice post

    A question and a comment which might help you understand this a little better:

    First the question: "Why did you chose to post the second graph?"

    The fact that public/private spending is around 50-50 in the US is the very graph that almost EVERYONE uses to make their particular political point in the health care debate. This graph can be literally be used to support almost ANY political position in the health care so I am a little confused which position you think it is illustrating?

    For instance, the insurance industry uses this exact graph to show how they and their rich paying clients are subsidizing the entire system. So be careful to define exactly what you mean with graph #2. Do you know?

    ... In case you are a little confused, be careful you don't confuse the terms "out of pocket spending" with "private spending" as they are very different. Misunderstanding this distinction would prevent you from appreciating the very intelligent comment made by bb in the last post regarding the absurdity of our current health insurance system (a relic of WWII deals between Roosevelt and labor unions).

    European governments pay more of the total than America's government does, but out of pocket expenses (e.g. what consumers actually feel after taxes) are much greater in Europe than the U.S. In effect, European governments require much stiffer "co-pays" than we do here in America and this often confuses a people.

    And re: graph #1.

    If you think the difference between the US and everyone else in BMI is big, try looking at trauma, murder, homicides, etc... (all considered avoidable deaths for the purposes of understanding your third graph).

    We love our cheeseburgers but we REALLY love our guns and never fail to use the opportunity to get into a good shoot out whenever possible.

    Indeed I have never quite understood why liberals love to complain about how much we spend on the war in Iraq when we spend that much every year (depends how you define things) killing each other in our own back yard.

    Instead we have TV shows that make it sound cool- everyone loves ER. Trauma teams, helicopters and all

    @But What do I know-

    You make a very valid point. If Americans try to unsuccessfully resuscitate neonates at say 21 weeks of life weighing 300 grams (which may or may not be related to higher use of compounds which cause premature birth like crack cocaine, etc...), while other OECD countries define stillbirth as under 500grams, infant mortality appears much higher in the US than Europe. Indeed, OECD itself says to use care when comparing us vs. them.

    I completely agree in health improvements need to come from either changes in our populations or changes in our populations behavior.

  9. To give you an example of how to interpret the graph PYLL, you could also make a graph called potential years of life lost per dollar spent on education PYLLES (which in the UK is ???)

    How long do we live for the money we spend on education?

    For aren't we supposed to use education money to teach each our kids how to make good decisions that will lead to longer lives?

  10. And @What do I know

    In case you think I am intending to be provocative provocative on the issue of cocaine and premature birth (I am not, although I did treat 2 people today for cocaine related conditions- one who came as a trauma/chest pain when he broke into a person's home at knife point and proceeded to attack the occupants with his knife (he did injure one person moderately) until he was subdued by neighbors and the police (thus he had trauma- a think one of the cops was injured a little), at which point he developed chest pain as he was being processed in the jail (happens with cocaine) so they sent him to me.

    External validation by currency sampling supports the idea that the Japanese do not use cocaine as much as we Americans (and again, they do have much lower infant mortality rates).

    Read for yourself.

  11. Infant mortality rate isn't relevant? Maybe not, until you lose a baby. Or your wife during pregnancy.

  12. "How long do we live for the money we spend on education?
    For aren't we supposed to use education money to teach each our kids how to make good decisions that will lead to longer lives?"

    Welllllllll, that's a complicated proposition there. How to safely ferry people from age 15 to 25 without them being pregnant, addicted, or shot? Hmmm. Prior to 15 parents still have some influence. After 25 they've generally grown some ability to manage themselves. Perhaps instead of education during these years we should just give them reversible sterilization procedures and offer them scholarships for when they "come to their senses".

  13. Anon- Amen (I say this from person experience).

    Dink my friend, do you think the people who work in health care are really that stupid? That they do not think of these things?

    At the risk of sounding a little like Yo and Marcus, as a young naive resident on the OB service 16+ years ago at Hopkins, I used to put Norplants in people all the time. I didn't have a clue as to the broader implications of what I was doing; we were just doing people a favor.

    Oddly unintentional obesity was the biggest issue at the time.

  14. While I certainly understand that by posting these charts the focus shifted to healthcare policy issues, the original purpose was to show that the US healthcare system is in a profound mess and that such jobs are NOT going to "save" the economy.

    I agree we need a revamp, of course. But my point is that, if this happens (eg Obama's plan), it will set the stage for fewer jobs and spending in this field and may even become a NEGATIVE growth contributor to GDP, at least in the accounting system we use now.


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  16. Thanks for the article, Thai ; it was really interesting but LONG...

  17. Ah, I was being dense. Fair point.

    ... I guess unless we spend even more (as many people want), in which case it would be a kind of Keynesian stimulus program, no?

    Indeed, I know I say this a little too often and it has become a bit cliche but health care is in the granddaddy of all bubbles right now. And reading the comments of some of your regular readers sometimes suggests to me we have a few more innings before the ballgame is finally over.

    Which reminds me, what debt metric did you originally use to predict the debt bubble was finally going to pop?

    I wonder if an equivalent metric could be created for the health care bubble?

    Some investors did very well positioning themselves in CDS when the housing sector collapsed, no?

    I suspect others might do the same when the health care sector finally gets whacked but the key would be timing.

    Anyway, worthless 2 cent investment advice

    Be healthy

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  19. Don't you guys ever think that life could be more than just moving from one bubble to the next ???
    It's almost depressing...

  20. "do you think the people who work in health care are really that stupid?"

    Oh good Lord, what an exciting article! Filled with sinister implications of race and class warfare, social engineering, and whatnot. Unconvincing though.

    * Like the young intern, I'm sure every medical professional's intent was for the young women to have happier lives which would subsequently be a win-win for their future children and society at large.

    * Pharma jumped the gun. Likely any similar future program will be marred because of it. Ideally there would be fast-acting drugs for both genders that would block fertility within an hour, last for 48 hours, and then leave the system completely without any adverse effects. Or have a culture like Sweden or Japan where drugs aren't needed because teens don't get themselves into these situations.

    * In the state where I've lived most of my adult life, both the underclass and overclass (?) are English-speaking caucasians. So when I refer to "drug users" or "teen moms" its not secret code for some race I'm subtly abusing; its people who look like me, but are making vastly different life decisions. Isn't Utah the biggest welfare state?

    "health care is in the granddaddy of all bubbles right now"

    If India or China can come up with a vending machine that can perform urinalysis and spit out antibiotics for colds it'd be handy. For anything life-altering or ending, I'd prefer the expensive route.

  21. Na, fast acting drugs to block fertility in both sexes, that's... PILL POPPING and just because it's contraception doesn't mean that it's not... PILL POPPING.
    Geez, maybe the grandaddy of all pill popping is that oral contraceptive ? Y'all ever think of that ?
    It was certainly promoted as a NIRVANA drug, that's for sure : SEX AND UNADULTERATED PLEASURE WITH NO CONSEQUENCES !!!
    The black women don't want these drugs because they feel rightfully, that they are ceding what little control they have over their bodies to the SOCIAL body. Who wants to do THAT ????

  22. So what did everyone think of the speech? (I think McCain must be smiling a little)

    The part of me that wants universal coverage and to selfishly see more money spent on health care is quite happy.

    I seriously think Obama did a great job and give him nothing but Kudos. Though I still fail to understand why he and the left are so resistant to financing universal coverage through any other method than income taxes?

    Why is it so hard to get them to pass increases on consumption taxes of those things that cost us so much in the first place?


    -Junk Food taxes?
    -Increasing alcohol taxes?
    -Increasing tobacco taxes?
    -Taxing motorcycles?
    -Taxing bicycles (I bike so this kind of hits close to home) or perhaps ski tickets a little?
    -I really think we should tax ATVs? (I continue to fail to understand how so many parents let their 11 year old children ride these things without helmets at 40+mph; I sometimes think they will put my kids through college)

    Or best of all, how about we tax Bullets???? (I understand we all seem to need to have our own gun(s), but can't we at least just tax the bullets a little?

    There are so many ways we could tax consumption to reduce expensive behaviors and thereby save our system significant amounts in the process.

    Why does he think taxing income will change anyone's consumption patterns one bit?

    "If you thought health care was expensive now, just wait till its free"

    And fwiw, did anyone notice the brief reference to the establishment of a body to look at effectiveness?

    ... As if we don't have this kind of thing already????? (only it is not under the control of any one entity)

    Rationing is coming

  23. I know what we should tax : ATM machines !!!
    Think about it : YOU pay out of your pocket a few cents for EVERY ATM transaction !!!! IMAGINE just how much we could finance health care this way !!!!
    Way to go...

  24. ...I don't know what he answer is..but taxing more for the everyday things people live for does not sound like the answer.
    How about taxing for Obesity, and then offer a tax incentive for those who go get lyposuction and maybe they can use the fat from that and make a new fuel ...call it lyposine...just a wild thought!! :)

    Kill two bird with one stone.

  25. Anon, it would be a pretty good deal for most people (except those who consume a ton of those things but then get heavily subsidized in health care and this is a small number compared with everyone else).

    We spend what % of GDP on food, guns, alcohol, tobacco, skiing, bikes, etc...?

    We spend what % GDP on health care?

    Even asking the same question looking at household finances?

    Of course if it were a 1:1 (e.g. zero sum) trade off I would agree, and in truth I do not know what the elasticity of consumption is for (say) junk food or bullets when prices are raised through taxes.

    Nor do I know what the consumption reduction needs to be in order see a benefit and the few things I have found on this don't leave me with the sense the issue has been answered well enough.

    Anyone else know?

  26. I was perfectly serious about taxing ATM machines, and why not... ALL credit card transactions over and above. Take off a few cents of every credit card transaction, and then see how much money YOU come up with.
    I think that it's safe to say that it would be enormous. It might not TOTALLY finance health care, but it would definitely be a good start.
    And it would also be a redistributive measure, and that's what taxation is for (when it's done right, that is...) NOT to punish people in short sighted anger and vengeance, something YOU do particularly well over in the old mother country these days.

  27. Re: taxing ATM transactions

    It is obviously not a progressive tax..

    How about a VAT that excludes necessities like food?

  28. No, because I think that the CREDIT CARD is one of the reasons why the U.S. economy is doing so bad. So... Taxation on ATM transactions for everyone.
    How many inner city families have that plastic mattress anyway ? So... it's more progressive than you think.
    Credit card and saving are like... oil and water.

  29. Re: VAT

    Though I see its advantages, I am skeptical that something so blunt can solve a focused special problem. And it may be counterproductive as people much cut back on Yoga classes/health classes and school tutors (which are more expensive) to continue to gorge on Krispy Kreme donuts (which are cheaper).

    Remember what the Swedes discovered with alcohol taxes.

    This is a small area (expensive behaviors/consumption) but huge in cost implications. And it needs controlling somehow unless we want to spend our money somehow- but you can tell people like bb are already getting upset as they see this is where there money is going (health care, education and more expensive houses).

  30. Debra,

    ATM transactions may occasionally involve credit cards when people take cash advances (i.e. loans) from them, but much more commonly they involve ATM cards, aka cash cards, with people accessing their regular savings etc. accounts.


  31. Thanks, Hell.
    You may know that up until rather recently we didn't have credit cards in France, and I'm not sure that they work the same way here as in the U.S. Probably not...

  32. Sudden Debt We always copy American trends twenty years later Too bad you don't make a further comment on this issue, as obesity is just one (small) part of a constellation of takes on the problem