• Skin in the game – even more, ctd.

    I feel like my last chart made some headway in terms of getting a more accurate picture of “skin in the game”. But it’s not perfect. Kevin Drum had a great idea, which he sent in an email to me:

    Your latest chart seems to be the right way to look at this, but it’s hard to read… It seems like it would be a lot easier if you just calculated out-of-pocket costs as a percent of GDP per capita, and then laid it out in a bar chart… it would make the comparison easier.

    And he’s right. So here it is, 2008 out-of-pocket spending per capita in US$ purchasing power parity as a percentage of GDP per capita. Or, another way, what percentage of per capita GDP is spent in out-of-pocket health care costs. I apologize, but you’re going to have to click through to see it clearly. There are too many countries on it to make it look good here:


    Once again, not the most OOP spending (that goes to Switzerland), but we aren’t an outlier on the low end. We have plenty of skin in the game.

    • There seems to be an assumption that it is a good thing to have “skin in the game”. I don’t know the reasoning behind this assumption except a blind belief in the power of markets.
      We have discussed this before and the fact is that health care is not a discretionary purchase. When you get sick you must see a doctor. Add in the reality that most decisions on what medical services are consumed and where these services will be received are made by doctors, not patients. Patients do not have the knowledge to make their own decisions and is is nearly impossible to discover prices for service so they have no effective say in the “market”.
      I think the only role of “skin in the game” is to make it more expensive for patients and this has the effect of rationing care in the worst possible way… not by need or effectiveness but by ability to pay.

    • Why is it that Americans’ overall poor health as compared to other countries is never linked to government policies that subsidize and promote poor agricultural practices which, in turn, have a major direct impact on everyone’s health because of the poor quality of our foods. There are tremendous amounts of chemicals infused into our bodies by the production, processing and bringing to market of those foods. This does not also consider the impact of the use of oil to grow and bring those foods to market. Also, I never hear of the outrageous expenses of pharmaceuticals, 80% of which don’t really work or which are actually harmful to those taking them and which would be unnecessary if our food supply was what it ought to be. Industrial pollution also accounts for damage to people’s health–again, within the realm of government to
      do something about, but apparently, mega corporations rule.

    • How does this view square with the post and follow-up comments by Austin Frakt.