laklak wrote:True to a degree. One of the biggest problems with Medicare and Medicaid is the unbelievably bloated bureaucracy and byzantine regulations. Mrs. Lak finally gave up clinical OT work because she was spending as much time filling out government paperwork (unpaid time, that) as she did actually treating patients. She worked till 10 or 11 at night almost every work night keeping up with the paperwork. One could be forgiven for looking at the regulations and deciding their true purpose was to increase costs.

Another issue is litigation. Doctors order a slew of unnecessary and expensive tests because if they fart sideways someone will sue them. You see ads on TV all the time about class actions lawsuits against pharmaceutical companies or for specific surgical procedures or devices. Tort reform would go a long way to solving that issue, but it never gets a look in through Congress.

All reasonable points.

Teague wrote:I have to ask because I'm not 100% sure but isn't medicare/medicaid/whateveritscalled the medical care the gov't already pays for???

Yes.

There's still a massive difference between state provision and state funding though.

Nicko wrote:

Teague wrote:I have to ask because I'm not 100% sure but isn't medicare/medicaid/whateveritscalled the medical care the gov't already pays for???

Yes.

So how is it that they don't know that. Even the most stupid of people in the UK must know the NHS is gov't funded.

I understand why these statistics are used to compare the performance and size of government systems, but I think they can only tell a limited story.

If most of these countries were to double their healthcare spending tomorrow, it wouldn't double the size of their public workforce in the healthcare industry. What I am trying to say is that high spending /=/ big government, spending to GDP is just a number and each country has it's own balance to achieve.

I think a better indicator would be exactly that, measuring how much the number of public workers increase in relation to a % increase in healthcare spending. A country with an efficient system would adjust quicker and with little addition to labour input. Places with all sorts of bureaucracy and pointless tests (possibly aimed at keeping people out of the system) would be the least likely to adjust well to an increase in funding, because they would need to invent and implement all sorts of new hoops to jump through and ways to waste everyone's time.

On a side note, even if the USA had 1/10th of the welfare spending as France or Australia or the UK. What's welfare/GDP when weighed up against the average time wasted by each citizen in airport security nonsense per year? I know what I think is "big government".

I would include prisons and all of the armed forces in the calculation, then if you add all the multinationals and bankers getting government hand outs this is making the USA the largest welfare country in the world.

It may go some way to explain why the average American has doubled their actual production and seen no personal gain whatsoever.

Ihavenofingerprints wrote:If most of these countries were to double their healthcare spending tomorrow, it wouldn't double the size of their public workforce in the healthcare industry. What I am trying to say is that high spending /=/ big government, spending to GDP is just a number and each country has it's own balance to achieve.

I don't really agree with this (the latter half that is), government spending as a proportion of GDP is a very good measure of the size of government. In most cases (although Australia and Norway are obvious exceptions) it's very tightly linked with taxation, by fiscal necessity, so it closely maps onto how much the government imposes on your financial life. Governments which do a lot of stuff have to pay for that stuff.

The important thing here though is that the US does not spend particularly much on pensions, healthcare and benefits (what they are calling welfare in the article) it's 23rd in the OECD. The figure that makes them look like they are 2nd is a net figure which counts tax breaks as money spent, i.e. money the government never had and never spent bumps up the spending figure about 50%.

mrjonno wrote:The word 'welfare' to me in a first instant means 'caring', which is why I find the idea of being against a caring state pretty strange

Exactly...many people whinge about "welfare" and the costs. Sometimes they're right, there are problems and flaws.

But would you honestly like to live in a society that simply threw you and your family to the wolves of something happened in your personal circumstances and you needed help?

That's for the UK, but the pattern is similar in all countries.

Spending on unemployment and disability is a small fraction of a small fraction of a small fraction of GDP. Pensions and healthcare dwarf all other welfare spending hugely. It's why government policies targeting welfare cheats typically fail - the amount to be saved is small and the cost is high.

It's also why Mitt Romney's gaffe about the "47% who will never vote republican" was quite as asinine as it was. The people on benefits he cited are actully republicans in the main, because they are pensioners. It's the one area of expensive and growing welfare that can be targeted, but the republicans won't do it, like conservatives everywhere they scare with the boogieman of the scrounger and ignore that it's a drop in the ocean compared to the benefits they provide to their own party faithful.

Thommo wrote:

laklak wrote:Calling the U.S. government "inefficient" is like calling a Krakatoa eruption a "bit of lava".

Although ironically the inefficiency is in the private sector in this instance. The US spends 250% of the OECD average on healthcare and has done since before Obamacare, for average-ish results. Every single one of the best and most efficient systems are managed by central government, with the outlier (the US) being the only system primarily in private hands.

The private sector is demonstrably failing in this area - catastrophically. I know this goes against the general trend of public sector inefficiency and bloat, but there are reasons for it.

The Dutch system is in private hands but is the best in Europe.

http://www.healthpowerhouse.com/index.php?option=com_content&view=category&layout=blog&id=36&Itemid=55

For the third year in a row.

It's certainly an interesting case study. I found this bit particularly relevant:

http://en.wikipedia.org/wiki/Healthcare ... etherlands

The health care system is in comparison to other Western countries quite effective but not the most cost-effective.[2]

A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.[8][9] However, an assessment of the 2006 Dutch health insurance reforms published in Duke University's Journal of Health Politics, Policy and Law in 2008 raised concerns. The analysis found that market-based competition in healthcare may not have the advantages over more publicly based single payer models that were originally envisioned for the reforms:

The first lesson for the United States is that the new (post-2006) Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?[10][11]

A comparison of consumer experiences over time yielded mixed results in 2009,[12] and a 2010 review indicated it was too early to tell whether the reform has led to gains in efficiency and quality.[13]

Thommo wrote:

Ihavenofingerprints wrote:If most of these countries were to double their healthcare spending tomorrow, it wouldn't double the size of their public workforce in the healthcare industry. What I am trying to say is that high spending /=/ big government, spending to GDP is just a number and each country has it's own balance to achieve.

I don't really agree with this (the latter half that is), government spending as a proportion of GDP is a very good measure of the size of government. In most cases (although Australia and Norway are obvious exceptions) it's very tightly linked with taxation, by fiscal necessity, so it closely maps onto how much the government imposes on your financial life. Governments which do a lot of stuff have to pay for that stuff.

The important thing here though is that the US does not spend particularly much on pensions, healthcare and benefits (what they are calling welfare in the article) it's 23rd in the OECD. The figure that makes them look like they are 2nd is a net figure which counts tax breaks as money spent, i.e. money the government never had and never spent bumps up the spending figure about 50%.

I agree with what's been said about using tax breaks to calculate net expenditure (the assumptions behind it are so faulty it renders the analysis almost pointless). I'm just getting a bit bored with spending/GDP figures, I think they are general at best. Wealth redistribution doesn't need to be labour or time intensive, so I don't immediately associate it with big government. I'm not disputing whether the OECD results trend towards that end though.

I spend much more time each year complying with the department of customs/immigration/transport than I do with the tax office. I think the welfare state is the least of my concerns with over-reaching governments. I suppose that's a bit off topic though, and I'm not taxed at the highest rate while paying off large sums of debt like most of the population