The United States spends an average of about $13,000 per person every year on health care. No other country comes close to spending so much:
What do Americans get for all this spending? Our health care system does tend to produce more innovation than many others. U.S. companies developed some of the first Covid vaccines, for example. But much of the spending does little to improve people’s lives. Despite all our spending, the U.S. has the lowest life expectancy of any high-income country:
Twenty years ago, a group of researchers — Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan — published an academic paper that tried to solve the mystery. The title told the story: “It’s the prices, stupid.”
The main reason that U.S. health spending is so high is not that Americans are sicker than people elsewhere or are heavier users of medical care (although both those factors play a role). The main reason is that almost every form of care in the U.S. costs more: doctor’s visits, hospital stays, drug prescriptions, surgeries and more. The American health care system maximizes the profits of health care companies at the expense of families’ budgets.
Dying broke
You can find a poignant example in a series that The Times and KFF Health News (a nonprofit) have been publishing in recent weeks. It’s called Dying Broke, and it examines the long-term care industry. One major part of the industry is known as assisted living, a name for facilities that are home to about 850,000 older Americans who need help with daily activities — like getting dressed or taking medications — but who don’t need constant nursing care.
These facilities can be highly profitable. “Half of operators in the business of assisted living earn returns of 20 percent or more than it costs to run the sites, an industry survey shows,” Jordan Rau, a reporter for KFF, writes. “That is far higher than the money made in most other health sectors.”
Many facilities, Jordan explains, “charge $5,000 a month or more and then layer on extra fees at every step. Residents’ bills and price lists from a dozen facilities offer a glimpse of the charges: $12 for a blood pressure check; $50 per injection (more for insulin); $93 a month to order medications from a pharmacy not used by the facility; $315 a month for daily help with an inhaler.”
Other countries tend to hold down health care costs through regulation. Their government officials set prices that are high enough for health care providers to operate yet significantly lower than in the U.S. Policymakers here, by contrast, allow the market to operate more freely. But competition often fails to bring down prices because the health care sector is so complex, with opaque pricing and bureaucratic insurance plans.
It’s worth pointing out that the U.S. didn’t always have such high health care prices relative to other countries. The gap began to widen in the 1980s, as Austin Frakt, a health economist at Boston University, has pointed out. That decade also happens to be when the U.S. began moving more toward a laissez-faire economy.
(Related: A 2018 investigation in The Washington Post found that care deteriorated at a chain of nursing homes after the Carlyle Group, a private equity firm, took it over.)
Cheaper at home
The problems with long-term care in the U.S. involve much more than high prices, as Jordan and The Times’s Reed Abelson explain in the Dying Broke series. They also stem from our country’s aging population; slow income growth in recent decades that has left families without much savings; a broken long-term insurance market; a lack of subsidies to help Americans care for aging relatives at home (which is much cheaper than institutional care); and a patchwork, inefficient health sector.
Many other countries are also aging and struggling with long-term care. But the problems are worse in the U.S.
For more: At an online event tomorrow at noon Eastern, Reed and Jordan will talk with people who are caring for their parents.
THE LATEST NEWS
Israel-Hamas War
Israel ordered more evacuations before an expected ground invasion of southern Gaza.
The evacuation orders have confused Palestinians. Many who already fled northern Gaza are now being asked to move again.
These maps show where Israel has attacked.
The U.S. said that it was pushing Israel and Hamas to restart cease-fire talks.
Many people in Ireland, which has its own history of conflict, are sympathetic to Palestinian civilians. They also condemn the Hamas attacks on Oct. 7.
Politics
A second Donald Trump presidency might be more radical than his first because the buffers to check him are weaker.
Nikki Haley has gained support among educated and relatively moderate Republicans and independents. But that may also be a liability, Nate Cohn writes.
Artificial Intelligence
Tech moguls, including Elon Musk and Larry Page, disagree on whether A.I. will help humanity or destroy it. Read more about their debate.
See who is who in the A.I. field.
At the U.N. climate summit, researchers predicted that the technology could accelerate efforts to combat climate change.
International
Convicts are sustaining Vladimir Putin’s war in Ukraine. Read more about Russia’s secretive effort to recruit in prisons.
A volcanic eruption killed at least 11 hikers in Indonesia.
More Chinese people are trying to cross the Darién Gap and find asylum in the U.S., Li Yuan reports.
The suspect in an attack that left one tourist dead in Paris had pledged allegiance to ISIS, the authorities said.
New York City
Venezuelan migrants could soon create a “Little Caracas” in Queens.
A man killed four family members and set their house on fire, the police said. Then he stabbed an officer and was shot to death.
Other Big Stories
Spotify said it would cut 1,500 jobs, its third round of layoffs this year.
Alaska Airlines said it planned to buy Hawaiian Airlines for $1.9 billion.
The Oxford English Dictionary’s word of the year is “rizz” — a Gen Z slang term derived from “charisma.”
Opinions
“We don’t want to let it go”: Watch an Opinion documentary about the fight for a family farm — and a way of life — in Ireland.
President Biden should support an African initiative to stop a Sudanese paramilitary’s ethnic cleansing in Darfur, or risk making the U.S. an accomplice, Alex de Waal and Abdul Mohammed write.
Here are columns by Nicholas Kristof on Henry Kissinger and David French on the Insurrection Act.
MORNING READS
Throwback: Live music is a time machine. At Phish concerts and Alanis Morissette shows, fans are reliving their teenage years.
Plaids and corduroy: Our style photographer spent almost two weeks documenting fall fashion on the streets of Tokyo.
Hark: Like the holiday season itself, Christmas music can be emotionally charged.
Insomniac: The writer of the Best of Late Night column for The Times reflects on years of watching and covering talk shows that air after dark.
On the mend: Divided by politics, a Colorado town has recently found a semblance of peace.
Metropolitan Diary: “He must look just like his father.”
Lives Lived: Myles Goodwyn was a singer, songwriter and guitarist for the Canadian classic rock group April Wine. He died at 75.
SPORTS
Sunday Night Football: The Green Bay Packers quarterback Jordan Love threw three touchdowns in a 27-19 win over the Kansas City Chiefs. Taylor Swift was in the house, too.
Around the N.F.L.: The San Francisco 49ers trounced the Philadelphia Eagles in a matchup of Super Bowl contenders, and the Houston Texans intercepted a potential game-winning pass by the Denver Broncos’ Russell Wilson. Here are takeaways from Sunday.
M.L.B.: The Seattle Mariners traded the former top prospect Jarred Kelenic to the Atlanta Braves in a five-player swap.
ARTS AND IDEAS
New York theater: By the 1940s, Jews had become an integral part of mainstream theater — creating, presenting, teaching and consuming it. But rarely was their product noticeably Jewish.
That changed, in part, with the Broadway opening of Arthur Miller’s “All My Sons,” a morality play about an airplane parts manufacturer whose corner cutting leads to the death of 21 airmen. “It is virtually Talmudic in its exquisite weighing of individual and communal responsibility,” Jesse Green writes. “Everything about it is Jewish except the characters.”
What followed is a long tradition of Jewish influence on American theater. Read more here.
More on culture
Long wait times frustrated Fortnite fans as they tried to watch a digital live event with a performance by Eminem.
The Philadelphia Eagles released a Christmas album.
The American Museum of Natural History hosted a gala. See some of the outfits.
THE MORNING RECOMMENDS …
Make this vegetarian skillet chili.
Use one of these bathroom scales.
Run with this gear.
Take our news quiz.
GAMES
Here is today’s Spelling Bee. Yesterday’s pangrams were inaptly and pliantly.
And here are today’s Mini Crossword, Wordle, Sudoku and Connections.
Thanks for spending part of your morning with The Times. See you tomorrow. — David
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