US Government Already Pays More Than Other Countries’ Single-Payer Systems

I blogged about this before, but I thought it was relevant to cover again after reading Paul Krugman’s brief post and listening to all the controversy (fear) on a single-payer system (please see the definition if you are not familiar – essentially single-payer means the government becomes the insurer, i.e. it pays the health care professionals).  Lost in all the arguments is how the government is already picking up nearly half the cost of health care already (46%), more than what insurers pay (41%).  Sure this is substantially less than most other countries, but it’s still relevant as part of the conversation.

Take a look at the two graphs below (I’m taking the top 22 countries by population that spend at least $1,000 per capita on health expenditures, which excludes BRIC and developing countries).  The first one compares (as a percentage) where the money for health expenditures comes from – government, out-of-pocket, or private/insurance.  The US clearly has the largest percentage coming from private/insurers.

The second graph looks at raw expenditures per capita.  The US doubles nearly all other countries in spending, as we all know (this is slightly self-selected as I only chose countries with over $1,000 in spending, see my earlier post for a more complete picture).  Yet it’s clear that the US government spends nearly as much or more than other countries spend combined (government, out of pocket, and private/insurers).   Correlation does not mean causation, but clearly the intricacies of our current employee/insurance-based model adds significant overhead to the overall system.  But are there other inefficiencies in the system that lead to the high costs?

Opponents of single-payer argue that our quality of care will be poor if we move that way, but what is the evidence of that?  Our health care as currently setup is not the best in the world (perhaps it’s in the conversation).  But only two countries listed here have insurer’s paying over 15% (US insurers pay 41%).

My personal hope is that we slowly begin to move away from our overly complicated system and begin to adopt a system that resembles other countries’ (albeit better).  This won’t happen quickly- half the “stakeholders” (or special interests) in these negotiations would be severely hurt by reducing costs, as inefficiencies to us mean profit to them.  The Obama administration is making progress (I would rather we do it right slowly than rush into a poor solution) but we must all continue to educate ourselves, keep an open mind, and avoid the knee-jerk reactions from phrases that opponents throw out to impede potential improvements.

Health Expenditure Split (by % overall)
Health Spending Overall
Health Expenditures Overall
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Amazon and Zappos Sitting In A Tree…But Is That Good For Us Consumers?

When Amazon announced its acquisition of Zappos yesterday, I was pretty excited.  Here were two of my favorite companies joining forces. I have become a huge advocate of Amazon (especially their Prime service) over the past couple years, as they continue to show innovation and reduce the pain of shopping (this doesn’t account for the Kindle and AWS, which I discuss here).  I’d say 90% of my online shopping goes through Amazon due to price/ease.

Zappos, on the other hand, is a more recent fad of mine.  I heard Tony Hsieh speak at TiEcon earlier this year, and it was the best keynote I can remember, especially given that I was able to stay awake (without coffee) on a Saturday morning with very little sleep.  And he was quite inspirational, though he didn’t talk just about Zappos or his background.  I actually bought a book on his recommendation – Happiness Hypothesis (which I will blog about sometime in the future), ironically on Amazon.

Their value prop is awesome (free unlimited shipping and returns) and their service is impeccable.  While they focused on shoes (competing with Amazon’s, they had already expanded into apparel, and it was only a matter of time before they moved to other types of goods that Amazon offered.  I loved where the direction they were pushing the market in, and was hoping that I’d eventually be able to choose between Zappos and Amazon for that next gadget or toy.

The question I wonder is whether, as a consumer, is it good that these companies are now one and no longer competing.  As Hsieh colloquially put it in his letter (btw I like his sense of humor), this was less an “acquisition” and more like “Amazon and Zappos sitting in a tree…”  In my opinion, Zappos’ customer service cred kept Amazon honest, but now that they are “sitting in a tree” together, who is challenging them, and pushing even their vaunted reputation higher?  I’m sure there are smaller companies out there that are evolving, but to reach their scale it requires significant capital.  Perhaps Ebay can challenge them but given their CEO’s recent statement, it looks like they’re going to push their Paypal offering (which has a terrible customer service reputation, fair or not), which to me means they may be deshifting their focus against Amazon.

Anyways, I will leave you with the presentation Hsieh gave to TiEcon – it gets really interesting around slide 36 (though even the beginning is great):

Why I gave up my Blackberry Bold (and Palm Pre) for the iPhone 3GS

I am probably not the typical phone user.  I rely on my device for a ton of things throughout the day and night, anywhere from email, maps, news, shopping, entertainment, and, of course calling people.  My Blackberry 8800 and then Bold served me well in all these functions – I used their integrated email, Google Maps, Viigo, Amazon App, the camera, UberTwitter, Facebook, and more, all at least once a day.  When the iPhone initially came out, I thought it was a cool toy, but nothing that could replace my daily needs.  Once the SDK was released, I started to grow a bit envious.  Cool apps were developed left and right.  I needed to buy an iPod Touch to help satisfy my gadget needs.

A couple things kept me excited about Blackberry – their App Store and OS5.  I thought here was a chance for Blackberry to demonstrate their full potential.  The Bold was a fairly powerful device when utilized to it’s max (see Google Maps, Vlingo, Amazon, Shazam apps), so it seemed like it could be somewhat competitive.  The problem is that Blackberry was originally built as a messaging device, targeted at enterprises, with lots of security built-in.  They did a good job of building a platform around it, but it wasn’t scalable.

Then the App Store came around – which tried to imitate Apple’s.  Soon after, OS5 pictures leaked out.  Here was a chance to even the playing field – and they didn’t come close.  The app store made installing apps easier (though you needed to know how to download the App Store app ironically), but OS5 looked just like 4.6, 4.2, etc, with some additional features.  They’ve tried to woo developers (see Blackberry Fund), but it hasn’t really worked.  The reason is not lack of devices- there are many more Blackberries in the market than iPhones.  It’s that from everything I hear and see, it’s not easy to develop on Blackberry.  From the poorly documented API, large number of models, different versions of OS’s, etc, it’s just tough to manage.  And it doesn’t seem to be getting better (BGR wrote a great piece on this).

The one advantage I always thought I’d have over the iPhone was phone service quality.  But once calls started dropping (quite an understatement), I decided to give the Palm Pre on Sprint a try.  Knowing I could return the device within 30 days, I went out and bought a Pre.  My quick review-  it’s great product but needs to mature (and it will, in time).  webOS was awesome – they did a great job with the “cards” and multi-tasking.  I really liked how the mail and notifications popped on the bottom.  I liked how most things worked, although at times it felt a bit too cute.  Problem came down to the keyboard.  I did not like the keys – felt way to plasticky.  And I especially did not like how it slid out.  Everytime I needed to do something I had to flip out the keyboard – I felt like I was going to drop it and it just slowed things down.  It actually made me crave a virtual keyboard.  That’s when I decided to get the iPhone 3GS.

I’ve had it a couple days now, and I can’t imagine going back.  It’s weird, because I was once a hard core Blackberry user (convinced friends and family to get one).  But now – I’m going the other way.  If you can get over the lack of a physical keyboard (which isn’t terrible unless you write a ton of emails) and the non-removable battery (which wasn’t much worse than my Bold, though I carried a backup), there’s no comparison.  And while I still have nostalgia for my Bold keyboard and its build quality (mine survived a beating), if you crave features and functionality, the iPhone is the way to go.  Sorry, Blackberry.

FYI – I am long Apple, and have been for almost 2 years.