Feb 24, 2023·edited Feb 25, 2023Liked by Buzz Hollander MD
Back in the mid-60s I had my first experience needing to see a GP in the small Maine town were I lived.
I'll call the now long gone physician "Dr. Smith" but only because at my advanced age there are black holes in my memory bank.
Short story long, Buzz, I asked my neighbor on the other side of the valley how much Dr. Smith charged.
She literally gave me a few dozen fresh eggs and a large bag of produce in case I was low on cash.
Everyone in Winterport, Maine knew I was just starting out as a writer of obituaries for the local newspaper.
I had a painful sinus infection that laughed at aspirin.
Dr. Smith turned out to be a fellow in his mid-50s, and told me my neighbor had called him to explain my lack of ready cash. I went out to my ancient jalopy and returned with the eggs and produce.
He chuckled, and I winced.
A dose of warm salt water in each nostril followed by a lot of nose blowing brought me some relief.
Doc Smith thanked me for the eggs and produce, and advised me to start learning how to become a newspaper reporter so I could one year soon give him cash.
He became my family doctor from that day forward until his passing several decades later.
His passing was mourned by the entire town.
My last position at the newspaper was as the business and technology editor, where I soon understood most of the people I interviewed made far more money than I found in my weekly pay envelope.
I left the newspaper in 1979 to start several companies that created software for the then new type of computer we called micro computers, and are now called cell phones.
As a long retired entrepreneur, I wish you well in trying to solve the problem of what I can only describe as a disaster for our citizens who are at the lowest levels of wealth.
Seems as though your recovery is going well, if only because you are now returning to writing essays that expose your inner gad fly 😏
Most consider insurance to be coverage for 'health' instead of 'a way to pay'.
Thus either pay 4-5x (I've seen bills 200x) based on the infamous 'charge master'
The 'charge master' is a 'private' doc that prices services at 4-5x+ for 'cash'
Logically, if one was paying up front, there would be less paperwork and cost should be less.
Solution: Anti-trust <understand there are exemptions in law as of now>....Just as Microsoft was not allowed to charge IBM more then Dell for the same Software, Hospitals and providers should not be allowed to charge patients more then insurers for the same services.
It is true that Microsoft is able to offer volume discounts....thus a company committing to a larger purchase will get a slightly better price verses purchasing one. These have to be posted and available to all (meaning a group of individuals forming a purchasing entity: committing to the same price level as an insurer.) The price difference is maybe 25% less for the largest companies sliding down to list price for small business or one person. VERY different then 400 to 500% plus if you don't pay the mandatory health insurance kickback.
Having the same (small volume difference allowed) prices would solve so much of the bankruptcy problem. MORE people can pay (with small loans, charity, etc) a $10k charge....they can't pay a $50k to $100k charge.
Easy to implement: ALL prices public. Legal to discuss. People can compare. If charged differently then hospital / Dr. etc. fined. Person doesn't get for 'free' <avoid lawsuit BS: not about enriching individuals>, the individual does benefit by getting (and pay) the public price. The fine is paid by the hospital and used for general public benefit (e.g. free public services | pay for the service below). The mistake charges are made public (individual privacy) and the CEO of the hospitals or CFO is held responsible and also fined.
Since prices are 'public', the cost doesn't have to be hiring a lawyer. There can be a central neutral group created to review (at no cost to individual or a small cost (refunded if the person was charged incorrectly. This process Incentivizes people to only submit if incorrect))
The 'charge master' allows hospitals etc. to claim tons of 'charity care' and deductions all based on rates that insured are not charged.
This is by design by Big Pharma and the Medical establishment. Have the government pay for as many as possible (insurance), have the person never question the costs (insurance pays), never consider alternatives (sorry: I have 'insurance' and alternatives are not covered...I'd have to pay out of pocket!) Rockerfeller medicine at its finest (sarcasm)
I suspect that many of us who have practiced for 20 or more years have similar thoughts on the changes in clinical medicine and concerns about the direction. I look forward to reading your parts 2 and 3.
I believe that pricing transparency is a great start as well. Anecdotally, I was raised on a farm and participated in many sports, and recall having made 0 trips to the Emergency Room for myself or my siblings. I doubt that was because we were lucky! My parents would take us to regular Dr. visits as well as acute care needed in between. My mother still likes to brag that she raised 6 children with 0 broken bones !! My point being, we weren't rushed to the ER for every (or any) sniffle or fever we contracted. My parents were very aware that even with insurance, those bills were expensive. My parents and grands would administer the care needed, if more than their expertise, then a Dr appointment was made. It seems as though people are using hospitals and ERs as a Dr. If they actually knew the cost upfront, maybe they would wait a few hours and see a physician during office hours.
Imagine if you went to a grocery store where your insurance pays for two carts filled with groceries, each week. But, which items cost what and how do you make good choices? And, what do you do if you need an extra cart?
That’s our healthcare system in a nutshell. It’s infantile. Even worse, it’s profit first.
We need more and more heath-care because of what we eat. Fix our food supply and health-care costs will eventually decline. Obesity, cardiac disease, diabetes continue, metabolic syndrome continue an uncontrolled climb because 75% of our food is highly processed and ladened with fructose sugar. We can’t fix health-care without fixing oiur food. The government is complicit. Big Food and Big Pharma run the show.
We need more and more heath-care because of what we eat. Fix our food supply and health-care costs will eventually decline. Obesity, cardiac disease, diabetes continue, metabolic syndrome continue an uncontrolled climb because 75% of our food is highly processed and ladened with fructose sugar. We can’t fix health-care without fixing oiur food. The government is complicit. Big Food and Big Pharma run the show.
I am a 75 year old MD who dropped out of the insurance based practice model in 1998 and decided to only treat people who value their physician as much as they do their plumber or electrician. no amount of money is going to compensate for America's Obesity and sedentary lifestyles. We are the fastest county on earth with a population over 2,000,000. (Tonga and several small pacific Islands are fatter) Obesity increases the risk of Cardiac events by 250%, about 80% of our type two diabetes, 20+% of our cancers, and at least 1/2 of our dementia population. If we coupled a national BMI under 25 with 30 minutes of daily vigorous physical activity we could Make vast progress towards a less expensive health care system. But the last time we had a President who gave a damn about America's health was in the 1960s under JFK.
I completely agree with your transparency point. The bigger issue in the industry is that it is nearly impossible to shop - and most of the mega players who pay the bills don't shop and don't want to do so, either. Its an asymmetric system where all those players - pharmas, hospitals, medical groups, insurers and government - have an interest in increasing charges, while the only players who really benefits from lower costs (patients and taxpayers) have no way to discern cost before the service is provided, no influence on charges, and if well-'insured' the cost doesn't directly matter as they get little or nothing for finding a better deal.
I would add one suggestion to your proposal: One Price for All. I believe a provider should be able to charge what it wants - you want to be a low cost/basic service or high cost/high service provider? Sure, why not? But you have to charge everyone you serve the same price. Hospital and network pricing rely on an opaque concept called a 'charge master' - and there are overpaid consultants who make big bucks 'negotiating' so-called discounts that have little bearing on the cost of service. The result is that it's not just (as you point out) that costs vary across providers, but costs also vary wildly within individual providers. Everyone pays a different price - and you can't easily find out what it is until AFTER the service is provided. And the rub is that the person who pays the most is undeer/uninsured, cash payer. And they are the most likely people to face medical-induced poverty as they don't have a charge master and a million dollar a year consultant.
The whole medical payment system is immoral and unjust for individual doctors (who are being driven out of private practice) and patients (who aren't in a position to haggle when they need urgent care). A moral system would advocate for docs and consumers - but they have no influence.
Thanks for sharing your experience and ideas. I don't expect action yet - but eventually the whole system will fail on the current path. It's just insane and bureaucratic.
Hi Buzz. Hope you are coping well with your treatments and that your prospects are looking well for a complete recovery. Cost of health care is a huge problem, but I also see problems conflating the terms, health care, health insurance and health. Sometimes having health insurance leads to better health care and thus better health, but not always. And as with most things in life, if individuals took more responsibility for their own health and lifestyle choices, their health would be better. Also the insane overprescribing of pharmaceuticals, many that now require other drugs to counteract side effects of original drugs is a huge driver of cost. Seems like there is a direct correlation, if not causation, between when pharmaceutical advertising started and the explosion in the cost of healthcare.
Price transparency is fine but no one shops the heart attack treatment. I’d like to see clarity on where all the money in the system is going.
As to a solve it’s fascinating that you are staring at the data on single payer efficiency (half the price and more effective in terms of outcomes) compared to the US model and can’t bring yourself to endorse one or more of these models.
I work as a doctor in an advanced country with absolute price transparency. The only major flaw would be with insurance. Here it a hybrid pay for service/insurance model, so people are very aware of costs, but in the US if your costs are covered by insurance, who needs to shop around? If BC/BS pays, why should you choose the cheaper doctor an extra 30 minutes drive away over the shiny hospital close to you?
There is no practical way for the US to get away from the current system unless it moves more towards universal government controlled health care. I like this better, but it was built from the ground up.
Buzz: this piece comes at an interesting time for my household. We have a growing list of health items we should see specialists about sometime in the next year: a couple questionable moles, arthritic knee, strained forearm, persistent neck pain, etc. We held off the final several months of 2022 because there was no way we could meet our deductibles by year-end, and nearly everything else would've incurred significant out-of-pocket expenses due to those high deductibles, low co-pays, and high cost of care in our northeast US metro area. We're now in 2023, and have made several forays into finding specialists in our region, and really struggled to find doctors that seemed competent, trustworthy, would take our insurance, and are accepting new clients.
We've given up our search for now. I guess we're waiting until we get a second boost of motivation to climb the vertical treadmill, or until one of our health issues gets bad enough that we can't wait anymore. We've paid thousands upon thousands in premiums over the past couple years, have used almost none of our benefits, and it simply feels defeating to know that seeing a dermatologist, for example, to remove a few moles, is likely to cost nearly $1000. I know that may sound absurd, but my brother is in a very similar position to me and went to a dermatologist for this very reason, received a surprise bill of $200 per frozen mole, and has thus far been unsuccessful in fighting the bill.
If I go to my physical therapist to address my forearm or get my lymphatic massage, I'll be paying $150+ out of pocket every single week until the deductible is met. If my partner sees an orthopedic specialist about his neck, he'll have to pay $450 out of pocket just for the initial consultation. I saw a therapist last fall for two sessions in the wake of a serious depressive episode. I had to stop going because I couldn't justify paying $250 out of pocket for each 50 min session. My partner had a sebaceous cyst become infected, and we had a virtual same-day appt with a nurse, who instructed us to apply a hot compress several times a day. That 10-min visit cost us $150 out of pocket. I went in for a dental cleaning last month and they instructed me to spend almost $900 on a "deep clean", despite having had no issues for years.
I'm personally at the point now of just wanting to say, participation in this whole health care/insurance scheme just isn't worth it anymore. The insurance companies, the employers, the health care providers, they've all figured out how to extract every possible ounce from the system, leaving individuals and families to line up for their milking every time they need even the briefest moment of medical attention.
Pro bono work or taking farm produce for payment requires having a profitable practice as well as a charitable heart.
Caring for poorer patients supported by the government means more administrative hassle and a larger payroll to compensate.
Evaluation and Management payments cannot support a practice adequately.
Rapid adaptation is the private practitioner's only superpower left.
Concierge medicine is for patients with disposable income. It removes good providers from helping the poor.
Hospitals want to control referral patterns and obtain major procedure profits, pushing providers to be employed by hospitals to get a better salary.
Insurance payers are purchasing hospital systems, leading to business-based ethics separating doctors and patients.
Government wants to deal with consolidated hospital systems, since that is where the waste is. Small hospitals and private practices are left to wither and close in that process.
America should not pay more than 25% more than other developed countries for pharmaceuticals.
My recommendation for healthcare is cost effective preventative care and catastrophic coverage (prorated for income/wealth/life risk and where the government can reduce "inefficient" charges to control their expenses) as a right of citizenship to save money and provide security. Also, convert Medicare for all to only cover qualified chronic disease care, also prorated for income and wealth. Patients and businesses (for their employees) can purchase "supplements" if they wish from the same exchange for more coverage.
these type of figures are always misleading. To do a proper comparison, we should first adjust for the differences in rates of obesity, diabetes and other related factors that the US has an over weighted proportion relative to most other western countries. Does the data look the same? I would suggest it is much closer.
In the early 70's, I had received degrees in Electrical Engineering and Math, and was then a grad student in Computer Science. My wife and I had two small children, and so we were on what you might call the "churchmouse" budget. Yet we managed to afford the $20 per visit to take each child to a pediatrician for checkups. We also had Major Medical insurance. It covered only serious accidents and major illnesses, so it was actually dirt cheap.
It is precisely when the Federal Government got into the act, that the costs began to explode.
What really concerns me now, is that the pharmaceutical industry seems to be swallowing the medical profession.
Back in the mid-60s I had my first experience needing to see a GP in the small Maine town were I lived.
I'll call the now long gone physician "Dr. Smith" but only because at my advanced age there are black holes in my memory bank.
Short story long, Buzz, I asked my neighbor on the other side of the valley how much Dr. Smith charged.
She literally gave me a few dozen fresh eggs and a large bag of produce in case I was low on cash.
Everyone in Winterport, Maine knew I was just starting out as a writer of obituaries for the local newspaper.
I had a painful sinus infection that laughed at aspirin.
Dr. Smith turned out to be a fellow in his mid-50s, and told me my neighbor had called him to explain my lack of ready cash. I went out to my ancient jalopy and returned with the eggs and produce.
He chuckled, and I winced.
A dose of warm salt water in each nostril followed by a lot of nose blowing brought me some relief.
Doc Smith thanked me for the eggs and produce, and advised me to start learning how to become a newspaper reporter so I could one year soon give him cash.
He became my family doctor from that day forward until his passing several decades later.
His passing was mourned by the entire town.
My last position at the newspaper was as the business and technology editor, where I soon understood most of the people I interviewed made far more money than I found in my weekly pay envelope.
I left the newspaper in 1979 to start several companies that created software for the then new type of computer we called micro computers, and are now called cell phones.
As a long retired entrepreneur, I wish you well in trying to solve the problem of what I can only describe as a disaster for our citizens who are at the lowest levels of wealth.
Seems as though your recovery is going well, if only because you are now returning to writing essays that expose your inner gad fly 😏
Look forward to parts 2 and 3.
Having no prices, allows for cost shifting.
Most consider insurance to be coverage for 'health' instead of 'a way to pay'.
Thus either pay 4-5x (I've seen bills 200x) based on the infamous 'charge master'
The 'charge master' is a 'private' doc that prices services at 4-5x+ for 'cash'
Logically, if one was paying up front, there would be less paperwork and cost should be less.
Solution: Anti-trust <understand there are exemptions in law as of now>....Just as Microsoft was not allowed to charge IBM more then Dell for the same Software, Hospitals and providers should not be allowed to charge patients more then insurers for the same services.
It is true that Microsoft is able to offer volume discounts....thus a company committing to a larger purchase will get a slightly better price verses purchasing one. These have to be posted and available to all (meaning a group of individuals forming a purchasing entity: committing to the same price level as an insurer.) The price difference is maybe 25% less for the largest companies sliding down to list price for small business or one person. VERY different then 400 to 500% plus if you don't pay the mandatory health insurance kickback.
Having the same (small volume difference allowed) prices would solve so much of the bankruptcy problem. MORE people can pay (with small loans, charity, etc) a $10k charge....they can't pay a $50k to $100k charge.
Easy to implement: ALL prices public. Legal to discuss. People can compare. If charged differently then hospital / Dr. etc. fined. Person doesn't get for 'free' <avoid lawsuit BS: not about enriching individuals>, the individual does benefit by getting (and pay) the public price. The fine is paid by the hospital and used for general public benefit (e.g. free public services | pay for the service below). The mistake charges are made public (individual privacy) and the CEO of the hospitals or CFO is held responsible and also fined.
Since prices are 'public', the cost doesn't have to be hiring a lawyer. There can be a central neutral group created to review (at no cost to individual or a small cost (refunded if the person was charged incorrectly. This process Incentivizes people to only submit if incorrect))
The 'charge master' allows hospitals etc. to claim tons of 'charity care' and deductions all based on rates that insured are not charged.
This is by design by Big Pharma and the Medical establishment. Have the government pay for as many as possible (insurance), have the person never question the costs (insurance pays), never consider alternatives (sorry: I have 'insurance' and alternatives are not covered...I'd have to pay out of pocket!) Rockerfeller medicine at its finest (sarcasm)
I suspect that many of us who have practiced for 20 or more years have similar thoughts on the changes in clinical medicine and concerns about the direction. I look forward to reading your parts 2 and 3.
I believe that pricing transparency is a great start as well. Anecdotally, I was raised on a farm and participated in many sports, and recall having made 0 trips to the Emergency Room for myself or my siblings. I doubt that was because we were lucky! My parents would take us to regular Dr. visits as well as acute care needed in between. My mother still likes to brag that she raised 6 children with 0 broken bones !! My point being, we weren't rushed to the ER for every (or any) sniffle or fever we contracted. My parents were very aware that even with insurance, those bills were expensive. My parents and grands would administer the care needed, if more than their expertise, then a Dr appointment was made. It seems as though people are using hospitals and ERs as a Dr. If they actually knew the cost upfront, maybe they would wait a few hours and see a physician during office hours.
Imagine if you went to a grocery store where your insurance pays for two carts filled with groceries, each week. But, which items cost what and how do you make good choices? And, what do you do if you need an extra cart?
That’s our healthcare system in a nutshell. It’s infantile. Even worse, it’s profit first.
We need more and more heath-care because of what we eat. Fix our food supply and health-care costs will eventually decline. Obesity, cardiac disease, diabetes continue, metabolic syndrome continue an uncontrolled climb because 75% of our food is highly processed and ladened with fructose sugar. We can’t fix health-care without fixing oiur food. The government is complicit. Big Food and Big Pharma run the show.
We need more and more heath-care because of what we eat. Fix our food supply and health-care costs will eventually decline. Obesity, cardiac disease, diabetes continue, metabolic syndrome continue an uncontrolled climb because 75% of our food is highly processed and ladened with fructose sugar. We can’t fix health-care without fixing oiur food. The government is complicit. Big Food and Big Pharma run the show.
I am a 75 year old MD who dropped out of the insurance based practice model in 1998 and decided to only treat people who value their physician as much as they do their plumber or electrician. no amount of money is going to compensate for America's Obesity and sedentary lifestyles. We are the fastest county on earth with a population over 2,000,000. (Tonga and several small pacific Islands are fatter) Obesity increases the risk of Cardiac events by 250%, about 80% of our type two diabetes, 20+% of our cancers, and at least 1/2 of our dementia population. If we coupled a national BMI under 25 with 30 minutes of daily vigorous physical activity we could Make vast progress towards a less expensive health care system. But the last time we had a President who gave a damn about America's health was in the 1960s under JFK.
I completely agree with your transparency point. The bigger issue in the industry is that it is nearly impossible to shop - and most of the mega players who pay the bills don't shop and don't want to do so, either. Its an asymmetric system where all those players - pharmas, hospitals, medical groups, insurers and government - have an interest in increasing charges, while the only players who really benefits from lower costs (patients and taxpayers) have no way to discern cost before the service is provided, no influence on charges, and if well-'insured' the cost doesn't directly matter as they get little or nothing for finding a better deal.
I would add one suggestion to your proposal: One Price for All. I believe a provider should be able to charge what it wants - you want to be a low cost/basic service or high cost/high service provider? Sure, why not? But you have to charge everyone you serve the same price. Hospital and network pricing rely on an opaque concept called a 'charge master' - and there are overpaid consultants who make big bucks 'negotiating' so-called discounts that have little bearing on the cost of service. The result is that it's not just (as you point out) that costs vary across providers, but costs also vary wildly within individual providers. Everyone pays a different price - and you can't easily find out what it is until AFTER the service is provided. And the rub is that the person who pays the most is undeer/uninsured, cash payer. And they are the most likely people to face medical-induced poverty as they don't have a charge master and a million dollar a year consultant.
The whole medical payment system is immoral and unjust for individual doctors (who are being driven out of private practice) and patients (who aren't in a position to haggle when they need urgent care). A moral system would advocate for docs and consumers - but they have no influence.
Thanks for sharing your experience and ideas. I don't expect action yet - but eventually the whole system will fail on the current path. It's just insane and bureaucratic.
Hi Buzz. Hope you are coping well with your treatments and that your prospects are looking well for a complete recovery. Cost of health care is a huge problem, but I also see problems conflating the terms, health care, health insurance and health. Sometimes having health insurance leads to better health care and thus better health, but not always. And as with most things in life, if individuals took more responsibility for their own health and lifestyle choices, their health would be better. Also the insane overprescribing of pharmaceuticals, many that now require other drugs to counteract side effects of original drugs is a huge driver of cost. Seems like there is a direct correlation, if not causation, between when pharmaceutical advertising started and the explosion in the cost of healthcare.
Price transparency is fine but no one shops the heart attack treatment. I’d like to see clarity on where all the money in the system is going.
As to a solve it’s fascinating that you are staring at the data on single payer efficiency (half the price and more effective in terms of outcomes) compared to the US model and can’t bring yourself to endorse one or more of these models.
I work as a doctor in an advanced country with absolute price transparency. The only major flaw would be with insurance. Here it a hybrid pay for service/insurance model, so people are very aware of costs, but in the US if your costs are covered by insurance, who needs to shop around? If BC/BS pays, why should you choose the cheaper doctor an extra 30 minutes drive away over the shiny hospital close to you?
There is no practical way for the US to get away from the current system unless it moves more towards universal government controlled health care. I like this better, but it was built from the ground up.
Buzz: this piece comes at an interesting time for my household. We have a growing list of health items we should see specialists about sometime in the next year: a couple questionable moles, arthritic knee, strained forearm, persistent neck pain, etc. We held off the final several months of 2022 because there was no way we could meet our deductibles by year-end, and nearly everything else would've incurred significant out-of-pocket expenses due to those high deductibles, low co-pays, and high cost of care in our northeast US metro area. We're now in 2023, and have made several forays into finding specialists in our region, and really struggled to find doctors that seemed competent, trustworthy, would take our insurance, and are accepting new clients.
We've given up our search for now. I guess we're waiting until we get a second boost of motivation to climb the vertical treadmill, or until one of our health issues gets bad enough that we can't wait anymore. We've paid thousands upon thousands in premiums over the past couple years, have used almost none of our benefits, and it simply feels defeating to know that seeing a dermatologist, for example, to remove a few moles, is likely to cost nearly $1000. I know that may sound absurd, but my brother is in a very similar position to me and went to a dermatologist for this very reason, received a surprise bill of $200 per frozen mole, and has thus far been unsuccessful in fighting the bill.
If I go to my physical therapist to address my forearm or get my lymphatic massage, I'll be paying $150+ out of pocket every single week until the deductible is met. If my partner sees an orthopedic specialist about his neck, he'll have to pay $450 out of pocket just for the initial consultation. I saw a therapist last fall for two sessions in the wake of a serious depressive episode. I had to stop going because I couldn't justify paying $250 out of pocket for each 50 min session. My partner had a sebaceous cyst become infected, and we had a virtual same-day appt with a nurse, who instructed us to apply a hot compress several times a day. That 10-min visit cost us $150 out of pocket. I went in for a dental cleaning last month and they instructed me to spend almost $900 on a "deep clean", despite having had no issues for years.
I'm personally at the point now of just wanting to say, participation in this whole health care/insurance scheme just isn't worth it anymore. The insurance companies, the employers, the health care providers, they've all figured out how to extract every possible ounce from the system, leaving individuals and families to line up for their milking every time they need even the briefest moment of medical attention.
Some of my thoughts from 35 years of practice:
Pro bono work or taking farm produce for payment requires having a profitable practice as well as a charitable heart.
Caring for poorer patients supported by the government means more administrative hassle and a larger payroll to compensate.
Evaluation and Management payments cannot support a practice adequately.
Rapid adaptation is the private practitioner's only superpower left.
Concierge medicine is for patients with disposable income. It removes good providers from helping the poor.
Hospitals want to control referral patterns and obtain major procedure profits, pushing providers to be employed by hospitals to get a better salary.
Insurance payers are purchasing hospital systems, leading to business-based ethics separating doctors and patients.
Government wants to deal with consolidated hospital systems, since that is where the waste is. Small hospitals and private practices are left to wither and close in that process.
America should not pay more than 25% more than other developed countries for pharmaceuticals.
My recommendation for healthcare is cost effective preventative care and catastrophic coverage (prorated for income/wealth/life risk and where the government can reduce "inefficient" charges to control their expenses) as a right of citizenship to save money and provide security. Also, convert Medicare for all to only cover qualified chronic disease care, also prorated for income and wealth. Patients and businesses (for their employees) can purchase "supplements" if they wish from the same exchange for more coverage.
these type of figures are always misleading. To do a proper comparison, we should first adjust for the differences in rates of obesity, diabetes and other related factors that the US has an over weighted proportion relative to most other western countries. Does the data look the same? I would suggest it is much closer.
In the early 70's, I had received degrees in Electrical Engineering and Math, and was then a grad student in Computer Science. My wife and I had two small children, and so we were on what you might call the "churchmouse" budget. Yet we managed to afford the $20 per visit to take each child to a pediatrician for checkups. We also had Major Medical insurance. It covered only serious accidents and major illnesses, so it was actually dirt cheap.
It is precisely when the Federal Government got into the act, that the costs began to explode.
What really concerns me now, is that the pharmaceutical industry seems to be swallowing the medical profession.