“ … the individual’s self-assessed state of health … is always the most significant of all of the explanatory variables [associated with individual self-assessed well-being] …” Helliwell, 2001

Health care goods and services are not GOODS, but BADS, or Regrettables. In and of themselves they lower, rather than raising, the user’s well-being. It is their effect on health that is valued. Ineffective or harmful care reduces well-being.

Total expenditure on health care is necessarily identically equal to total incomes earned from its provision

WHO PAYS? WHO GETS? WHO GETS PAID?

“Costs will increase to the level of available funds “Costs will increase to the level of available funds . . . that level must be limited to keep costs down.” Aaron Wildavsky’s (1977) Law of Medical Money

After controlling for demographic and clinical differences, length of stay in Canada was 16.8% longer than in the United States; there was no difference in in-hospital mortality; and the cost in the United States was 82.5% higher than in Canada. Eisenberg et al., Ann. Int. Med. 2005

Figure 3. Per Capita Utilization of Hospital and Physician Services During Follow-up by Study Cohorts .77, (1.57-1.99)* AMI Cohort 1.59, (1.45-1.74)* Colorectal Cancer Cohort 1.69, (1.59-1.79)* Hip Fracture Cohort 1.52, (1.41-1.64)* MCBS Cohort The graph presents unadjusted spending on hospital and physician services for each cohort in each quintile of the End-of-Life Expenditure Index. The data shown for the AMI, colorectal, and hip fracture cohorts exclude the first six months of follow-up.   * Relative rate of utilization in Quintile 5 compared to Quintile 1, adjusting for baseline differences in patient characteristics.

for the MCBS Cohort Across Quintiles of Medicare Spending. Figure 4. Average Annual Per Capita Utilization of Physician Services, 1991-1996, for the MCBS Cohort Across Quintiles of Medicare Spending. Level of Spending from Quintile 5 to Quintile 1 in Each Category*:   1.72 1.78 1.65 1.45 1.05

Inreased Risk of Figure 1. Relative Risk of Death during Follow-Up across Quintiles of Medicare Spending.

“Confidential budget documents from the leading pharmaceutical trade group show that it will spend millions of dollars lobbying Congress and state legislatures, fighting price controls around the world, subsidizing "like-minded organizations" and paying economists to produce op-ed articles and monographs in response to critics.” Robert Pear, NYT

The drug trade group plans to spend $1 million for an "intellectual echo chamber of economists — a standing network of economists and thought leaders to speak against federal price control regulations through articles and testimony, and to serve as a rapid response team." Pear, NYT

“At CMA, defending and promoting the interests of Canada’s doctors is central to our mission. Advancing the medical community’s financial interests is an important element of that commitment.” -- Victor Dirnfeld, former president, CMA