A Comparison of U.S. Health Care Spending with Other OECD Countries

The Organisation for Economic and Co-operation and Development (OECD) released the “OECD Health Data 2009” report which compares the health care statistics across OECD countries.

Some of the key points from this study comparing the U.S. health care system with other countries are listed below:

  • In 2007, the total spending for health care accounted for 16% of the country’s GDP, the highest share among the OECD and almost double the OECD average
  • On a per capita basis also the U.S. spent the highest with a total of $7,290 which is two-and-half times the OECD average
  • The public share of health care expenditure in the USA (45%) is less than any other OECD country
  • Despite spending the most, the U.S. provides health care coverage for only the elderly, disabled and some of the poor people
  • In comparison, the same amount is enough to provide universal health care insurance by the government for all citizens in other OECD countries
  • 35% of total health care expenditures is done by private health insurance which is the highest In OCED
  • Despite the high medical expenditure,there are fewer doctors per capita in the U.S. than most other OECD countries
  • Life expectancy in the U.S. is lower when compared with Japan,Switzerland, Canada and Australia
  • Infant morality rates  in the U.S. is higher than most OECD countries. In 2006, it was 6.7 per live births relative to OECD average of 4.7
  • The proportion of daily smokers has fallen the most (> 50%) between 1980 and 2007 in the U.S. due to public awareness and high taxation
  • Obesity rate among adults is the highest in the U.S. in the OECD countries at 34.3% in 2006. Higher obesity rates leads to higher health care spending in the future

Charts:
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US-OECD-Healthcare

US-OECD-Healthcare-Spending

The above data lead me to do some research on the health care system. In 2007, we spent an astonishing $2.2 Trillion on health care expenses. The government social programs Medicare and Medicaid spending grew by 7.2% and 6.4% in 2007. On a long-term basis I observed that the price food has fallen continuously over the years but the cost of health care has gone up in the opposite direction.

One benefit of spending so much on health care is that it provides stable and well-paid employment opportunities for many people in that sector. In fact, it is one of the safest sector to be employed in now.

One reason for the fewer number of doctors per capita in the U.S. is  the total number of medical schools in the U.S.  is low.There are only 131 accredited M.D.-granting medical schools in the country. The total number of graduates coming out of these schools per year seem to be low as well. For example, last year just 16,167  students graduated to be physicians.

In his speech to the American Medical Association last month, even our President Obama highlighted the problems in the health care system. Some of the points mentioned by him match with the OECD’s findings as noted above. President Obama said:

“Today, we are spending over $2 trillion a year on health care — almost 50 percent more per person than the next most costly nation. And yet, as I think many of you are aware, for all of this spending, more of our citizens are uninsured, the quality of our care is often lower, and we aren’t any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do.

Make no mistake: The cost of our health care is a threat to our economy. It’s an escalating burden on our families and businesses. It’s a ticking time bomb for the federal budget. And it is unsustainable for the United States of America. ”

The current administration is planning to dramatically change the health care system in this country. The official site of the U.S. government healthreform.gov states:

“The President’s 2010 Budget lays the groundwork for reform of the American health care system, most notably by setting aside a deficit-neutral reserve fund of $635 billion over 10 years to help finance reform of our health care system to bring down costs, expand coverage, and improve quality.”

It remains to be seen if the reforms proposed will lead to reduced costs and improved efficiency in the system.  A few other interesting stats from the site include:

  • Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages.
  • In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job.
  • Americans pay more than ever for health insurance, but get less coverage.

Some of the other causes of issues  for the inefficient health care system are: malpractice suits, bureaucracy, monopoly pricing power of drug companies, lack of transparency of prices for various items such as medical procedures, surgeries, etc. preventing comparison shopping by patients, greedy doctors,  paperwork hell,  defensive treatments performed by doctors, inadequate medical facilities, growing number of retiring baby-boomers, increasing population, seeking medical care for unnecessary situations,etc. What are your thoughts on this issue?. Please feel free to share it in the comments section.

What happens when Capital Flows to Emerging Markets Stop Suddenly?

One of the biggest risks of investing in emerging markets is that capital inflows from advanced countries can stop suddenly. This can be due to many reasons such as political problems, higher possibility of higher return in advanced countries, over-heating of the emerging market economies, etc. When capital inflows into emerging markets stop suddenly the real economy of those countries will be affected severely for many years to come.

The following historical charts from a study by authors at IMF shows that once capital inflows stop, real growth trajectory of emerging markets is negatively impacted and it takes many years to recover and follow the normal growth that existed before the crisis.Source: The Transmission of Financial Stress from Advanced to Emerging Economies, IMF Working Paper

Related ETF: iShares MSCI Emerging Markets Index (EEM)

A Look at US Trade with China

The latest trade data shows that US exports to fell slightly in April over March. However imports were up.Imports have picked up since reaching lows in February. The trade deficit with China continues to be still high since the US imports more than four times what it exports to China. US exports to China is down 15.6% year-over-year thru April this year.Though China’s imports are up thru May, it has not turned into higher export opportunities for US companies.

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US Trade with China

Data Source: Census.gov

From a historical perspective, both imports from China and exports to China from have to rise in sync with each other. If the US exports continues to be flat-to-down and imports from China improves then the trade deficit will grow more and it will also imply that the Chinese are importing goods from other countries or sourcing goods from domestic producers. Given the current state of the US economy and the 9.5% official unemployment rate reached today, the US will import less from China.This may lead to further social unrest in China unless China is able to stimulate domestic consumption.

The World’s Most Profitable Banks in 2008

The following are the 25 most profitable banks in the world based on their 2008 earnings as per The Banker magazine:

[TABLE=167]

Not surprisingly Chinese banks dominates this list with a total of five and three among the top five ranks. ICBC of China ranks the most profitable in the world with a profit of $21.2B. Banco Santander (STD) of Spain came at third with a profit of $15.8B. Among the British banks , Barclays (BCS) and HSBC (HBC) are in this list because they are relatively in better shape than their peers like Llyods (LYG), Royal Bank of Scotland(RBS), etc. Royal Bank of Canada(RY) ranked number ten. Royal Bank is the most profitable of all large Canadian banks and is a long-term consistent performer. Banco Bradesco of Brazil (BBD) made it to this list at number two beating competitor Banco Itau Unibanco (ITUB).Among the big four Australian banks Westpac (WBK) and Commonwealth Bank Group are on this list.Bank of America Corp (BAC) and US Bank (USB) are the only two US banks in the rankings but came in at the bottom of the list mirroring the performance of the housing markets and the U.S. economy in general.

Deleveraging by American Consumers Continues

Consumers in the U.S. started fixing their finances last year. This process has gained momentum in the last quarter and this week we learned that the savings rate reached a high of 6.9%. Americans have been reducing their debt and spending less during the past few quarters.

Household-Debt-Laibilities

Household liabilities fell to 131.1 % of disposable income (after-tax income) in the last quarter from a peak of 141.0% in 2007.At the end of 2008, the number stood at 133.9%. In the first quarter consumers paid down debt and did not add new debt to their finances. From the above chart, we can see that liabilities grew form about 87% of after-tax income in 1990 to an all-time high in 2007 due to the availability of cheap credit and excessive borrowing. In this decade household debt-to-income ratio rose considerably faster than previous years.For the first time ever, households debt fell for two quarters in a row for 4Q, 2008 and 1Q,2009.

Since the U.S. economy is a consumer-based economy the fall in debt growth has a negative impact on a any recovery.

A historical chart of the household liabilities is shown below.

Household-Debt-Historical

Source: BEA,  Flow of Funds of the United States, Federal Reserve

From the late 80s households continued to accumulate more liabilities up until last year. In Q1,2007  total household liabilities decreased by $255b compared to taking on about $2.8T debt in Q1,2008. Just like the borrowing binge went on for many years, the deleveraging process will continue for a few years.