I remember when I heard about my uncle passing away in America. He had the symptoms this lady had. For some reason he didn't go to the doctor, and it really puzzled me. At the time I'd put it down to inherited stubbornness, because my dad had had the same thing happen as well and would only go to the hospital because I forced him to.
Now I'm wondering whether my uncle was simply scared of the bill. I found out he'd told colleagues he was feeling numb on one side and had blurry vision, yet still didn't go to the hospital.
My uncle died, it was more serious that he thought.
My dad survived and still lives. In Denmark you rarely think about the cost, but rather the queue to see a doctor (if you have something minor, you might wait a long time). The doctors knew what was going on immediately, so it wasn't a long wait.
Is it common for blue collar workers to be without health insurance in the US? I don't want to ask my cousins about it, too painful and it would probably trigger a big rant about healthcare.
Also, if your healthcare is tied to your job, what do you do between jobs? Just be really careful when chopping the onions?
If one is a blue collar worker for a large corp (not a small biz), he/she usually have a health insurance. However, it comes with lots of co payments, out-of-network payments, etc; this can ruin a person financially.
Many employees of small businesses don't have insurance or super crappy insurance with lots of copayments.
How about Uber drivers? They don't have any health insurance.
> Is it common for blue collar workers to be without health insurance in the US?
Yes. More so now than in the 1980's say. Collective bargaining doesn't really work when a company can just move a factory to Mexico.
There's cobra which covers the health insurance gap up to 18 months, but you have to pay the company's rate, not the discounted rate. The downside of it is that it can be rather expensive, and so unemployed people will often forego it.
I think we should have universal healthcare, but I don’t know how I feel about the “medical bankruptcy” angle. It strikes a chord with the middle/upper middle class readers of the Atlantic because those people fear losing their financial status. But to me, protecting the financial status of middle class people seems like a particularly poor justification for universal health care.
Why should the government use tax dollars to keep a middle class person from going bankrupt, instead of giving that money to someone who started at $0 and stayed at $0? You’re a middle class professional and you get unlucky and get cancer, the government will pay hundreds of thousands of dollars for your treatment. But if you’re unlucky in a different way, say you are born in the ghetto to poor parents, the government won’t give you hundreds of thousands of dollars. That seems completely backward.
Say you raise taxes hundreds of billions of dollars. Is protecting middle class people from being wiped out financially if they have a medical catestrophe really the highest and best use of that money? For about $100 billion you could give every child born into poverty an “inheritance” of $100,000. Wouldn’t that be a better use of the money?
Isn't the best idea to make healthcare affordable/free at point of use for everyone (rich or poor) with the rich contributing more (through taxes) to subsidise the poor.
Doctors charge way too much for their services. When's the last time you saw a doctor who was justifiably worried about money? They're all driving around in very nice vehicles, several houses, the best golf clubs you can buy,three months vacation to places most people only dream of. It's the same age old story your loved ones dying and all they care about is getting your last bit of gold for the treatment.
Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0].
In Sweden we pay less per capita than americans do (from taxes) and my total _maximum_ healthcare costs for _all_ treatments, medications, surgury etc, that in the US would be paid by your employer or yourself are:
$125/year max for all visits and procedures [1]
+ $250/year max for all prescribed medications (with up to 75% discounts before reaching those $250)[2].
This makes treating my Crohn's + MEN-1 an issue of going to visits, doing surguries and scans, and picking up my medications at the local pharmacy (I order in their app since my medications are rare) every three months.
If you make American-level software engineer salary in Sweden, your EFFECTIVE (not marginal, effective) tax rate is a freaking 55% - at least that’s the number given to me by a recruiter whi tried to bring me there. Also, you pay 25% VAT. I’m sorry, but that’s a bit outrageous.
As a German software engineer that used to work in the USA, do I pay more taxes in Germany, yes. But, I don't have to worry about going bankrupt from medical issues. In Seattle where I used to live daycare is 30,000$ a year per kid. In Germany it's at most like 200-300 euros a month. Plus you get kindergeld too(200 euros per kid). We don't go into 10s of thousands to hundreds of thousands of dollars in debt for school. Even with my "good" benefits I had at my job in the US, I would never move back.
Most Americans have good healthcare through their employer. The premiums are reasonable, and the quality is great. Only if you're self employed or part time do you pay out of pocket, something you need to factor in when you make life decisions.
I think maybe you mean to qualify that as “most American software engineers?” Or maybe even “most Americans in white collar jobs”, although that’s not a universal, and the premiums and quality of care in many of those plans is absolute crap. Heck, even as a software engineer, my medical insurance is mediocre and a high-deductible plan costs more in premiums ON TOP OF what my employer pays than I’d spend out of pocket in a year without a major medical emergency.
In 2017, 91.2% of people have coverage, 67.2% through their employer. 71% of Americans answered they are satisfied with their employer-provided coverage.
I have “excellent” coverage in the US and am now pregnant with my second baby. My first pregnancy and birth ended up costing thousands of dollars. During pregnancy, I received an endless stream of unpredictable lab test bills (why does this test cost $13 and this one costs $273?). After the birth itself, every provider who saw me in the hospital sent me a separate bill, on top of which I was billed for the room itself and for the individual drugs.
Almost any other system would be better than this. If it were out of pocket there would at least be downward pressure on prices and clearer pricing in the first place. Or we could provide it as a public service like every other developed country.
That survey was for employee provided coverage, so it would be 71% of the 67.2% Americans who get their coverage via employers. I couldn't find satisfaction rates for government provided coverage.
No that means the majority of people with employee provided insurance are happy.
There aren't stats on satisfaction of government provided healthcare, but if they are unsatisfied it furthers my point that the government should stay out of healthcare. And if they are satisfied then there is no problem :)
Uh..no..I'm not sure where you're getting your facts but no this is completely false. Most Americans have either Medicare/Medicaid, or various levels of employer sponsored healthcare, most of which are really poor or push large burdens on their employees. I have fully paid for healthcare through my employer and I STILL have a $5000 max out of pocket that I have to cover before insurance fully covers me. To put that in perspective that's an entire month's income in a country where most people live paycheck to paycheck.
Oh and the cherry on top of that is that in the US you can literally be fired for getting a prolonged medical illness, such as, oh say, cancer, which impacts nearly every single American. It's totally legal, which then takes your wonderful healthcare and removes it right when you need it most and can least afford to lose it. Another fun fact is that it's really hard for most people to work when getting prolonged medical care, which means, again you can't really pay for the bills you are getting.
If you think quality is great, then you're lucky. US hospitals can flat out refuse to treat you properly if you're "lucky" enough to go to a Christian based hospital, which will deny care unless life threatening, in some states this nears the majority of hospitals.
So no, most people who go bankrupt from medical bills in America HAVE health insurance. You're living in a fantasy bubble I suggest you step out of before you get a huge shock. I sincerely hope you never have to experience this first hand because it's absolutely hell for those who have to go through it.
Edit:
I don't mean to suggest US healthcare providers are poor, it's generally the best in the world if you live in the east coast, Texas, or west coast the south and midwest generally have poorer coverage with the exception of cities. We basically have the best healthcare that you can afford, the problem is that most people can't afford it.
Over 71% of people are happy with their employer coverage, as am I. I also chose a high deductible of $5000, but I have a $0 monthly premium. If I chose a $50 premium, I would pay $500 deductible. And that's only for major expenses. Drugs and checkups don't need the deductible. Yes, there's reforms needed, but it's not the apocalyptic picture people paint.
> Over 71% of people are happy with their employer coverage
That statistic is not terribly revealing, as I suspect that the vast majority of those 71% are relatively healthy/young people. I'd like to know the percentage of people who have had significant health events in the past 12 months that are happy with their coverage.
It usually takes a few months for employer coverage to kick in. And most people stay at their jobs for well over a couple of years. I'm sure most of those people have had to use their insurance in their period of time of working at their job. I find it harder to believe the opposite.
> I'm sure most of those people have had to use their insurance in their period of time of working at their job. I find it harder to believe the opposite.
Using your insurance for regular doctor appointments or the occasional flu or bronchitis is quite different from realizing you have a serious chronic condition, or require a major surgery. You don't buy insurance for regular needs, you buy it for the unforeseen serious ones. These are rare, but it's here where the quality of insurance really matters.
Judging the quality of insurance from the standpoint of the "average person" is not the correct perspective. You need to judge it by the person who needs to file serious claims. From this perspective, 70% of "average people" being happy with their insurance seems remarkably low.
Funny you talk about quality insurance, but its employer provided insurance that's higher quality than the government or self paid ones. Because the employer gets a very good bulk deal and pays a high premium, much more than the average person can self-pay. That is why satisfaction is so high for employer provided insurance.
> Funny you talk about quality insurance, but its employer provided insurance that's higher quality than the government or self paid ones.
Government insurance, at least for federal employees, is actually very good, and for the same reasons you stated. There are few with as much bargaining power as governments.
But I don't quite get your point. You said that 70% of people are happy with their insurance. And my point was that doesn't seem very high at all as most people aren't that sick. You can't use a majority's viewpoint to judge the quality of a service that they don't use.
It's true, but it also includes benefits and not only taxes. An American-level software engineering salary in Sweden is also probably twice that of the average software engineer, so you are going to pay a lot more in taxes than the average software engineer. That is because wealth transfers and income equality is Sweden's way to create a nice society. The problem is however that today an average salary, even as a software engineer, doesn't go very far in Sweden. And especially not in the housing market. You need wealth, which isn't taxed much by comparison. So in that sense your outrage is correct.
True, but those taxes pay for things that money can't buy; for example job security, open spaces, parks, social services such as cheap child-care, paternity/maternity leave, etc, etc.
You can't just compare salary. The lifestyle is different. You'll get 4-5 weeks of (paid) holiday, you'll live in a modern country where the taxes are high, but the streets are clean, people are looked after, and you'll have effective health-care.
(Disclaimer: I'm in Finland, not Sweden, but things are similar here.)
There's a reason I was comparing healthcare costs per capita, because then we don't have to argue about things like total tax rate, because it doesn't matter. US taxes wouldn't need to increase.
As far equitable goes, Swedish elites are probably as dodgy as any other country's. For example, the IKEA is famously set up as a maze of international companies and non-profits (IIRC) to pay minimal taxes. Also, Nordea (largest bank by far in the Scandinavian region) was recently involved in money laundering and organized crime.
As for comfortable, stress free living, here's a fun fact about Sweden - the average length of a mortgage is over 100 years.
Absolutely, public spending on healthcare in USA is enormous. Higher than military budget. USA is unfortunately country where enormous amounts of people are sick. Mostly side effects of obesityand lack of physical activity.
All of this is a side-effect of the uniquely American philosophy that says that if someone is making money they must be making a net positive contribution to society, because otherwise why would anyone buy their product? This approach overlooks externalities and rent-seeking. The net result is that we have a lot of people making money selling things to people that they want but makes them sick (soda, cigarettes, corn chips) and a lot of other people making money professing to make them less sick, and yet another group of people making money by professing to control the costs of the second group, and lot of other people making money lobbying politicians to keep the laws in place that maintains the status quo. So everyone's making money (except for the slackers who dare to get sick), so everything must be hunky dory. The American health care system is the broken-window theory writ large.
While I do not disagree with you altogether, I have a hard time believing it would be possible to come up with some sort system that is inclusive of these externalities. Look at what a crapshow nutrition science is - do we really want government encouraging/discouraging foods more so than it already is? Look at how bad farm subsidies have affected our health in general.
That's the government's spending on healthcare insurance. Which furthers my point, those insurance companies are paying the cost of development that gets tacked on to drug prices and other healthcare services.
I think most medical professionals may agree with this: the U.S. healthcare system is built on rewarding volume and doing more things. It's an especially attractive field for clinicians who specialize because they have to do special things - with highly regulated barriers to entry.
And while there has been recognition by experts in recent years to push for quality and efficiency (since doing more procedures, especially those unnecessary, raises the risk of harm), the system has been slow to both incentivize this and lower the overall costs.
With healthcare you either have a true free market, as in no licenses, no patents, etc or you need the State to regulate it and provide it for everybody.
The US has the worst possible combination.
A “true free market” doesn’t have no patents any more than it has no rights in land. Patents prevent what would othwrwise be a market failure (free riding) just as property rights in land prevent tragedy of the commons. Put differently, you can’t have markets where you can just take things instead of entering into transactions. Because you can do that in the state of nature, markets are inherently artificial constructs.
America's healthcare system is what furthers the world's healthcare through research and development. Because it is for profit, the quality and advances are superior. Other countries that reap the benefits of drugs that America create while only paying generic prices when Americans have to pay for the inflated prices that pay for those expensive drug trials.
but of course that doesn't mean Sweden pays more from those taxes on Healthcare than the US.
Looking at the "Government and compulsory" figures here https://data.oecd.org/healthres/health-spending.htm the US appears to be at $8407 per person for gov. + compulsory spending and Swedent is at $4606.
Healthcare gets funded in each country by a combination of taxes and people paying out of pocket. In the U.S. employer subsidized health care insurance should be viewed as part of an employee’s compensation. What matters in such discussions is not the tax rate but the overall spending per capita and how much it costs at point of contact. The relevant facts are that the U.S. spends far more per capita and costs far more at point of contact than every other OECD country.
I think the person you responded to was attempting to point out that Sweden’s healthcare costs come mostly from taxes and is cheap at point of contact. I don’t believe they meant to give the impression that taxes in the U.S. are higher than in Sweden.
>>Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0].
Americans don't actually have an objection to paying more for healthcare.
What they do have an objection to is paying for other people's healthcare.
America is a deeply individualistic society, and the idea of one's tax dollars being spent to benefit others lies at the root of most people's objections to single-payer, or anything else that smells like "socialism".
Ironically, I support single payer healthcare (or at least a dramatic restructuring that decouples pricing from employment) specifically because of individualism.
Right now, you need to work at a corporation to get collective bargaining for healthcare prices. This presents a huge disadvantage to people wanting to be contractors, self-employed artists, people wanting to start small businesses, people who only want to work every other year for whatever reason, etc.
Your options are limited because you need to be part of a corporate collective to get reasonable healthcare options.
I support a variant of single payer healthcare too: you pay for your own healthcare out of pocket. All this requires is that wages be high enough and health care costs be controlled. If this sounds impossible, you should consider that it was how our system worked in the USA in living memory.
As currently implemented? Absolutely, it observably isn't. Why do we need middlemen preying on fear, confusion, and preventing any reasonable price discovery from occurring while driving an absolutely absurd inflation rate[1]. Please note those are monthly, not annual numbers, and some months alone hit 5%! Keeping costs down and wages up has plenty of other positive effects too.
It's interesting you say that, I've heard that line of argument before but it is quite puzzling.
Are you suggesting that a person on Low income in the US doesn't object to paying more than they have for their own healthcare (i.e. that they wouldn't like that healthcare to be cheaper)
That seems a bit counter-intuitive, as usually people don't like being bankrupt.
I can understand (although not agree with) the idea that rich people don't want to subsidise poor people's healthcare, but the argument I was responding to appeared to say that Americans don't mind paying more for their healthcare, which puzzles me.
I'd have thought that lower income Americans would be pretty happy to have a source of cheaper healthcare, even if it wasn't quite as effective as the expensive stuff.
And you do have a system where you pay more than anyone else for the pleasure of poor people dying. Harshly worded but that is already solved, and somehow I don't see people being happy with it.
I think it's pretty clear that taxes per capita to healthcare being third highest in the world isn't common knowledge.
All this leads to is less people going in for annual checkups and preventative health care which leads to people becoming catastrophically sick ($40k medical bills) vs. preventing that situation from happening at all if it can be prevented; or catching it early on so it can be mitigated.
It's been a long time since I've worked in retail where I had no employee provided healthcare but back then I'd only go to the doctor if my arm was falling off. Everything else was "this feels weird, I'll wait it out, hopefully it goes away because I don't have $150-200 for a checkup if it turns out to be nothing."
A simple example is dental care. Yearly checkups, cleanings, etc and actively working to prevent major issues leads to far less diseases (blood, etc). But when you don't have decent insurance knowing that you might go in and get told you've got a $400 cavity or need a $1500 root canal out of pocket dissuades a lot of people from even going in. Thankfully I have generally healthy teeth but I hadn't gone to a dentist since my teens (parents insurance) until a few years ago. And once you tell someone that you might be shocked by the number of people who come out of the woodwork to tell you they haven't gone either.
I generally thought I was incredibly healthy and invincible until 28 when out of the blue I got appendicitis, which was $35k. I still had my "only go if my arms falling off" mentality back then but eventually the pain was so unbearable that I drove myself to the ER as I knew something serious was going on. Thankfully I had insurance. That really taught me that there's a lot of things in my body that I have no control over regardless of how healthy and active I am and having a fall back plan to help when catastrophe happens is critical.
Oh believe me, I sat in my car outside for an hour before I even forced myself to go into the ER. I was afraid of doctors, hadn't been in years, and my first foray since then would be taking myself to the ER. I was terrified.
And.. it wasn't bad at all. I'd never had surgery. They knocked me out and I woke up and didn't even know it was over with until I checked my stomach for the scar.
I agree. Unfortunately, Americans are not all multi millionaires or billionaires and almost all Americans are too stupid to realize that they won't be able to afford their own healthcare without a "socialized" government run system. Such stupidity is a hallmark trait of such an individualistic, selfish society in which people cannot think of others or or collective action. Other traits are high levels of depression, anxiety, and drug abuse due to isolation and the complete lack of community. But hey, at least you can watch your neighbor die slowly of cancer he can't afford to get treatment for from afar. That seems to be something Americans enjoy.
I don't think that "individualistic" is a strong enough word. European society, for instance, is also very individualistic, yet doesn't have anywhere near the levels of indoctrination against "socialism".
It seems Americans (generalizing here) have been let to believe that someones gain can only happen at someone else's loss, thinking there can't be a win-win situation.
- 65% of Americans don't save, despite most having the ability to do so. 1 in 3 have less than $5,000 saved for retirement! It's a massive cultural problem. [1]
- Most Americans live unhealthy lifestyles that contribute to $1.5 trillion in estimated healthcare costs from preventable disease. 1 in 3 Americans have pre-diabetes and 2 in 3 Americans are overweight. 1 in 3 Americans are obese. Again, a cultural problem. [2]
Our culture is toxic and unsustainable. Government can't fix this. It's a generational problem that's been growing with each generation.
2nd reply, for some reason HN refuses to accept my edit of the 1st one where I appended this, although it still lets me open the "Edit" option even when I reload.
As for your second point, I have a similar argument to make as in my first reply about your fist point about "saving". Unless you think that suddenly, within the last fifty years somehow humans especially in the US were born radically different than any human or pre-human generation in the million years before them, it's kind of strange to blame it on the individuals. I would say humans have stayed pretty much the same. So if the outcome suddenly is bad, why do look for the reasons in the individuals who did not change? There must be something outside people that changed, and I would say that is where one should look for a solution. Not in changing the people ("You buy wrong! You eat wrong!"), which won't work.
You have touched on what i think is the critical underlying difference between Left and Right thinking.
Systemic responsibility vs personal responsibility.
The thing is, they are not mutually exclusive. They are more like two sides of the same coin. And while those two sides may not be exactly equal, most arguments between the sides seem to centre on the disjunct between these two ways of thinking.
If you can acknowledge, but frame the very real issue of personal responsibility within the context of a system, we may find it easier to bridge this divide.
For example, judge the responsibility of three hypothetical people with a sweet tooth.
1. Tries to eat healthy, but goes out to buy a cake every day.
2. Tries to eat healthy, but friend brings around cake every day to tempt.
3. Tries to eat healthy, but friend brings around cake everyday, and empties pantry of all other healthy food.
Most people will waver on 2. or 3. But depending on where you live, 3. may well be the closest to reality.
That is not a difference of politics but of what you are looking at. If the subject is public health policy you look at statistics and the big picture. If you look at one particular patient you don't. Same here: If the subject is the fate of one person and one person only (meaning that person isn't a "Fake" stand-in example and the subject really is the big picture) then you can and should talk about that person's behavior. If the subject is the big picture that's useless because you can't change people and you should make policies that work and don't demand a huge genetic change. Same in crime: Individuals are and should be held accountable, but public policy should not and does not rely on people to change but sets the framework.
So, no contradiction necessary. The exact same person can have both views - depending on what the subject is. However, lots of discussions and comments focus on individuals (even if no concrete one is chosen) when the subject is the big picture.
I think so-called conservatives and progressives would find that they are not actually all that far apart at all if they really looked at individual cases. It must be true individual cases - people tend to extrapolate and still think about the population (coming up with things like "slippery slope" arguments, or giving small criminals huge sentences to "send a signal").
On the level of the economy there is no "saving" (ignoring small things like leaving resources under ground for later instead of digging them up now). What is produced now is consumed now, especially services. Governments may keep strategic reserves e.g. of oil or some basic foods but that's outside the economy, that's (obviously) not added to by "saving for retirement" and all the other kinds of "saving" that individuals are encouraged to do.
Just think about it for a moment, what it actually means when people "save". The future economy certainly doesn't need that money, it's used in the current economy and not buried underground. Not to mention that money, being completely virtual (which is a good thing IMO), never is a problem - unless the government (or the world) messes up big time (like in the 1930s).
Businesses don't need anybody's "savings" either, banks create money (through debt) if a lender, especially a business, has a good plan.
So again, just take a moment to think about what it means when everybody is encouraged to "save". One aspect is - do those with any power (and I don't mean this politically, simply that different people have different roles and positions) really want everybody to save? Because if everybody does it the economy goes down. One person's expenses are another person's income. However, having this "you don't save!" sure is great to have to throw into conversations to show "it's your own fault". Of course, that's not the intention why "you must save" is kept, I don't think anybody (of those who are relevant) consciously thinks like that. Overall though "saving" helped lower the government's role and funnel lots of money streams through a thriving and ever increasing financial industry. If the government actually wanted people to consume less they could have achieved that decades ago.
isn't taxation, in this case, a type of government enforced savings :)
So the gov. could force people to essentially provide for a level of healthcare for everyone.
Also on the Obesity point, if the UK was a US state we would rate somewhere in the middle of the pack on obesity levels.
Yet the UK pays far less per capita on healthcare and provides a basic level of healthcare free at point of use (rich people are free to increase that if they want)
The bulk of research shows the US spends more on healthcare due to higher prices, not more care. Increasing taxes will not solve anything without some sort of strategy to control prices.
One solution is price controls for common, well understood procedures and medications, like most other countries with single-payer. The UK for example, engages in price controls.
I met a guy at university who suffered a car crash and where he wasn't at fault. Guy spent a month in a hospital bed and now has trouble walking. Owes 50k+ in medical bills and doesn't want to declare bankruptcy. He was in CS so he will probably survive but I just feel it's completely unnecessary that he suffer the added stress in life of owing finances for medical treatment. Specifically when he had no control over the accident and is in no way to blame. I left America for Canada because morally the country makes me sick.
Regardless of where you stand on this issue politically, I think what upsets me the most is that we have the means to solve this problem. And hunger. The most basic needs for all humans can be solved: we have enough food to feed everyone. We have enough money and doctors to treat everyone without going destitute.
And it is entirely because the powers that be have rigged the market so that they can charge whatever they want.
How have they accomplished this? First, they set strict quotas on who can be a doctor. Then, they set strict quotas on who can offer what medical goods and products. Then, they strap everyone up with student and business debt.
I'm not saying it is the correct way or not, but there's a reason that in other countries you can buy over the counter things that you can't in the USA.
There is something more direct. When Bush signed the prescription drug add on for Medicare, it was made illegal for Medicare to negotiate rates - even though the VA can.
Not only can they charge what they want, it's also almost impossible to compare prices or find out what something costs in advance. With no competition, medical providers may charge what they wish.
A doctor can charge you $300 for your yearly visit. If you’re healthy he comes in the room for about 5 minutes, asks you a question or two and looks in your ears and says “see you next year”.
They still charge you if you don’t show up and will even asses a fee if you don’t cancel with enough notice.
Every functional society regulates who can be a doctor and who can produce medical goods and services, that really isn’t a problem. It can probably be helpful to try and look for differences between countries as opposed to just going for a libertarian end-run. Problems with the US system are an out-of-control pricing structure due to fragmentation of bargaining power, insane patenting laws which allow evergreening strategies, ideological opposition to functional and prove reforms, and good old fashioned cronyism.
The need to regulate the healthcare space is unavoidable, but simply bending over in the name of a free market that isn’t free is quite avoidable. The nature of for example, pharmaceuticals as a natural monopoly is acknowledged and confronted in those countries which offer OTC or generic options where the US doesn’t. The need for a strong bargaining position to negotiate pricing has been consistently undermined in the US.
> It can probably be helpful to try and look for differences between countries as opposed to just going for a libertarian end-run. Problems with the US system are an out-of-control pricing structure due to fragmentation of bargaining power, insane patenting laws which allow evergreening strategies, ideological opposition to functional and prove reforms, and good old fashioned cronyism.
It’s funny what “differences” people choose to fixate on. For example, patent systems are very similar between the US and Europe. And I doubt you can quantify any difference in “cronyism.” Supply of medical professionals, and doctor salaries, are quite different. So to are limits on what the state will pay for end-of-life and terminal care. (For example, when you see stories about people reaching their lifetime limit on insurance in the US, go check if the UK NHS’s death panels would have allowed anywhere near those expenses under their QALY calculations.)
I’d also love to hear your theory for how pharmaceuticals are a “natural monopoly.” EU countries lower drug prices through good old monopsony (single buyer), which has similar detrimental effects to a monopoly (single seller). They just get away with it because the US continues to resist such efforts.
I accidentally stabbed myself in the finger while cutting open a package using a knife. Stupid, I know.
The would was small, maybe 1 centimeter, but deep enough that it wouldn't stop bleeding on its own. My girlfriend insisted we go to the ER (urgent cares around here are closed on Sundays), so we did.
I was the only one there that day. I was ushered in to see a doctor. The doctor looked at the wound, and said, "this is way too small for stiches, let's just use glue." So the ER nurse handed him a skin glue, and he used it to close the wound. After a few minutes, the wound was closed. I was prescribed antibiotics (kitchen knife, in case it had salmonella etc.) and sent my way.
Three months later, the bill arrived: $2,600.
That isn't a typo. Two thousand six hundred god damn dollars for skin glue on a small cut on the finger.
My insurance successfully negotiated it down, but still, the audacity of charging four figures for five minutes of medical care is just absolutely insane.
We desperately need single-payer healthcare in this country.
I sliced a banana peel of skin off my finger on glass by accident. 3 hours of various stages of waiting rooms after triage and I had been x-rayed and sewn up and sent home.
Cost me $8 in parking a $2 in Tim Hortons coffee.
I felt an immense level of pride in the taxes I pay (43% income tax before deductions) when it clicked that anyone who walked in would have gotten this same service.
I'll be honest, it was actually a hot chocolate and I love their hot chocolate when it's scalding hot. I sip it really slowly in a weird "aeration" move that mixes with air.
It reminds me warmly of 6am hockey practices when I was a kid.
You weren't paying for the glue and the five minutes. You were paying for the overhead of maintaining all the other stuff that was there that you might have needed under different circumstances but happened not to need that day.
While that's true, that's also true for all other countries where hospitals don't bill you $2,600 for glue and five minutes. So now the question merely shifts to why America needs that much money for stocking supplies and keeping doctors sitting at hospital.
Good point. There are three additional items that U.S. hospitals have to pay for that non-US hospitals don't (or that they have to pay a lot more for):
1. Malpractice insurance
2. The overhead incurred by insurance companies and
3. The cost of serving uninsured patients who can't pay out of pocket.
The third one is huge. US emergency rooms by law must treat serious conditions -- but only serious conditions -- whether the patient can pay or not (for some value of "serious" -- I'm not sure of the details, but that don't really matter here). So there's a substantial population that can't get preventive treatment and so have no choice but to let minor conditions go untreated until they become serious (and, of course, much more expensive to deal with).
So currently if you get sick, you "win" the sick lottery and get to pay for other people's illness as a result.
What's a fair rate for a cut that just needs skin glue and some antibiotics? $500? or is it more like $2600? Because it sounds like he's paying somewhere around a 5x multiplier just because 1) he got a cut and 2) he can pay it.
At some point that won't be sustainable, and emergency rooms will shut down from the cost. People will just stop going to emergency rooms if it means getting a bill for 5x for what it should cost.
It's more that they paid to cover the costs of all of the other emergency room patients that never paid their bills.
No one actually pays the sticker price anyway, that's an artifact of the strange ways that medical billing works. People that pay in cash (rather than insurance) are given large discounts.
Please go back and re-read what I wrote, paying particular attention to "might have needed under different circumstances but happened not to need that day".
Oh, I didn't notice that my bad. So like the hospital is prepared to do open heart surgery on me, I should pay for that just in case I need it when I go to the hospital for a common cold. Makes 100% sense.
You need single payer because you can overcharge anyone who can't negotiate lower rates (i.e. individuals who's personal business with the healthcare system doesn't have much if any effect on it).
Compare that to a state bargaining on behalf of 10+ million customers.
I'm not sure the government can do a good job negotiating on behalf of its citizens. It doesn't work well for student loans (blind checks that increases tuition) [1], California's power cost (rate set with gov cooperation) [2], or even Medicare [3].
I think we need to fix several more issues before single payer would be a suitable option.
How is this, from your link, the government bargaining on medical costs?
> but the plan bypasses an obvious remedy - one that President Donald Trump embraced as a candidate: allowing Medicare to negotiate drug prices directly with pharmaceutical companies.
To me (non-english native speaker) it reads as if though they are literally not allowed to negotiate.
When it comes to schools, here (Sweden) the government negotiates how much money the schools get per student, not just the interest rates of loans. Lowering interest rates means students can afford a higher loan. None of this is comparable to negotiating costs.
The points I posted are a few examples of the government doing a poor job at dealing with the public's money. With medicare they past laws preventing their ability to negotiate. For schools in the US, the federal government has no limit on the amount of loans they can give it. I think these are relevant to the government's negotiation ability as in both cases they're allowing the counter party to abuse them to the detriment of the public. I don't trust that if the government is the single payer for healthcare that they won't let the pharmaceutical companies and hospitals take advantage of them.
You just need more competition and regulations to make prices public and stated before the procedure.
I live in a country with single payer healthcare. It sucks tremendously. Instead of paying there is waiting, sometimes for long months for absolutely crucial procedures.
Fortunately I also live in a country with reasonable regulations and sizeable private healthcare facilities. I pay reasonable prices (which means often 5x-20x less than in US) if I need treatment and I can get it in timely manner.
It's not single payer that makes our system better. It's competition and reasonable regulation that makes it possible to have cheap services available.
The single payer solution assumes the status quo is the only possible way healthcare can be priced. However prices for the same procedure can vary wildly depending on the provider in the same area in US. In all other areas of commerce, prices tend to be comparable among competitors especially within the same geographic area. So why is healthcare the only industry that doesn't act like that?
I honestly don't know, but I think part of the problem is a lack of price transparency. People cannot shop for the best prices for non-urgent procedures, etc. I bet price transparency would at least help stabilize the prices across providers. Is that enough to solve the problem completely? Doubtful, but it would be a start.
There's a difference between single payer and universal coverage.There are many other systems. For example, France and Germany do not have single payer. Single payer is just well known in the US due to the proximity with Canada.
Well. A for profit entity can hardly be regarded as bargaining on your behalf. They are bargaining on behalf of their revenue. The difference between what they negotiate and what they charge you is their entire business.
That's if you have insurance, which - surprise - is only reasonably priced if you are part of a group (e.g. employer) which can negotiate on your behalf.
Ah, so then that's what this boils down to? The high cost of health care is a symptom of capitalism run a muck? We're being charged these exorbitant rates simply because they can get away with it? If only we had a single payer that was able to negotiate, these costs would evaporate over night? Not sure it's that simple...
Although, in a way it does kind of make sense. Unlike consumer goods (television, cars, etc.), one's health is something they're likely willing to break-the-bank for. So without any kind of restraint, I could see costs getting out of control. The hospital is focused on making as much money as they can, and the consumer is focused on preserving their health. If one doesn't have their health after all, what do they have?
Add an ever increasing demand (baby boomers are aging rapidly) and suddenly, things begin to look much worse for the demand side of the equation.
Consider:
- The US is much fatter, on average
- Medicare's standards for reimbursement are often not based on cost effectivenes
- The US government will pay around $150K/QALY vs. e.g. the UK's c. $40K/QALY.
More expensive healthcare per capita is what I'd expect given those attributes and "single payer is the only solution" does not seem to be logically linked to the problem and facts.
Please note that the data you link does not address obesity and health costs simultaneously! Obesity is indeed a contributing factor, around 5% of total.[ξ] And from your references, the US has substantially more obeses and overweights per capita than the countries against which it is compared for health costs
Thanks! That seems high, although I suspect the pricing has something to do with opportunity cost for the hospital. ER docs are limited, and he wasn't available to assist with [serious life-threatening trauma] while he was gluing your finger up.
I had something similar (knife slip, a few stitches) come out to like $350 at urgent care. I paid with (literal) cash.
Any other system is going to be written by lobbyist relying on complexity for cover.
If consumers had as much political strength on capitol hill as the medical industry, another system could be worked out. But they don't. The window was closed on that option with Citizens United.
The pricing for medical bills is always insane but hospitals routinely take much less. I don't know the purpose of these "shock bills" that are never actually the real price. But I've seen the actual price paid be as low as 5-10% of these insane bills.
Well for a minor cut you went to a facility that has staff and equipment available 24x7 to deal with multiple concurrent heart attacks, strokes, major injury and trauma.
Next time wash it out, bandage it up and wait for cheaper treatment if you still need it.
Now I'm wondering whether my uncle was simply scared of the bill. I found out he'd told colleagues he was feeling numb on one side and had blurry vision, yet still didn't go to the hospital.
My uncle died, it was more serious that he thought.
My dad survived and still lives. In Denmark you rarely think about the cost, but rather the queue to see a doctor (if you have something minor, you might wait a long time). The doctors knew what was going on immediately, so it wasn't a long wait.
Is it common for blue collar workers to be without health insurance in the US? I don't want to ask my cousins about it, too painful and it would probably trigger a big rant about healthcare.
Also, if your healthcare is tied to your job, what do you do between jobs? Just be really careful when chopping the onions?