I had a health crisis in France
latimes.com
latimes.com
Diet has a lot more to to about that than medical care.
Using body mass index as a (arguably quite bad) proxy for a healthy diet we find [0] that many of the southern countries such as Spain, Greece and Portugal are more overweight than many countries farther north.
With the healthcare being paid for by taxes, there is a lot more incentive for governments to push healthy eating. It also means that policies for bike/walking routes pay off more.
Generally if you are well off, the US is a fine place to be. If you are addicted or poor, it's not so great.
In most of Europe, it's easy to get into rehab even if you're destitute. We have drug workers out on the streets providing advice, clean needles and referrals to other healthcare services. Homeless addicts still have access to exactly the same services as anyone else. The death toll from addiction falls remarkably quickly if there's a concerted effort to abate it.
We also avoided the opiate epidemic that is currently blighting the US - pill mills simply don't exist when there's no profit motive to dole out opiates like tic-tacs.
Setting aside the obvious humanitarian issues, failing to address the healthcare needs of the very poorest is costing the American taxpayer dearly. The economic benefits of preventative medicine and social care were described better than I could in Gladwell's essay "Million Dollar Murray".
http://www.newyorker.com/magazine/2006/02/13/million-dollar-...
I think this is the real benefit of socialised health care. Your wealth will survive a health problem. You will not lose your house because you got cancer.
Health insurance works when it works (I have some), but when they decide they're not going to pay your bills, for whatever reason, and you have to pay the bills to keep the doctors working until you can take the insurer to court, then it's a nightmare. Socialised health care avoids this.
Really? Maybe a long duration but highly curable health problems. What happens to the blind or someone who loses both arms? Do they really have more wealth than their counterparts in the US?
http://www.usatoday.com/story/money/personalfinance/2016/10/...
I can almost guarantee that nearly all of the 30% of Americans WITH savings have health insurance with an out of pocket max.
I can almost guarantee that many of the people without insurance are in the no savings group.
So perhaps I am missing something, but I am not seeing a huge group of Americans that have their wealth in danger by the current healthcare system.
And furthermore, that the system doesn't affect them because they're not part of it?
What do the 70% of Americans with no savings do when they get sick?
From http://data.worldbank.org/indicator/SH.STA.MMRT?view=map
* 0.014% of dying during a pregnancy in the US
* 0.008% of dying during a pregnancy in France
It'd be interesting to see the numbers after accounting for obesity.
Analysis of the mid-Victorian period in the U.K. reveals that life expectancy at age 5 was as good or better than exists today https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/ Digging into it you find women have a shorter life expectancy and men had a longer one.
PS: Using birth or at age 70 modern England has longer lifespans.
Can you expand on this?
I've heard many critics of Obamacare (that say it doesn't actually work that well in reality), and in general, it seems that it was only tackling a part of the problem. In Europe, you usually have a single payer, single buyer and single executor (or at least each of those is very regulated, so there's less chance for exploitative monopolistic behaviour than in the US).
The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider.
One of the main reasons ACA is more expensive than it should be is because health insurance companies are jacking up the price. The insurance companies are surplus to requirements, once the US gets rid of them (and cuts down on price gouging by the pharmaceutical industry) the overall healthcare costs should drop dramatically.
Back in my native New Zealand, the total income tax for an average household is about $6,000 USD. $14,000 just for insurance vs $6,000 for "free" healthcare and all of the other infrastructure a country needs.
The US healthcare system is a joke. A joke that wastes money and costs lives.
I took my kid to the doctor recently and a 15 minute appointment was $250. It doesn't cost $1,000/hour for a doctor to do a routine exam.
Part of the problem is the US is that the actual cost of insurance is buried in your benefits so people think that the $200/month they pay is the cost of insurance.
1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations.
By forcing everyone to pay the idea was that you could even out the cost.
2) Pre-existing conditions. I.e. the insurance agencies wouldn't cover you if you came into their plan with an existing condition. To give you an example of that from real life.
I had a stage 1 melanoma. They tried to excise it but didn't get everything out and I had to get more complicated operation.
My insurance wouldn't cover it because they claimed I had that coming into the system. I later convinced them otherwise but until that happened the only thing my doctor could offer me was to monitor my melanoma for the year I had to wait until they would cover me again. Imagine that.
This shouldn't be a significant problem. In an actuarial sense, the burden of the cost should largely be born by the party with the risk. If you aren't doing that, it isn't insurance. If you are providing healthcare instead of insurance, you don't pay for it by taxing poor young people (those are the young people opting out of the system, not the wealthier ones).
So the premiums the young people weren't paying should anyway only be high enough to cover the cost of insuring them.
The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
But the whole point of insurance is that you make it work because most people wont be needing their insurance so it's a question of interpretation.
And yes I think you are right about your solution. I can compare same treatment in Denmark with those of here in the US and the difference is just too big to be true.
Because this is a bit bait-y, I think a better analogy would be to say: "it's like forcing safe drivers to also have insurance".
Worse still, Obamacare was structured with a bunch of subsidies that expire over the next few years, lasting just long enough to push the pain into someone else's presidency.
Anyway, my point in my other comment was that while Obamacare did try to shift costs to younger people, low participation wasn't a problem to be solved, it was seen as an opportunity to grow the pools and make it sort of work. The pools probably should have been grown by ending group policies.
Broadly speaking, I probably agree with you. Spending is unlikely to solve a pricing problem.
Why then are healthcare costs significantly lower in countries where everybody has "a third party payer that will cover almost anything" (i.e., the national health system)? People in these systems also "don't care whether prices are remotely fair or not"--in many cases people don't even know what the prices might be, because they aren't charged--and yet these countries spend much less than the US for health care. Why is that?
National health systems make choices about what to cover. Some of them fix prices.
edit: also, I meant stuff like 'all the expenses of a visit to the ER' rather than 'cosmetic surgery'. So the people I was talking about don't have a lot of visible expenses. If we fixed prices that would work out fine, but we don't fix prices.
> The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
Yes!
The funny thing is people in the U.S. are so indoctrinated and separated from costs that even smart doctors make fun of you (and eventually lash out at you if you EVEN DARE to ask what a specific procedure is going to cost): https://news.ycombinator.com/item?id=12522037
Or look at the condescending post at Quora: https://www.quora.com/How-do-I-find-a-general-physician-in-S...
If the participants in the healthcare industry itself have no understanding of the issues it faces, and suffer from such apathy in realizing when told about it, I am afraid there will never be a solution
> We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
Yes!
Employers should have no say who the provider/doctor/lab for an employee should be.
Quora: https://www.quora.com/Would-the-average-person-who-gets-his-...
The U.S. has ended up with a system where every party except the patient stands to benefit.
While this is inconvenient for me (I can just fly to another state or at worst, to India for very expensive procedures, it's embarrassing to see Americans get into debt to fix a broken leg!)
As to one, ObamaCare is still failing, because too many young people are able to do the math and realize that, if they don't have chronic conditions or children, the IRS penalty for not having insurance is significantly cheaper than the premiums on the high-deductible, terrible plans that are available to them at any reasonable price. For anything less than a catastrophic illness or injury, the ObamaCare plans I have seen just don't make any sense.
Before ACA I went through a period of unemployment and had to buy my own health coverage. I had been on Kaiser previously through my employer, so they had my health records. And they rejected me for a pre-existing condition -- eczema. Seriously. A decidedly non-fatal skin condition, in my case a minor annoyance, and they won't cover me at all.
IIRC in the US, the main problem is that those setting the prices have much more bargaining power than the insurers (especially the smaller ones), so they're pretty much free to raise prices...
This is how it works in Germany for example. As a hospital you have to accept the money you'll get or you won't get any at all.
The healthcare market in the US is not balanced and this gives healthcare providers to increase prices to ridiculous levels, especially in rural areas.
Can you expand on this? I don't know where I could take my money and receive better medical care than someone totally indigent. If anything, the experience as a poor person is better: my friend has had a kid and two major surgeries in the past year, plus regular checkups, and has paid nothing as she is on Medicaid. I see the exact same doctors, but I get a flurry of bills that come months after my visit, multiple bills for the same thing, and have to evaluate what's legitimate or if I need to argue and I end up spending a lot of money out of pocket due to the craze for high-deductible health plans - even though my premium is over 20k/year and I am still paying taxes to support Medicaid and Medicare!
I mean, I guess the ultra-rich can buy their own doctors, or visit special superstar doctors, but I feel like that's probably universally true. But my feeling in the US if that if you qualify for Medicaid, you are actually better off than someone in the middle class - for example, I broke a bone early this year and I didn't bother going to the doctor because I didn't want to spend hundreds of dollars for something medical care couldn't do much about anyway - but if I had Medicaid, I could just go and not worry.
On the subject of the ACA, the best thing it did was expand Medicaid eligibility, though unfortunately due to the Supreme Court decision some states were able to refuse the expansion. I'm not really convinced the rest of the bill really advanced us much in the right direction. If only one of the carriers on the exchange was a public option...
Here in austria free, yearly "health checkups" are offered to you by every doctor. Meaning, when you go there because of a cold, he will tell you that you ought to do a checkup every year, which include blood tests, psychological screening for alcoholism and other individualized tests like prostate cancer for men.
It's just convenient to use the system. I even had multiple MRIs and dozens of XRays after minor sport injuries just to be sure.
I'm not sure where to draw the line, though. How do you determine when "just in case" costs too much?
Remember, all Austrians paid for your mris and X-rays. I don't doubt it was worth it this specific case, but aren't the incentives wrong?
Systems like these can be susceptible to abuse and this should be researched and prevented as much as possible but this attitude that any free health care receiver is to be treated with suspicion and distrust till proven innocent is not healthy, sorry for the pun.
This is good in theory but very difficult to implement effectively. The conservatives take an extreme condescending view of social welfare and demand extreme checks on it whereas any checks and balances for abuse is what is attacked by many liberals/leftists.
That's where immigration is playing a destructive force. A lot of immigrants (if not all/most) can be seen abusing social welfare.
Also slightly related is what is happening in Briton w.r.t brexit. Brexit was welcome by many Britons also for this reason.
https://translate.google.com/translate?sl=auto&tl=en&js=y&pr...
> How do you determine when
> "just in case" costs too
> much
the physicians usually try to take the safe route just in case - if they deem it worth it. i'm still in the low risk category (~~young~~ not old, passably athletic) so my doctor told me more than once that it's probably nothing and we don't need to do the (expensive) X, the (cheap) Y is enough (maybe Y reveals something that justifies X).
it doesn't always work; as a personal anecdote - my uncle suffered a debilitating headache once and was told to take aspirin for several days until my aunt had enough and drove him to the hospital on her own. turned out to be cerebral bleeding. he barely survived and is now mentally disabled.
this a) takes him out of the workforce, which looses the state money through reduced taxes and b) ensures him an invalidity pension, which costs the state money.
was it worth it to save the money? on paper it's the additional cost of checking N people who're having headaches plus the cost of treating M people who're actually affected vs. the money he would have paid into the system plus the money he now costs the system over, say, 20 years. additionally he consumes less and his wife's business is struggling because he's not much help anymore.
for us, personally, it's still a tragedy, but those cases happen. you have to draw the line somewhere. it's not just additional costs though, it's still a trade off.
Older doctors might still give you referals to specialists or radiographers upon request, and check every tickbox on a blood test sheet, but younger doctors are tought that every additional test puts strain on the solvency and labor capacity of the health care system, and will not have irrelevant or unnecessary tests performed.
In Belgium, MRI and CAT scan capacity is limited, and you can't have an MRI on a whim - you need to be referred by a general practitioner to get one.
No. If you see bad outcomes from wrong incentives, come forth.
Sorry, but this is hard to believe. The use of XRays for minor injuries is not standard anymore. Not only for cost reasons, but also for the still unclear situation about increased cancer risk due to xrays.
Mass screening of healthy men for prostate cancer is probably more harmful than helpful.
About U.S. what saddens me is the natural reflex toward individualism and self responsibility being a better moral value than mutualized health as in France. I wish they could have a more balanced POV on things.
The Affordable Care Act was not proposed as some "left", "socialist" initiative. Mainstream America as a whole -- including the "conservative" side, business, etc. -- was clamoring for some sort of effective control on health care costs.
Then, the Republicans made it a political issues. They "lost", and they weren't having any. All their rhetoric and obstruction, not of a "liberal", spendthrift proposal, but of a middle of the road plan that would provide, per their worry, a perceived "win" to the "other side."
Once the ACA was passed -- in its further compromised form -- they did their best to kill it via the budget process / spending, which is a separate activity under control of the legislature (House and Senate). Facets written into the law, such as adjustments to control insurance losses during an initial, transitory period (the demographics and so costs of the newly enrolled not being known in advance), simply were not funded.
That America doesn't have fair, cost-effective, productivity enhancing health care, is a function of political self-interest. And, in a Democracy, said politics are tied back to the electorate, however imperfectly.
Republicans lied about health insurance. People bought the lie. Now we are living it -- ever more.
P.S. Not to mention, blocking actual cost-controlling measures at every chance.
By the way, for all the complaint by insurers about their "losing money" on the ACA, as I understand it, they've seen significant savings due to the ACA in their traditional, employer group plans. Are those mentioned and factored into the rhetoric about the ACA?
Health care in the U.S. is indeed in crisis. At this point, it comes down to a simple trope: If you're not part of the solution, you're part of the problem.
The ACA bashing pols are simply part of the problem. Witness their inability to offer up an alternative of any substance.
P.P.S. In other words, I don't give a flying f-ck whether you are "left" or "right". You make progress towards solving the problem, or you don't.
And, I see it both as a economic and structural problem, and as a moral problem. A "moral" Right that is content to leave its fellow citizens suffering when resources and remedy are at hand (and this country can certainly afford them, in the dollar amounts estimated, if it makes the decision to), is not moral. It is merely hypocritical -- at best. I might contemplate using the word "evil".
It highlights a core difference between one of the two most "advanced" places in the western world.
For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right.
It is a as essential as a core human function as breathing and blinking. We don't notice it, it's just there.
And most of us are more than happy to pay higher taxes in order for us ( or our fellow citizens ) to enjoy these.
Granted , our taxes could be better managed, institutions could be more efficient, and governments less corrupt. But until someone shows us - with long term data backing up these claims - that there is a better alternative , we will keep giggling .
La Fac is one of the worst places to get an education though.
what is a "fac mindset"?
I guess what the parents refer to is that Universities in France are not as elitist as in other countries; the most prestigious higher education public schools are often considered to be the so-called "grandes ecoles" (engineering schools) or some specific administration/economics schools.
And then there's the 'diplomas for all' aspect which incentivises the faculty to reach out and lower the barrier of passage into the next year, with obvious consequences....
(+) oh the humanities, mostly
While it is true that there are some very bad Facs and cursuses, dissing 'La fac' altogether seems a bit harsh
> some facs seems to be
> doing pretty good
I never know why people rate these rankings so highly when there are such unimpressive metrics like these.
Not to mention that this particular ranking does not seem to consider education at all anyway, which is what the GP was talking about.
You can even put a market spin on it: None of the risks involved in starting a small business in Australia have to do with health care for myself, or for people who might consider joining my small business as employees.
I've never felt as if I'm giving up autonomy or surrendering to the yoke of the state or whatever. Public universal health care gives me freedom. From and for so many things.
Note: that person may be you, depending on taxation
So yes, that's precisely the trade-off. We accept to lose a little bit of money in exchange for the ability to flourish.
But you lose the freedom to decide.
That's also why it's important to call taxation for what it truly is. Until people can be born free without automatic obligation to the state to provide for "your freedom", then they're not really free. That is the only freedom that matters and is definable outside of feel-good politics. So lets be honest: I'm losing the "Freedom" to spend all my money how I choose, so you can be free of the worry that certain "bad" things may happen to you.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
How are you "free" when you're being scammed by your insurance companies and hospitals into paying more than twice what you should be for your inferior healthcare?
If there's really a scam, people could make good money from it.
http://insights.som.yale.edu/insights/why-is-healthcare-so-e...
People do. Generally wealthy people. That there is so much money being made in the healthcare industry is a large part of the problem.
I like to think of western-europe as an all-in or full-service country. Maybe you pay a bit more, but you get way better service, and by not having to decide and buy yourself you're left with more of what's really important: free time.
Most of what is state provided is fairly high quality: from health-care, to education to infrastructure our government does a pretty good job.
Keep in mind that there is even more leverage, as people who are only employed to take care of the elderly, the young, ... make up a significant part of the workforce and shouldn't be counted as employed for this purpose (a geriatrician, a teacher, a nurse, ... is paid from taxes to take care of non-workers, that means he doesn't contribute to the economy). Therefore the numbers in Australia, are about 1 for 1 (ie. tax rate of just shy of ~50%), in Europe the numbers are really about 1 for 3 (ie. total tax rate of slightly over ~75%)
But even in Australia it's essentially over. Australians should have started to have way more kids about a decade ago to prevent what's now pretty much inevitable. Although once again Australia gets to sit back and watch what happens in other economies before it's forced to take action itself, like in the financial crisis. It should do well. Doesn't change the outcome though : taxes in Australia will have to rise to halve your post-tax income over the next 2-3 decades. In Europe ... let's not go there, taxing at 100% would not allow for enough economic activity to support the pensions and healthcare at the current level of provided care. Dedicating all economic activity in the EU to just that single purpose is ... not enough. Therefore, elderly care and health care will have to scale down, a LOT (and may God help them if Trump follows through on forcing Europe into defense spending). The basic problem is, the lower the working population gets the more massive the advances in productivity (the economic kind) have to be. There is a slight issue with that:
http://www.tradingeconomics.com/european-union/productivity
(I've had healthcare in both Europe and Australia though. Let me tell you, Europe is better. Though I guess it does greatly vary based on the exact location)
A simplification that has been valid for pretty much the entire 20th century has been that a given labourer has a given productivity. So I assume that if we have 2 young people for every 1 old person or child, for example, that the economy would work to make that actually happen. This is not guaranteed, of course, but historically this worked.
As for the productivity measure you mention, that's not what I've seen in the data. Productivity measurements rose for most of the 20th century, then flattened across the world starting around 1985 or so. There has been little to no productivity rise in the US since 2000, and most of the world is worse off, with the notable exception of China and some smaller parts of Asia.
Lack of inflation rises are masked more than a little bit by government fudging. By the inflation measures of the 1980s we've consistently seen 3-4% inflation in Europe (except in the south). The measure currently used in the US is called "PCE deflator". You should look up why it's called that.
I am now a net beneficiary but for the first 30+years of employment I wasn't that's how it works.
Everyone's on the payer side of the bills. We're happy being on this side.
If you pay 10 dollars and get a car while someone else pays 100000 and get the same car you're on the receiving side.
Though you may have heard politicians in the USA profess their love of small business, in general, their actions are contrary to it. Both parties regularly do things which are good for big business, but which do hardly anything to 1. reduce the tax burden on small businesses, 2. reduce the paperwork/bureaucracy burden on small businesses, 3. make it easier for a larger percentage of society to engage in the creation of new businesses. Even though ACA (Obamacare) has been somewhat of a step in the right direction, it's still the case that if you want _good_ insurance, you better be part of a group healthcare plan (i.e. not an individual plan.)
keep in mind that this is not a given in all EU countries. In the UK (still an EU country, though not for long) one has to either get a student loan from the British state, or cover their own tuition fees.
It doesn't show up on your credit report, you can't miss a payment and damage your future creditworthiness, and lenders don't include the value of the loan when calculating your total indebtedness.
It's much closer to a graduate tax than a personal loan for mortgage purposes.
http://www.moneysavingexpert.com/students/student-loans-tuit...
And I do think some people are put off by the debt-ness of it, but that's very tricky to measure.
You do know that there's (currently) literally nothing stopping you from getting your degree in those EU countries, right?
Then there's the plausible scenario of having to apply for a visa in a hurry if the Brexit balloon goes up.
One, why tax graduates? In other EU countries, free is free as in beer and you never need to pay anyone anything, for higher education.
Two, why double-tax the future workforce? I mean, they'll pay taxes once they start working anyway. And obviously, those who do go into higher education will end up making more money, and therefore pay more taxes. The state will get back its penny'orth alright, so what's the point of adding a cherry on top?
Full disclosure- I'm from Greece originally but graduated from a UK university, and am repaying a tuition free loan, to which I was entitled as an EU citizen; so personally I benefit from the system (because I'd probably not be eligible for free education anyway). It still doesn't make sense to me.
I once chatted with a US girl thinking about going to college, IIRC one year there was almost the price a full fledged private school 5 year cursus. We both went silent for a minute.
Many people in the UK fear for the life expectancy of the NHS. It's featured in the media very often. Ditto welfare benefits.
We pay for dental care and prescriptions. Hospitals and health centre are closing left, right and centre. Benefits are being slashed in cruel ways. Many have private health care through their employers. Kids are leaving University with £40,000+ loans now.
:(
Just a few examples:
- https://www.theguardian.com/society/2016/oct/15/bma-theresa-...
- http://www.huffingtonpost.co.uk/dr-zoe-norris/nhs-cameron-hu...
- http://www.thetimes.co.uk/tto/health/news/article4713380.ece
- https://www.ft.com/content/35a3e764-705a-11e6-a0c9-1365ce54b... (or without paywall: https://www.theguardian.com/society/2016/aug/31/bma-announce...)
Other articles were written by doctors in the NHS, what they had to say didn't sound good at all. But the problem is that the government wants to abolish the "socialized" system and mishandles it (deliberately, as many article writers claim).
http://kff.org/health-costs/issue-brief/snapshots-health-car...
And yet the US has lower life expectancy than those countries:
https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
births out of 1000 that are stillbirths:
France 3.87
UK 3.50
USA 2.95
Germany 2.43
Infant Mortality (under 5) per 1000 live births
USA 5.87
UK 4.38
France 4.30
Germany 3.70
Combining the two for a birthed (Still or not) and didn't make it to 5 rate:
USA: 8.8
France: 8.2
UK: 7.9
Germany: 6.1
Obviously the studies aren't matched, but it does suggest that the variance isn't as great as either statistic shows, and there likely is a very strong ranking.
On a purely statistical level, it makes very little sense. Does he believe that poverty and drug addiction are uniquely American phenomena? Does he believe that the healthcare system has no impact on the number of people with drug addictions or chronic poverty-related diseases?
France is closer in composition to New Hampshire than the US as a whole.
So comparing health outcomes of the US as a whole to France is wrong.
Compare health outcomes of say New Hampshire or Vermont to France....
This is the same mistake the news and popular politicians use to exploit the groupthink. "Look how bad the US is at X compared to this homogenous European country". Be it prison rate or poverty level or what have you.
Does New Hampshire have any cities where 30-40% of the population are Muslim?
http://www.pbs.org/newshour/bb/resentment-growing-christians...
To describe France as homogeneous is utterly, profoundly ignorant.
If you want actual numbers, you can start here:
https://en.wikipedia.org/wiki/List_of_countries_ranked_by_et...
It is not a huge difference, but it's there. I wouldn't consider religion the top factor to pivot on, I would consider things like native language a better model.
Here is data that suggests infant mortality ranges from 9.6 in Mississippi to 4.2 in MA. So by this metric, infant mortality is in fact LOWER for many people than in France (or many parts of Europe).
http://kff.org/other/state-indicator/infant-death-rate/?curr...
If anything, healthcare systems ought to be ranked on the life expectancies of the bottom percentile. Making a great health care system for the not-poor, not-addicted and those without preexisting conditions isn't a hard problem.
Part of the difference in mindset might be that addiction or poverty is partly seen as self inflicted in the US whereas I would always classify both as being mostly beyond the control of the individual. Even with our socialized medicine rich people eat bettter, excercise more, stress less and thus live longer. I'm glad our healthcare system offsets the life expectancy difference down to 5-10 years between me and a poor person, and I'm happy to pay for it.
If that is the case the interesting comparison would be the rate for the populace excluding those people.
http://kff.org/other/state-indicator/infant-death-rate/?curr...
Sure, but the French social security system (la secu) is completely bankrupt and survives only because France continues growing its national debt. NO matter how you look at it, all these health systems are not sustainable anywhere on Earth.
An example of how much money is in the system: I was talking to a nurse in the US whose adult son had a series of mental illnesses. She was going to see a specialist neurologist about one of them. "Why not ask him about all of them?", asks I. Turns out that in the US, it's quite common for specialists to specialise into a single syndrome, and will happily reject similar things in their field that aren't their specialty. I was horrified - here are people that take a decade and a half of training, all to become a glorified lookup table. I used to work in a neuro lab myself, and while I could see a motor neuron specialist perhaps referring on a brain problem to someone more suitable, the idea that any of the doctors would only take patients with a single, prediagnosed syndrome... was just alien.
But in the US you can do that, and get ridiculous amounts of money for it.
If an MD cost zero to get, doctors would still be paid well, but not crazy well.
The US also takes in a lot of foreign-trained doctors, who don't have those same education costs.
Foreign doctors can certainly help lower salaries for doctors but they need to be a large fraction, if they are a small fraction they'll just enjoy the high salaries of their US educated peers.
Its harder to make health care cheaper because of the salaries, drug cost, hospital costs, etc.
A lot of those things are expensive because of education costs, housing cost, etc. And don't forget the lawyer happy culture that raises costs too.
Then once you fix that, you have to take into account the added cost of the current poor demographic, illegal immigration, etc.
Then when you fix that...etc etc etc.
Its a very complicated net of problems. Its not as simple as "LOL wave a wand and make it free".
It's made worse in that you have to kick down some people a few notches to have similar taxes (upper middle class would get taxed way more) combined with how a lot of people moved to the US because they did better $$ money with low taxes, and you'll have a lot of pissed off people.
Yes, all that needs to happen eventually, but it's very painful to actually do.
The total cost: 250 euro out-of-pocket The cost of one sonogram in the US: $1500 (before insurance)
Healthcare in the US is a byzantine protection racket and very potentially a means to mass surveilance beyond the scope of public health.
*even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright (https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...)
US health system needs competition more than socialism [1].
[1] https://mises.org/blog/lack-epipen-competitors-fdas-fault
EDIT: A really good comment from link above.
Mark S - https://mises.org/blog/lack-epipen-competitors-fdas-fault#co...
The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives.
People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
If you go to a mall to buy a TV and see two different models offered by two producers you have THREE choices: buy TV A, buy TV B, or buy none, if both are too expensive.. When you are sick and need to see a doctor the third option is not viable - you need to be treated otherwise your condition will get worse and you might even die.
That's why free market in healthcare causes high price inflation: you are not buying a product, you are buying your own life and well being.
There is also a public healcare system here which is quite terrible.
Interestingly, some public hospitals offer "special clinic" hours where you can get treatment on a cash basis instead of using the public healthcare system. Since the "special clinics" are not so heavily oversubscribed the wait times are shorter and service is better. Not luxurious like the private hospitals (which are indeed luxurious) but solid care by excellent doctors. I had foot surgery at Siriraj Hospital (oldest and largest public hospital [0]) by an excellent specialist [1] who also practicies at Bumrungrad (pricey private hospital). Total cost of everything, including two nights in hospital, was USD700.
I guess that's a sort of hybrid of public and private and is an excellent value. But the private healthcare is outstanding and (again) luxurious, and while more expensive still only a fraction of western pricing. The thing is, the prices are known and even advertised in advance and you can just pay out of pocket. Wife had surgery at Bumrungrad to remove an ovarian cyst, three nights in hospital with pampered treatment, total cost a little over USD2,000.
[0] https://en.wikipedia.org/wiki/Siriraj_Hospital [1] https://www.bumrungrad.com/doctors/Bavornrit-Chuckpaiwong
I'm pretty sure the private healthcare in Thailand is very good, but the only reason it's affordable for us is the difference of the cost of life, I doubt a farmer there can afford those services.
And those fundamentals are why the private system is so much better. It's not free and consumers are spending their own money on themselves so seek out the best value they can. And the competition between private hospitals is pretty fierce so they are contantly upgrading, innovating, and advertising (including their prices) to attract customers.
It is common here for many of the best doctors to practice in both private and public sectors. My anecdote mentioned the fact that the doctor who did my foot surgery does that.
As for cost, those private hospitals, and there are lots of them, cater primarily to Thais. So plenty of Thais can afford private care. It's not a huge unknown cost going in that is potentially ruinous like in the U.S.
Like you said, in order to exist the private system must be better than the public system. That is the wonderful effect of markets when they are allowed to operate.
The nominal GDP in Switzerland is actually much higher than in the US, it's just that the country is way more expensive to live in. Therefore, when adjusted for cost-of-living (PPP), the GDP are about equal.
Of course, the absolute amount of money per capita is still much higher, which lowers the relative cost of, say, medical equipment.
The private healthcare in Switzerland is also compulsory and insurers are forced to offer a basic, non-profit plan. Furthermore, individual payments may be subsidized by the government. It's therefore not that different from Obamacare, nor are private insurers left to the devices of the "free market".
You point at some facts that happen to be similar (when adjusted) for the US and Switzerland, but it's rather arbitrary. What the hell does gun ownership have to do with healthcare? And of course, like most industrialized countries, there are "lots of cars"...
The absolute difference in wealth doesn't affect just medical equipment, it affects practically everything besides labor. One of the reasons why labor is so expensive is the high taxes (VAT etc). When the government subsidizes that expensive labor, it'll get a big part right back.
You also edited your post to agree more with mine (i.e. Obamacare), when the original point was more like "private insurance can work look at Switzerland!".
Yes, it can work, if you're wealthy Switzerland and you regulate the fuck out of everything. Touche...
I just like to use it to point out how the common American argument against universal healthcare don't really apply.
"it's socialist!" - no, you can have a system where everyone pays in according to insurer determined risk factors, pay less overall and still be within what people at minimum wages can afford. Below that you subsidize with taxes, but that costs very little compared to total health spending.
But it is. Insurance works by pooling money from a group of people where only few are going to use it.
>People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
Which makes sense, as survival and physical and mental well-being are humans primary needs.
Except not everyone paying the same amount. Most pay nothing. That is, in socialist health care system.
And I am not just refering to insurance but also investment toward better medical education. If there is medical advancement going on then we have to collectively make sure that we all get it at good price. I am advocating more proactiviness toward our own health rather than rely on government to do it. But sadly government interference make this very difficult.
Ehm, the national health care systems in Europe are paid by our taxes. The only persons who do not pay to them are those that are entitled NOT to pay (below poverty level, children, etc).
The US has a gigantic "socialized" spending on that compared to everyone else. It's just that it's rather focused on one single thing. You can even hear politicians promise to spend even more taxpayer money on it.
There is little evaluation of physicians so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go.
The system runs a massive financial deficit.
It is run in an administrative way which creates odds behaviors. For instance department allowances based on % of occupation of hospital beds, which lead them to keep people overnight unnecessarily to preserve their budgets.
The system is very liberal in term of allowing you to see specialists. That's great in certain ways. The UK suffers from the opposite, where generalists' job seem to be to prevent people from seeing a specialist. But it is also a paradise for hypochondriac patients who will do dozens of useless exams subsidised by the tax payer.
Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
There are always variations, obviously but in general we have pretty good doctors AFAIK. If anything we don't have enough of them. I'm not sure how it relates to the article though, would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones? I'm really asking, I honestly don't know about that.
>The system runs a massive financial deficit.
It's still pretty massive but it's steadily shrinking these past few years, although parts of it might be caused by degrading the service slightly.
The government plans for a balanced budget in 2017, although the opposition says it's not completely true: http://www.publicsenat.fr/lcp/politique/budget-securite-soci...
This article gives a good overview of the situation as far as I can tell: http://www.lemonde.fr/financement-de-la-sante/article/2016/0...
>Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
What does that even mean? You went full tinfoil here. Whose career are you talking about anyway? Do you have any source?
I am not sure it is a liberal vs non liberal. But doctors like any profession need to have a way to be evaluated. It is a fact that there are good, average and bad doctors (like any other profession). I understand that in the US, insurance companies play this role. They are maintaining detailed statistics of acceptable success rates and will apply pressure when they see physicians underperforming.
On careers, I come from a family of doctors, so it's rather a long succession of first hand anecdotes than articles. Careers in public hospitals are very much driven by these things at a more senior level. I'm afraid no tinfoil there.
French person here. Although the deficit of the healthcare system is often pointed at by the media, it is far from "massive". From [1] translated in English:
"This budget is in deficit, (...) but this deficit is far less than the budget of the State. In 2011, the deficit of the Social Security represented 2,66% of its total budget (11,7 / 440,8 billions €) compared to 45% for the State budget (92 / 200 billions €)."
I'm not saying that it's OK to have a deficit because the State deficit is bigger. But we should keep orders of magnitude in mind (the French budget would be in super-duper-massive deficit then?). Plus, as you can also see in [1], the deficit is shrinking since 2010 and getting close to zero.
Yes, there are some optimizations possible in the French Social Security. I can't find the source anymore but the cost of running the public Social Security is lower, in percentage, than French private healthcares (if my memory is right its 8% vs 25% of the total budget of each organization) It is not hard to imagine that economies of scale play a major impact for this.
[1] https://fr.wikipedia.org/wiki/Budget_de_la_S%C3%A9curit%C3%A...
Sometimes things cost money. I imagine that keeping the country healthy is a plus.
Not to say that making improvements isn't a bad idea, but a cost-centric view on things almost always ends in bad decision-making. Decisions based on revenue generation, instead of the "real" objective (keeping people healthy).
My brother broke his leg horribly a few years ago. Ambulance, helicopter, plane, 3 surgeries, a month in hospital, steel plates, etc. etc.
In Australia, you don't pay a cent out of pocket for that, it's all covered with taxes.
Similar story in Canada too. Even little stuff like I broke my nose - into hospital, xrays, time with dr to straighten, appointment a few days later to check, etc. All free.
The difference is simply that Health Care is run for profit in the USA. Someone wants to profit off your health (or lack thereof) so you must pay a lot of money to line their pockets. Some story for Higher education, incarceration, etc.
I was staying in a remote house, miles from the nearest village, an hour from the nearest hospital. After about four days of continuous vomiting in 40 degree heat I caved and called a doctor, in the hope of getting a prescription for antiemetics over the phone. It's Sunday. I figure it's a long shot but can't hurt.
Well, I call and she says "sorry, can't give you a prescription over the phone - but the doctor will be with you in ten minutes". I was sat there expecting a call back when the doctor shows up at my house. Checks me over, says I need IV fluids pronto, do you want an ambulance for €20 or do you want to get yourself there.
Wife gives me a ride to the hospital an hour away. The place has recently undergone big budget cuts so they've mothballed a big chunk of it, and it looked a bit sad, but inside everything was new and clean, and I'm seen within a few minutes of arriving. By a consultant surgeon who was called in to arrive a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and about six hours later an functioning again, and they're saying I can stay or leave, my choice, and here's a folder of information for you to follow up on back home.
All of this cost less than €60, and I honestly felt like I had all of France mustered and rallied to my care.
I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I still got decent treatment, of course, but it was all with a grumbling, discontented overtone - and despite it being a new (15 yr) old hospital, unbelievable amounts of equipment didn't work. There was a diabetic guy on a sugar monitor/drip on my ward that kept crashing - so their solution was to have him wake up and reboot it every 20 minutes so he didn't die. They didn't have another one available.
It's just astonishing to see how two supposedly similar socialised healthcare systems can end up so very different in their output.
I'm 50. I remember what London was like way before Labour first got into power.
Lets look at today. Immigration is way out of control. London has probably 10 million people? It's busting at the seams.
I even travel to the south near the beach. Waiting for a doctor there? Sometimes up to a month.
I can remember when I would call a doctor and be seen the next day. Not any more.
The reason for the attitude is that doctors and nurses are at breaking point. I'm sorry if the down voters don't like hearing this but it's true.
Incidentally I voted to leave. But I think it's too late. We should have left before Labour got into power with Tony Blair. Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.
I'm not even going to venture to disagree with you, I'll just provide those facts.
You're being downvoted to unreadability anyway, but I feel I should clarify this just for the sake of people who are unaware of it: immigrants to the UK don't get a vote in parliamentary elections and therefore Blair's Labour could bring in the entire population of Asia, he still wouldn't have got a single vote out of them.
And he couldn't have just given them all British citizenship either: in general one needs to have residence before being elligible for citizenship.
Residency is obtained automatically after five years of living in the UK (if you can prove it anyway). Parliamentary elections happen every four years. We now have a Tory government, the second after ten ish years of Labour. Clearly, if Blair had a cunning plan it wasn't cunning enough.
And even if the numbers don't move you, think of it this way: if immigrants had any say in the governing of the UK, the country would not have just jumped off a cliff with a weight tied around its neck (a.k.a. Brexit).
We simply don't spend enough on healthcare. We have an ageing population with increasing medical needs, but our spending hasn't increased commensurately. As more people reach retirement age, the ratio of workers to pensioners falls. We don't want to pay more in tax, so inevitably we'll end up spreading our resources more thinly.
There are a number of problems with this statement.
First, immigrants are overwhelmingly young and healthy. They are overwhelmingly in work (and therefore paying National insurance....)
So, to answer your questions directly:
1) you can't get an appointment because GPs are either going bankrupt, or retiring faster than they can be replaced.
2) Baby boomers are all starting to succumb to chronic problems like diabetes, cancer, dementia etc. This costs a very large amount.
3) Diabetes costs 20% of the total NHS budget[1].
3) Social care budgets have been slashed, which means that old people come in to hospital for X, go home too early and with no support and come back with either a compound fracture or pneumonia.
4) The increase in NHS demand is 4% annually.
5) the "funding increase" comes from the cut in community & social care.
6) the degradation is entirely down to the lack of funding since 2010
[1]http://www.nhs.uk/news/2012/04april/Pages/nhs-diabetes-costs...
So they have socialised health care and they also fund it very generously.
https://en.wikipedia.org/wiki/World_Health_Organization_rank...
There's a lot of talk about privatisation of the NHS, but personally I'm really not ideologically attached to the idea of a state-owned health service provided coverage is still universal and free at the point of use.
We see a lot of private provision via the NHS (NHS patients going into private hospitals) in mental healthcare, and it's almost all lousy. (Even worse than the NHS MH care, and that's saying something.)
When you have 1 million patient contacts every 36 hours the gap between "good enough" and "good" is a lot of people and a lot of harm.
Infact most of the NHS is being deliberately underfunded. Its partly what the junior doctor strikes about.
I agree that there are severe problems with the Welsh NHS.
For details on the French system see The Healing of America by T.R. Reid. It also covers the U.K. and several other countries.
British people have both a strong sentimental attachment to the NHS and a strong aversion to taxation. They're willing to overlook the flaws of the service if it means they don't have to pay more for it. I can't say it's an unreasonable position.
- Severe diarrhea accompanied with excruciating abdominal cramps (hot knife w/ twisting, etc)
- Call ambulance. Taken to Saint-Anne within 15 minutes.
- Given IV fluids, pain-killers and anti-spasmatics
- Released one hour later; was able to walk home (I live near Denfert-Rochereau)
- Total time in care: 2 hours. Total bill: 0 (after reimbursements).
Say what you will about France, but they care for their own.
There are sometimes long very wait times for non critical scheduled tests, which is a problem.
The real problem is people with chronic conditions who will have to dedicate much more of their life to their health, which is dangerously demoralizing and a career killer, but I am not sure that's much different in other parts of the world.
>"We must have universal healthcare...I'm a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses...
I know he flip flops all over the place but maybe if people lobbied, something could be done.
> an American might assume. I pay an annual income tax of
> about 23%.
How comes this number is that low? Tax revenue in France account for about 48% of the country's GDP[1].
I'm living in Belgium, and my payroll tax is already higher than these 23%.
--
[1] https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...
[1] https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_s...
You pay nothing on the first 9700€
You pay 14% on the money you make above that, that is 14% of ~17k€
You then pay 30% on the money above that, that is 30% of the extra 5k.
My example was for a system that doesn't work in that way but switches from 14% to 30% for all the income, and not only for the amount above the threshold.
Maybe I should have worded it better but I take the downvotes I got as a demonstration of my point, that it would be insane.
http://www.journaldunet.com/business/salaire/paris/departeme...
A low income person in the US can pay effectively 0%. Your percentage in most countries depends heavily on how much you make.
Some other taxes go to fund the medical system (e.g. Forfait social, Taxe sur les salaires, TVA on drugs), but as far as I know those two are the main ones.
Long story short: the level of care is fantastic but it costs the country a fortune and there's huge waste within the system (seen it first hand). Note too: most French also pay for private health insurance to augment the default level of state care (for things like dentistry work, optician etc.).
So it ain't cheap but if I had a serious condition there's no place in Europe I'd rather be to have it treated.
Maybe he has some kind of private health insurance. Here it's very common when you have kids or you don't want to wait for your turn for non critical medical assistance.
For one thing, some care are very expensive, like dental crowns and implants. In the article, the author says he had to pay 1300 euros for 47 days in the hospital. You're likely to pay more for one dental implant, unless you have a very good insurance in addition to the regular social security (most people don't).
If you have to go to the ER and if you don't have a life threatening condition, expect to wait many hours in an overcrowded waiting room. Moreover, to see some specialists (e.g. eye doctor), you may have to wait for months to get an appointment. The list goes on...
About the decreasing quality: there is a clear pattern where, you cut financing of public resources and, then, you can show how bad they work and how best a private system would be.
It feels like it's purely because of government limiting the number of optomitrists. It reeks of some doctor's association lobbying the education ministry to keep the incoming number low (there's a hard limit set by the gov't on the amount of people who can study medicine).
For comparison, in Tokyo I can walk into any optometrist office without an appointment and just wait 15 minutes or so
I think it's along the lines of "Why should I pay for someone else's healthcare?".
I've heard similar arguments from British people (I'm rather more socialist in my outlook than average, for a UK resident, I fear) and I don't really have an answer to that. Why indeed?
I'm probably conditioned to answer this with a "duh, because they're your fellow citizens". But I guess that's not everyone's cup of tea.
>and I don't really have an answer to that. Why indeed?
Because you don't know what is going to happen in the future. One day you may wind up broke and be diagnosed with a serious illness. And what about any children you may have. Wouldn't you like to know that they will receive care after you are dead no matter what is going on in their life?
And in the past I was very young and couldn't yet fend for myself. I benefitted from being born in a developed nation and, like you say, if my parents had died while I was young, I'd have been taken care of (though in my country's case it would probably be my extended family that'd have looked after me, first, and the state would only intervene if I had noone to care for me).
Like, I totally get what you're saying, but a significant number of people don't see it that way. Maybe they forget they were once too young, or that they will one day be too old. Maybe they just think they can do well enough for themselves that they'll just wing it.
My point is that for many people contributing to things like public healthcare doesn't make sense.
For instance- in the UK education is not free, and you will hear lots of people saying, indeed "why should I pay for someone else's education?". That's much more common than grumbling about having to pay for the NHS, but in the end it's just the same thing.
Do you really want people to actually DIE? I hope not and that you'll rather pay "for someone else's healthcare" than to see them suffer and if YOU are ever bad on your luck and need the help, I'll gladly pay for your healthcare if you need it, because I know that you paid into the system when you could and now we're just paying you back.
I am already paying taxes for a lot of things that I may not want to anyway, like overbudget defense spending, over the top salaries for MPs, failed research, government websites that cost way more than they should and other initiatives that nobody asked for, financial support for hugely profitable multinationals etc. etc. - if I am paying for that, OF COURSE I'll pay into a system that will help a human being when they need it and be confident that I or my family members can expect the same, should it ever come to it.
It always seemed to me that in the U.S. they're fed up with having to pay for an excessive budget, yet they always blame the wrong part of it for their high taxes - don't blame healthcare spending, blame the way it's implemented, blame the fact that over 50% of your tax dolars is spent on the military, blame the failed, overbudget F-35 project etc. etc. DON'T blame Flint residents who don't even have access to clean water - where's the logic in that?
Something I read on hn a while ago involved trying to place others who have had bad things happen to them in mental categories apart from oneself, to not have to deal with the possibility of bad things happening to yourself without any reason. E.g. a traffic accident, cancer etc.
With traffic accidents, is very instructive to see that people will reflexively think that the persons involved did something wrong, this removes the need to accept that life isn't safe and that our behavior often has little influence at all on wether bad things happen to us. I think it's the same with healthcare. The defense mechanism is: they got sick so they must have lived unhealthily - granted, there are a lot of things your behavior can influence: cardiopulmonary disease, some forms of cancer but not all of the tragedies of health that can befall you are in any way under ones control. By sticking together we can shoulder the burden of the few that didn't have any blame on their fate.
What I'm saying is that free healthcare and education (and other stuff like that) is a cost that civilised societies are prepared to pay to remain civilised, and it's weird that one such society seems to think very differently than the rest in that respect.
This has not affected my personal finances and I only had to focus on getting better.
I would like to move to the USA but I have got to admit that it frightens me that this kind of issue would have costed me a lot and a serious health condition could bankrupt me.
This is not ok. It saddens me that USA have not been able to instore a sane health care system.
This translates to higher costs because maintaining hospitals in low density areas raises the cost of care per capita. This is also a reason that inter-regional train service has never been a good option in the US.
There are regions where it works, but coming up with a one-size fits all solution is hard. The metropolitan regions of the US have always subsidized the rural parts. We people of the cities have always paid a fee on our phone bills that helps reduce the cost of phone service in rural areas, as an example. I actually dislike this, because I think it subsidizes sprawl.
I believe the ACA is a good step (personally I'd like to see Medicare offered as on option alongside all state insurance plans), but it does need fixes. Whatever the solution, it's going to look different from Europe and France in particular.
So you don't pay any kind of VAT?
That also wouldn't mean anything, if the State is not taxing you so much, but it still has money to finance these things, it is obviously because it is taxing other people a lot more and using the money to treat your health.
I would not find it very good to have my needs fulfilled with stolen money, as you seems to be finding.
Also for some reason this reminded me of a BBC story I read a while back - where "Heavy Legs" is described as a medical condition that only exists in France: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspon...
The military health system (for veterans, the VA) mostly have their own facilities, but don't have the best reputation (and have had some scandals recently... https://en.wikipedia.org/wiki/Veterans_Health_Administration... )
Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered)
All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like https://en.wikipedia.org/wiki/Massachusetts_health_care_refo... and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance).
https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...
So yes, it's a complex kinda mess...but there are too many stakeholders in the current system for it to be easily changed.
Thus while individual states could implement their own health care system, it would have to be on top of everything that's federally mandated, which they're already paying for. The tax burden would be outrageous, so it just doesn't happen.
It's also odd to see other Europeans dismiss the argument many Americans have for a smaller federal government, while in practice that's pretty much what we have over here in the EU. Could you imagine a EU-wide single-payer health care system? It would be a complete disaster.
So in that sense I wonder if the better solution for the EU would be to roll back all federal health entitlements (Medicare etc.) and just implement this completely on the state levels, then states like California and the like could have European-like single-payer health care systems, while perhaps other states would opt for different systems.
But there is fishy stuff going on too...
1 liter sterile bag of saltwater for intervenous use in American hospitals is charged at over $300, not considering the cost of the procedure, which can total $500.
The pharmaceutical industry also does some sort of disservice to society by inflating prices so much.
Then, some money stays at the insurance companies instead of going to actually improving healthcare itself.
I'm guessing - but I do not think it's a good thing when people who make the purchasing and oversight of things are far away from the actual practitioners. It leaves a lot of room for different kinds of shenanigans, fraud and sub-optimal choices. I think that applies regardless if you're for Private or Public health care.
[1] http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte...
It's nuts.
And if you want physicians to make 100k - 150k, don't expect me to work 80+ hours a week, not including call. Attorneys give me $500 / hr for consultations, but in my real job I make $80 / hr, but just work a ton more hours a week (no overtime bonus, tho). I don't get sick days. I don't get vacation days. When I don't work, I don't get paid. When I was in private practice, when I didn't work, I not only didn't get paid, but still had to pay rent / malpractice / insurance / electric / employees which was about $5000/week for me. So taking a week off cost me lost revenue and $5000/week. Medicare pays $600 for taking out a gallbladder. Do the math to see how many have to be done to take care of the bills.
How would you improve this system? Do you think universal healthcare would help?
Imagine if medicare started receiving payment at age 20. By the time someone turned 60 the return on investment / interest would more than pay for their care. Insurance companies don't want the average american to know that. I think that either 1) offer medicare plan for anyone, regardless of age and discount based upon years of contributions or 2) make insurance companies allow individuals to pay medicare rates once they turn 65 if they've participated for, let's say, 15 years.
I'm almost 50 and have used less than $400/year since 21. Yet, I pay $4400 for a $6000/deductible plan. So I've given my insurance companyn $100k at least in my lifetime. But when I turn 65, all my care will be covered by medicare. Trust me, I know what symptoms to say and may have multiple bad symptoms from age 62-64 and undergo lots of tests, instead of medicare paying for preventive tests.
The system is broken, but so is politics, so nothing will change. Even Trump ran under the pretense of allowing us to buy pharmaceuticals overseas, allow purchase of insurance plans across state lines, make hospital costs transparent ---> all that would lower costs, but apparently, they won't happen.. Just like with the democrats. The US healthcare system is controlled by the pharmaceuticals, suppliers, and hospitals and nothing soon, other than a Bernie Sanders, will change it. The 3 competing hospitals in my area, serving less than 1million people have a CEO cost of more than $7 million! So across the US, I would imagine that total CEO cost is in the billions.
I don't have solutions, only depressing facts.........
It's interesting that my comment is somehow controversial, because it's been down to -2, is now back to -1. I wonder whether they are objecting to my calling "universal healthcare funded by taxes on the general populace" socialism, or whether they are objecting to the claim that the USA populace would ever accept a socialist policy.
Indeed, while I've been editing this comment it's gone back down to -2. Interesting to watch, and I really do wonder what it is that's provoking people into downvoting it.
... and now back to -1. Fascinating!
https://en.wikipedia.org/wiki/List_of_countries_by_military_...
...but maybe that doesn't count as "socialism" because most of the profits ends up in the hands of private companies?
Some random thoughts:
You can never spend enough on healthcare. There is always new machines, new technologies, new drugs, new treatment types, better educated doctors we could spend our money on if we wanted to. Furthermore we are treating people earlier and earlier and for more and more things. The old saying that if you are not sick it's just because we haven't found the right diagnosis for you seems to be true.
In effect whether you are in a private healthcare system or a universal one whether you pay double or your get taxed 100% there will never be enough money for healthcare.
Now depending on whether you have private healthcare or public healthcare the way you measure it is completely opposite. In a private healthcare system everything is a potential profit center. I.e. the more people who are sick the more money can you potentially make.
In a public universal healthcare system everything is a cost center. You have a budget and you have to deliver to a politically decided standard.
Both have pro's and cons. To give you an example.
It took me 3 weeks to get a time with my dermatologist in Denmark, when i finally got it it was the day before I moved to the US. The Danish dermatologist found one they considered troublesome, but they couldn't themselves do the biopsy and I had to get a time at a hospital to get it.
I decided to wait until I got to the US ignorant as I was I thought it was just a question of formalia. But no I had to wait a whole month for my insurance to work (that is a whole other discussion for another time)
When I finally got it though, I got a reference for a dermatologist same day and they did the biopsy, same day. Today I am at Sloan Memorial with one of the best dermatologist in the world getting checked every 3 months having a complete 3d scan of my body (in blue speedos and a white net) and hopefully we will be able to make sure that I am being managed properly.
What I am trying to say is that the level of expertise a private healthcare system allow for is more flexible than a public one because it allow for the allocation of resources. On the other hand if you look at those let fortunate than me, with worse healthcare plans etc they will get a less favorable treatment. I.e. the system isn't evenly distributed.
What the public healthcare system secures is that it's mostly evenly distributed but with less of a flexibility to build experts as there are budgets and a bigger need for priorities in any publicly funded system as it's a cost center.
So you have fundamentally two system where one covers only those with insurance but allow them to potentially pay their way to the latest treatments with the best doctors and the other where everyone gets treated but you don't have the same amount of experts and potential treatments.
Neither systems are really optimal. Do we want to have people die because they can't get healthcare coverage or because they can't get the necessary treatment because it doesn't exist in the country they live. I know it's more complicated than this of course but in broad strokes thats at least my perspective and this has lead me to the following observations.
1) Both systems are fundamentally financially unsustainable in the long run. Whether the system succumbs to it's own weight by costing the tax payer too much to pay for everyone while only delivering average treatments or whether it's impossible for the insurance companies to secure a large enough part of the population without leaving too many without proper coverage. Both just doesn't sound "right" (I know Germany, and Switcherland have some variations that sound more right but I am not sure they don't fall into the trap of either the cost center, or the insurance cost issues.)
2) One way to solve it is to ensure that people pay for all the normal encounters they have with the doctors (sore troth, hernia, back pain etc) but that you insure yourself against long term illness. In other word we should pay for normal things but no one should be going bankrupt because they can't pay for long term or serious illness.
3) By removing the insurance part from a lot of the normal encounters with the healthcare system and only putting it towards more serious conditions hopefully doctors will start to compete against each other rather than spend all their time fighting with the insurance companies.
4) I have a naive hope that technology could somehow limit the cost of many of the more complicated treatments. Over time hopefully many of the things that are wrong with us can be treated via gene-therapy hopefully not requiring too many people to do the actual treatments.
5) I think we have to come to terms with the fact that none of the systems really work and that all of them have solutions to problems in the other systems. That way perhaps we can start to break down healthcare into more discreet parts rather than the giant monster that it is today.
Thoughts?
Public health care will just transfer more money from poor to corporations (like with education). You need to fix the leaks first, for example sponsor medical tourism to other countries, etc...
It's just that in other countries you have the government setting up a monopsony and dictating costs and salaries.
I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.
Unfortunately, a free market for helathcare does not exist in the U.S.
Wow, just wow. You must not have ever had a family member or close friend fall ill. If you think someone making $50k/year is financially capable of paying $30k up front, you need a reality check.
>> In the end, this entire ordeal set me back about 1,300 euros, or $1,455. I sometimes wonder how my health crisis would have played out had I returned to America instead of deciding to stay in Paris more than 20 years ago.
In the U.S., it's likely they would have died; or at least gone $100,000+ in debt - if they could have even qualified for that much credit.
I can understand not covering things like lung transplants for lifetime smokers, or other similar "meh it's their own fault" situations. But when it comes to treating the health of citizens who are not severely at fault for their conditions, there should be absolutely no cost to the individual. Taxes should be enough to handle this, without one's own insurance being part of the equation.
The difference of course is I'm not paying for a bunch of cowboys who invade other countries at the drop of a hat
I don't know, altogether how much taxes we pay. It varies depending your salary, your job or location (farmers have a different healthcare for exemple). Including everything, If i remember well, an employee cost twice his salary to the employer. A salaire net is something like 2/3 of the salaire brut. Income taxes depends of your income. In comparison with european countries, I think that it's mainly the employer part of taxes that are high.
No, its much higher than 23% as claimed by the author. At least in the 30 or 40% depends on your level of income. Its also fair to say that there is a large amount of households in France that pay no taxes at all.
If you're living paycheck to paycheck, that's 20% tax on your income. If you're a multi-millionaire, I doubt you're spending too much on groceries for the VAT to matter.
It should be specified that this is because the French tax code provides exemptions to people making less than I-forget-how-much per year.
https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...
In the US, that's 26.9%. In France it's much higher, at 47.9%.
To a conservative opponent, getting high quality care at a low out-of-pocket cost is a result of health care being a redistributive social good, and "social good" is just code word for "shirking individual responsibility". They look at this situation and this author like they do their proverbial welfare queen...a beneficiary of their taxes.
If we actually want to convince them, we have to prove to them that Single Payer is an objectively more efficient system than insurance. In other words, were the total incurred costs lower than they would be in a our system? Because for them, that's an argument that matters.
Unfortunately even I, a strong proponent of single payer, would find a cross country comparison here to be disingenuous. Because it doesn't matter how efficient the French are at administering health care. What matters is how efficiently we would be at administering it. And hands down, we suck at government administration. Whether it is infrastructure, military, health, or whatever...everything we do costs more and takes longer than other governments doing the same thing.
And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things.
Well, that'll continue happening as long as you force it to be one giant pie. If you let people choose in the first place, then you can have your nice things. You just have to pay for them yourself along with those individuals that agree with your viewpoint. And the rest of us will have to choose to either join you, or do it some other way.
All arguments eventually lead to choice. Freedom and consent are fundamental properties of a libertarian belief system. We don't get to throw those out just because it'll be efficient. You could argue that it's efficient to just execute all repeat-criminals, but we don't do that because of fundamental human rights that are completely separate to the concept of pragmatism and efficiency.