yes, insurance companies are very corrupt. I would say they are inherently corrupt given their place and power in our system.
I don't have a solution other than don't get sick or have a car accident.
I don't have a solution other than don't get sick or have a car accident.
It's not a trivial problem, but it's also largely a solved one. The US just hasn't implemented any of the models that work elsewhere.
I'm not aware of a general solution that covers all cases, but in auto insurance we found that the model of replacing underwriters with crowdfunded groups works.
Would you rather live in a society where everyone has a right to medical care regardless of their social standing or financial wherewithal, but some people will die because of bureaucratic incompetence or because the person who could've saved them has no incentive to? Or would you rather live in a society where medicine can work miracles, even the most debilitating ailments can be cured, but only if you happen to be rich?
The former is (to a first approximation) what you get with European-style single payer. The latter seems to be where American health care is headed. There's no situation where everybody can be saved, simply because we're all going to die in the end anyway, but the distribution of who dies and from what can be changed by different policies.
Aside from the fact that most European countries - even those with government-mandated healthcare - do not have single-payer insurance, this is a false dichotomy that ignores the global market dynamics.
Just as Medicare in the US could not operate in its current form without the existence of the private market to implicitly subsidize the public system, European countries would have a very different healthcare story in the absence of the US market.
Nobody likes to admit it, but there's a reason that the US is the source of over half of all direct biomedical and pharmaceutical research worldwide, including research conducted by European pharmaceutical companies. These companies use sales on the US market as the source of funds for the research that all countries benefit from, and in the absence of the US market, either those costs would be borne by Europe, or that research would simply not happen[0]. They also pull funding from the US market via other, less direct means.
Yes, the US system has massive problems, and yes, it could and should be cheaper. But you can't analyze these as binary options in isolation, because they're not binary[1], and they're not operating in isolation either.
[0] If you want to make the argument that Europe could come up with a system that pays for this research in the absence of the US market, fine, but then you have to explain both why that would not simply recreate the same expenses, and explain the fact that, so far, that system has not been created even by the European pharmaceutical and biomedical companies.
[1] The UK has four main payers; the Netherlands doesn't even have single-payer at all, and so forth.
The question still stands - would you rather live in the world where everyone has access to medical care but it isn't cutting-edge, or one where the very best in care and the very best in research techniques are available, but only for a price? I'm honestly curious about peoples' answers, because it is a dichotomy. Not necessarily a sharp one - you could imagine several intermediate systems in between - but there's a tradeoff between universal access vs. incentivizing further research and new techniques.
Again, there is no "would you rather". You can't treat these as binary options, and you can't treat these as operating in isolation. They're an array of systems that mutually operate within a global context. There is no answer to that question, because the dichotomy assumes both a binary and isolation.
There is indeed a tradeoff between quality and access, and there's a worthwhile and necessary conversation to be had around that. But that's not the same as the difference between the US and the multitudinous systems within Europe (most of which are not single-payer). And it's not the same as the question you opened with.
There is no dichotomy between universal coverage and cutting edge technology.
If I see someone drowning, I have no financial incentive to go save them. But I will go save them. Financial incentives aren't the only incentives. They aren't even the best incentives.
Why might someone go into medicine and/or research if it didn't pay huge salaries? Maybe because it's meaningful work. Maybe because it brings prestige. Maybe because they enjoy it. Maybe because they care for people.
I contribute to open source software and have never been paid a dime, yet you can hardly say that open source software is inferior to proprietary/for-profit software.
Is this honestly a question?
There are way more non-rich people who need health insurance than there are people who may die because of "bureaucratic incompetence" or lack of incentive(what? do people really need money to not let someone die?).
The way you phased it the former is obviously(to me at least) better than the latter one.
It also sounds like you think medical research advances only in countries with the latter style of health insurance. Do you really think medical advances happen only in America?
Copied from earlier comments by me:
let's go through a quick run-down of the 'major' pharmaceutical companies of the world, and where they are headquartered.
Company Revenue (USD) Headquarters
Novartis 53.6 Bn Switzerland
Roche 47.8 Bn Switzerland
Sanofi 36.9 Bn France
GSK 34.9 Bn UK
AstraZeneca 26 Bn UK/Sweden
Bayer 43.4 bn Germany
Baxter 15.3bn US
Pfizer 49 Bn US
Merck 42.23 Bn US
BMS 18.8 bn US
So, 4 of the top 10 pharmaceutical companies by revenue are headquartered in the US. By Revenue, those 4 account for 125.3 Bn out of a pie of 367.9 Bn; or 34%.
It is not easy to get a list of the number of drugs under clinical trial, or the number of drugs that were recently brought to market by various manufacturers; and, as a side matter, a number of the more innovative drugs brought to market recently were all developed by small pharmaceutical companies (Boceprevir, Telaprevir, Imatinib, Ipilumimab) that were later acquired by the big boys.
So a small pharma company did the innovating, usually funded by a university or the product of particuarly profound insights by PhD students; turned into successful drugs; run through to the stage 3 trial stage and then, once all the development costs are done and dusted, acquired for a discount price of the predicted future revenue stream So tell me, where are all the drugs being developed by america? I would say the rest of the world is more than pulling it's weight.
In fact, given rough population parity between the European first world and the United states, it could in fact be argued that the United states is not pulling it's weight.
Going by where the companies are headquartered is meaningless, because these are all multinational conglomerates. The question is where they procure the funds for their R&D.
As it turns out, not only is 50% of the entire world's medical research actually conducted in the US, but even for research developed outside the US, the US market still serves as the primary driver for the funding, which is pretty easy to see if you bother to dig into their public financial disclosures.
>"In addition to a favorable IP and regulatory environment, U.S. laws allowing direct-to-consumer advertising creates immense demand for specific patented drugs. More importantly, the United States is the world’s largest free-pricing market for pharmaceuticals. As a result, prices are comparatively high to make up for lower profits in other countries and to cover R&D costs.
The United States also has high per capita incomes, unmatched access to healthcare, a large elderly population, a culture of end-of-life prolongation, high rates of chronic diseases and drug consumption and a strong consumer preference for innovative drugs.
All of these factors contribute to it being, by far, the world’s largest pharmaceutical market with $333 billion in sales in 2015, about triple the size of its nearest rival, China.
The United States will remain the world’s most important market for the foreseeable future with healthy growth expected across all product sectors."
<trade.gov/topmarkets/pdf/Pharmaceuticals_Executive_Summary.pdf>
The rich will have better health care even in a single-payer system, and I'm fine with that.
The thing I really don't want is the pre-ACA system, where only people with good jobs can get access to health care.
BTW I saw a great Yonatan Zunger blog post on this a while back... ah, here it is: https://healthcareinamerica.us/how-to-ask-good-questions-abo...
We have unprecedented means to distribute information for "free" (or at least cheaply enough that even homeless people can access insane amounts of information, unlike in the past when a lot of stuff was only accessible to the elite) and diet and lifestyle are cited over and over and over as contributing to deadly conditions. There is lots of room here to do good things for everyone, quite cheaply.
Though I am for the U.S. transitioning to universal basic health coverage for its citizens. The current situation is terribly broken.
Most ailments get 'treated' alright, but the actual help you get isnt statistically better than placebos would've been.
Often, you get better despite of the treatment, not because of it.
Even something as basic as a broken bone just boils down to 'force patient to keep still while nobody does anything for weeks'.
.. heck, the biggest impact on healthcare continues to be personal hygiene. Most of the life expectancy improvements within the last 200 years can be attributed to that.
there are absolutely examples of its success, as you've correctly pointed out! It's still not nearly as amazing as the grand-grandparent made it sound. and my previous statement still stands: personal hygiene continues to save more people than any other treatment. this includes vaccinations and antibiotics (they're both wonderful discoveries that help save a lot of people).
And single payer systems mostly don't prevent private treatment - you don't need it because the single payer is good quality and the only benefit you get from private treatment is access to ineffective experimental very expensive treatments and nicer hospital rooms.
That is delusional. As a doctor in a single payer country, I can categorically say that the quality of living of myself and my colleagues is excellent. In fact, for those not from privileged backgrounds (many, as we have relatively affordable tertiary education) not having a quarter to a half a million of debt" graduation actually means we are better off.
So there's that, then there's the fact that I aggregate, the level of care in Australia, or the uk, or Japan, or Germany, is actually substantially better than that I the US.
Inform yourself sir.
Rest easy - you can still buy your way to better care.
Fwiw there is an "Intellectual Care Advantage" in that someone who is articulate and educated (aka well off) has a much better chance of getting good care, through their ability to navigate system, communicate with healthcare professionals, do their own research, be the squeaky wheel. But in my experience that advantage exists equally in both the US private system and in the European socialized system.
Give them the option, and they'll just make the best walled garden they can and fuck everyone else.