A Mexican Hospital, an American Surgeon, and a $5k Check
nytimes.com
nytimes.com
Since it's this bad, it alludes to vast untapped potential for more cost saving measures that are both funny and embarrassing.
A quick google suggests prisoners have to pay 10-100$ copays in some states, but otherwise receive care. I wonder if there's a topology of illnesses where a financially optimal course of action to acquire treatment is to commit some petty crime and receiving treatment in prison? After lost wages, and earnings potential from your now tainted record, and all else. There might be!
Here's a business idea that might already exist, vocational-technical elementary / pre-school for trying to lead your own children into and through medschool. Doctors are so expensive you might as well make your own!
That one baby saving medicine that just got approved costs like 2 million dollars, right? For anything ~ 200k+ that isn't literally holding your baby hostage from imminent death, it's probably cheaper to get a degree in chemistry and some lab equipment.
https://www.vice.com/en_us/article/43pngb/how-to-make-your-o...
It's crazy, but only in a crazy system can things like this approach rational.
Here's another idea. What if patients could rent hospital administration as a service. Put payment for a procedure in escrow, sign all the malpractice waivers and try to attract a doctor like tinder. I'll sign all malpractice waivers if you'll just cut this cancer out of my gut. We can use my living room! It's this or death anyways so fuck it! America WOO
How involved are you with other US government organizations? Do they usually strike you as highly competent and efficient? Are you sure that if we did what you suggest we wouldn't have a whole different set of monstrous absurdities?
“Government” doesn’t have to mean “incompetent and inefficient.”
[Edit: enraged_camel said that the VA is pretty good. Is that accurate? I've heard otherwise, but I don't know firsthand. If the VA example isn't accurate, though, replace it with "California high speed rail" or "Amtrak" or "the Department of Education".]
It doesn't have to mean incompetent and inefficient, but it seems that it often does.
My only direct experience with the Department of Education was college financial aid. The FAFSA wasn't particularly awful and I appreciate the help I got--the work study job not only paid for my books and food, but got me started in my career.
People love to act as though government can’t do anything right. Government does plenty of things right, those just don’t get much attention.
I sit here next to my government road with government postal service, lights powered by a private utility heavily regulated by the government, and wish the government provided trash service to me like they do for my neighbor because I’m getting fed up with the shoddy trash service I get from the company I pay, and think, yeah, government health care could be pretty good, just like it is in so many other countries. The US is not uniquely incompetent here.
Fair point.
https://jdasolutions.aero/blog/guest-author-robert-poole-faa...
Some more descriptions of the problems with US air traffic control:
>...Much of the system still depends on radar technology developed in the 1940s. A new system called NextGen has taken so long to develop and install that controllers are still operating a clunky patchwork that combines antiquated and updated equipment.
>...You could hardly find a more egregious example of serial mismanagement than the history of NextGen. Between 2004 and 2006 the FAA spent nearly $26 million just planning the system. Since 2010 it has spent nearly a billion dollars a year on attempting to implement it, frequently missing deadlines and, according to government watchdogs, exceeding budgets.
https://www.thedailybeast.com/lobbyists-and-congress-just-ki...
Or less than .10 USD per American. Nor does spending a billion USD a year since 2010 scream mismanagement to me given the magnitude of the public benefit if it eventually works.
By far the most important barometer of the quality of the US's air-traffic control system is how many fatal collisions there have been between aircraft being controlled by the system, and you haven't offered any data about that.
>“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.”
https://www.dallasnews.com/business/american-airlines/2017/0...
This wired article also has some more background on the US air traffic control system:
https://www.wired.com/2015/02/air-traffic-control/
The US is the last major country to still have government act as the regulator and provider of air traffic control. This is an inherent conflict of interest for the regulator that other countries avoid. By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example:
https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo...
Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland:
>…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety.
https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co...
Considering that every other major country has separated the regulation and provision of air traffic control, those who are opposed to it should cite some evidence why the US should be different in this regard.
In the article written by Poole, the data he quotes is from:
>...The data source is CANSO’s Global Air Navigation Services Report 2017: The ANSP View. This online document provides the raw data, explains the methodology to construct each key performance indicator (KPI), and notes that all cost numbers have been converted to U.S. dollars, for apples vs. apples comparison. Reviewing the data from all 32 participants in the 2017 report, it is clear that there is some degree of economies of scale, but since costs such as payroll are so much lower in developing countries, metrics involving costs are best compared among ANSPs in countries at the same level of economic development.
Is the data source bad? Was the data inaccurate?
The other article which goes into more detail is not associated with Bob Poole.
We all have to apply heuristics to the information we take in, because there's far too much to be rigorously logical to it all. And my heuristic here is that libertarians in general and Reason in particular are not typically purveyors of good arguments, and this is very clearly an ideologically motivated argument, not a dispassionate analysis. Ideologically motivated arguments can be correct, but they're much less likely to be.
I'm sure the data is just fine. Interpreting it is tricky. The US and Canada are such vastly different countries. For example, Canada has a huge number of flights passing over it without stopping there (lots of flights between the US and Europe and Asia pass over Canada) and ATC for flights in cruise is vastly easier than ATC for flights descending to land or climbing to cruise. Does this actually make a significant difference? I have no idea. But the fact that this isn't even mentioned in the article, nor are any other potential explanations for the difference other than the supposed inherent superiority of privatization, makes it suspect.
At any rate, privatized ATC is still under strict government regulation and control, so they really just show us another effective model for socialized health care, rather than serving as an argument against it.
If there's a country where ATC is run by many different competing businesses with wide latitude in how they operate, and that country's ATC is better, then that would be another matter. I doubt there are any.
>...To commit a preemptive ad hominem attack against an opponent. That is, to prime the audience with adverse information about the opponent from the start, in an attempt to make your claim more acceptable or discount the credibility of your opponent’s claim.
https://www.logicallyfallacious.com/tools/lp/Bo/LogicalFalla...
>...For example, Canada has a huge number of flights passing over it without stopping there (lots of flights between the US and Europe and Asia pass over Canada) and ATC for flights in cruise is vastly easier than ATC for flights descending to land or climbing to cruise.
This is odd speculation on your part. Doing a google search on air traffic safety brought up this paper which examined the air traffic control systems of the US and Australia, Germany, New Zealand, and Switzerland:
>…An analysis was made to determine the effect privatization had on operating cost and air MIC safety involving the privatized ATC systems of Australia, Germany, New Zealand, and Switzerland. The study showed reduced operating cost and increased safety would result from corporate structuring of the ATC system. It was concluded that corporate style policy regarding personnel management and equipment procurement procedures would increase efficiency, which would reduce operating cost and increase ATC flight safety.
https://commons.erau.edu/cgi/viewcontent.cgi?article=1521&co...
>...At any rate, privatized ATC is still under strict government regulation and control, so they really just show us another effective model for socialized health care, rather than serving as an argument against it.
Most people don't associate the idea of "socialized health care" with the regulatory bodies that exist like the FDA. Most people would not say we have "socialized nuclear power" just because the NRC regulates nuclear power plants, etc.
>...If there's a country where ATC is run by many different competing businesses with wide latitude in how they operate, and that country's ATC is better, then that would be another matter. I doubt there are any.
Straw man. I didn't claim there was. What I said was "Air traffic control is not a great example to cite here. The USA is one of the few countries where the regulator also provides the ATC service." and I cited 2 articles showing how it is less efficient and behind other countries. Your claim was that it was "superb".
Considering that every other major country has separated the regulation and provision of air traffic control, if you want to claim the current ATC system is "superb", you should provide some evidence why you think that.
As far as "socialized health care," there are many different models for it. The oft-discussed "medicare for all" plan would be a system where regulated private entities provide health care and the government pays for it. Another common model involves public and private insurance and private providers, regulated to provide for universal service (essentially the ACA, but less crappy). If "socialized health care" means the government directly runs it all, then that excludes most countries commonly considered to have it, including Canada, Australia, and most of Europe. I realize that the comment I originally replied to specifically discussed government owned health care from top to bottom, but I'm expanding the discussion to include more real-world models. I think one of the big problems with this discussion in the US is our complete unwillingness to look at what other countries do and how they work, and there are a variety of different examples to consider there.
As I noted elsewhere, other countries like Canada have implemented technology like GPS flight tracking and digital messaging between pilots and controllers which makes flights safer. In the US, they try to mitigate the dangers of the aging air traffic control system by spacing the planes out further. You might not notice the inefficiencies being put into the system, but as the American Airline CEO has said:
>“Today to fly from DFW to Philadelphia is about 30 minutes longer than it was in 1979,” Parker said, “simply because we have an [air traffic control] system that hasn’t kept pace with the rest of the world.”
https://www.dallasnews.com/business/american-airlines/2017/0...
At a minimum these kinds of inefficiencies result in more pollution and higher ticket prices.
By having political control of air traffic control, it also means air traffic control is routinely held hostage to government shutdowns and budget impasses which can also impact safety. For example:
https://www.theatlantic.com/ideas/archive/2019/01/how-shutdo...
This article talks about how LaGuardia was shut down due to the government shutdown:
https://www.zdnet.com/article/how-the-air-traffic-control-sy...
These sorts of things don't make air travel more safe - they make it less safe.
Having the regulator regulate themselves is an inherent conflict of interest. For example, this paper done by the NTSB a long time ago addresses the issue of the lack of study of ATC failures:
>…However, current accident and incident reporting systems were not designed with ATC errors in mind, making the analysis of latent factors, such as supervisory and organizational issues, extremely difficult. What is needed is a new error-analysis framework that will facilitate the gathering of information during ATC related accident and incident investigations ...
https://www.faa.gov/about/initiatives/maintenance_hf/library...
later we see:
>…In April 2007, the NTSB made four further recommendations, three measures to avoid fatigue affecting the performance of air traffic controllers
These recommendations were prompted by analyzing _4_ previous accidents.
https://en.wikipedia.org/wiki/Comair_Flight_5191
Yet this quora discussion implies that fatigue and the unwillingness to report mistakes are still a problem at the agency:
https://www.quora.com/What-is-the-penalty-to-air-traffic-con...
Does anyone actually think having the regulator regulate themselves is a good long term approach?
In terms of your comments health care reform, you make some good points, but your argument deserves a HN discussion all its own. In this one, I am simply trying to show that the current ATC system in the US is not an example of "a superb" government program and I would say it should be reformed to be more like every other major country.
The US government is alone among major countries of being the regulator and provider of air traffic control. In comparison to other countries we have higher costs, less efficiency and arguably less safety. The first proposal to break out the regulation of air traffic control with the provision of the air traffic control was done by the Clinton administration. Support since then has been bipartisan and opposition has also been from members of both parties for various reasons. (I read somewhere that one of the biggest long time opponents of breaking out the air traffic control has been the associations of owners of private jets as they currently pay about 1% of the cost of ATC, but are closer to 10% of the flights in major airports. In reality, owners of private jets can likely afford to pay a more proportional percentage of the costs they impose on the system.)
In the end, it i disappointing to see people immediately reject the idea without even examining the evidence. If we can't reform something this blatantly obvious, I wonder how we will ever come to a resolution on big complex issues facing the country. Those who want to keep the status quo on air traffic control should provide some evidence why having a self regulator who relies on decades old technology and is more costly than other countries is the best we can do for air traffic control.
NOAA and NASA do a great job forecasting weather and tides. The CDC does a ton for public health: no recent pandemics I can recall. The NIH is one of the best biomedical research agencies in the world—-and the NSF, NASA, DoE, and DoD research divisions are no slouches either (GPS, internet, etc). The Library of Congress and Smithsonian make a lot of American heritage accessible to everyone—-and also do serious research of their own. The National Parks are awe-inspiring. The USPS can reliably get something to my family on the other side of the continent for $0.50. The USDA has kept our food supply wholesome, and the FAA/NTSB have made flying—an intrinsically crazy activity, absurdly safe. The SEC and FDIC have keep American markets aboveboard and attractive to investors from around the world.
There’s more to the government than the DMV and taxes.
In fact, if you’ve ever had to interact with the IRS, they are astonishingly pleasant—-I got a question answered and a (small) amount of money refunded in a ten minute phone call. It was vastly better than calling Comcast or the insurance company.
And based on the scandal around the VA a few years ago, no it wasn’t well run at all.
Scandals aren't unique to government. The private sector has them all the time. In fact, sometimes private sector scandals are so massive they crash the entire economy.
Most people on Medicare are generally quite happy with it. The idiocies generally start when the government let private companies get involved (Medicare Part D).
In addition, the person who brought "socialized medicine" to Canada is regarded as as a hero.
Talking points without citation are not data.
Far from all but,a decent number of them yes
Think about the market's provision of grocery stores: plenty of competition. Most places they don't enjoy geographic monopolies like car dealerships do. They manage to get one of the most vital goods to a huge population spread across a huge area on time and at a great price, with local variations anticipating the specific desires of local consumers. There is no central coordinator or Department of Grocery Services. The market figures it out.
How can someone look at healthcare, with its absolutely absurd outcomes, and not understand that it is precisely because of government interference that nothing makes any sense? Costs keep rising unsustainably, which is the opposite of the way markets work. Paperwork and administrative staff balloons in proportion to patient care.
Once the state gets involved, now it becomes political. Do you think the current political climate in the US should be further embedded into healthcare? If the state controlled everything, then you'd get outcomes like red/blue states losing/gaining funding depending on the results of the most recent election. One could imagine more dystopian outcomes quite easily.
Disclaimer: I'm in favor of a preventative care system available to everyone, regardless of income.
You can never purchase local, small batch ____ than you can from large companies. That's why companies get large - they are more efficient the larger they get (to oversimplify).
Your local farmer has much less land than factory farm, and he doesn't have the state of the art equipment to harvest or store his crops. He can't justify spending so much money on equipment when he runs such a small farm.
There's also a good chance he uses "organic" as a selling feature, which means his yeild per area land is way lower than an efficient farm.
He also has to work much harder to actually sell his crop. He doesn't have large commercial deals that put his product directly onto shelves at Aldi. He has to spend half his time driving all over the place to various farmers markets to try and get people to buy his stuff.
You might think all of this is pedantic or obvious, but I think efficiency of food production is very important. Food production is a massive contributor to climate change and opting for methods than can save on land area and water usage can have big impacts.
I think if you want to pick some aspect of American life that is free of government involvement, you started in the wrong place.
This is a bit of a tangent, but do car dealerships have geographic monopolies in some places? I don't think I've even seen just one dealership. They always cluster around each other where I'm from - you could car shop on foot and see at least 3-4 different dealerships.
At the ER I was made to sign something on the way in in a state in which I couldn’t really tell what I was signing. I was given various drugs and sent through a CT scan. I had no idea what was going on. I certainly was in no position, with symptoms of a life threatening condition on top of being incapacitated to say “hey hold up, I think the Safeway has cheaper CT scans can you guys transfer me there!”
Healthcare is entirely different from buying groceries. It does not and will never operate like a typical market for typical commodity items.
A lot of medicinal procedures allow time for determining what the most cost effective offering is.
America is the only one with this very unique problem and going further in the direction of a 'free market' won't work. Because healthcare can never be a free market. The insurers have an incentive to not give quality healthcare and give people the bare minimum while hiding details from customers and no amount of freedom would solve this. The end result is that you'd see something like ISP companies where they work together to enforce a regional monopoly and gouge people all the same.
And you can have both a public option alongside a free market.
Because they see how much of the mess is the markets fault. They also see how nearly every other first world country has a working system while spending less on healtchare. In some places its private non profits subsidized and regulated by the government, in some its the government providing insurance like in Canada, in some it's really socialistic and government employs most doctors like the NHS. In each case the system works much better then the US and the US system is rightly considered a bogeyman. I'm unaware of any place that works like you've described
>Thousands more patients made to 'beg for treatment' as NHS rations hip operations, investigation finds https://www.independent.co.uk/news/health/nhs-rations-operat...
It's a question of how contrieved the scenario would need to be.
Dude I know you're going for the absurdum but if your search term was "prison health care" and you'd wish for that level of treatment - the actual level provided, not the one the law promises - then one of us needs to check our search engine or treatment expectations. A felony conviction's not going to land you in the Cleveland clinic. You'll be lucky to get antibiotics and sewn up if you survive having the shiv pulled out of your stomach.
I'm trying to look at the factors that build up this reality and see other ways to zag through it. My hypotheticals, properly evaluated, would take into consideration the expected quality of inmate care. You might notice by tone that I grabbed onto it as an idea more gingerly than enticing a doctor with waivers and cookies to cut me open in my living room.
Lawyers are the only thing that might possibly make that one not a winner in my way of grading. Prison requires a whole new calculus.
The situation is BAD. I have a vested interest in this. My consulting career was great for the people that live with me. Unfortunately, my abjectly poor father in-law needs a heart transplant, insulin, and much else.
Taking the system for granted, It's a shame I like him so much. Now I need to find a full time salaried position that's remote or in my area. My stochastic income can't be relied upon anymore, a life is on the line. I'm doing my best, but it makes me pretty angry to be in this position.
A remote position specifically would be great, then I could make sure this guy gets to spend his final years (months?) without financial stress living next to his daughter... I'll take any interview, I'm pretty good at most software engineering... React/Nodejs/C#/WPF/ASP/PHP/Python/Unity/GLSL/HSL/C++.
Fuck the U.S. healthcare system.
best of luck and i hope things go as well as they can.
It's probable that I'm angry at a system as a proxy for anger I would otherwise direct myself. I should be able to handle this.
And where did you get your knowledge of prison, reality TV? The type of felony you would commit to get prison treatment isn't going to put you in a situation where that is commonplace...
YES!
https://www.theatlantic.com/health/archive/2013/02/on-purpos...
"The next week, he went to a department store and, making sure a security guard saw him, pocketed some moisturizing cream. He looked up at the guard, smiled, and walked out.
"After he was arrested, he wrote a note to the judge saying that he needed to get back into prison for a year, to get an operation. He told me the judge said "I'll give you 14 months, go get your surgery."
>Any patient with end stage liver disease who does not have insurance (and is not eligible for Medicare) has the option of trying to qualify for state-funded Medicaid (which includes demonstrating both poverty and disability), stealing moisturizing cream from a department store, or dying.
>I have personally taken care of a number of patients who did not want to put their family through the formidable weight of bankruptcy and opted for number three.
In countries with fully socialised medicine, if you’re not happy with the level of care provided you don’t even have the option of paying for better care.
In most countries with socialised healthcare, you can buy extra private health insurance that allows you to be transferred to a private hospital, for example, to receive better care if that is what you wish.
In this type of scenario, the government would still pay what it deems is the price of the service, then your health insurance will pay some % on top of that and the rest of will be from your own pocket.
Finally, even if you can somewhat argue for some potential benefits of private health insurance, in Australia I can buy the very best health insurance for me and my wife for the price of $AUD125 per week with no deductible and very small waiting periods.
In the USA I would probably have to pay triple that amount and have a 10k deductible on top of that.
Finally, not having to think twice before to go to the doctor is amazing.
My wife has a lot of health issues and even though I would love one day to emigrate to the USA for potential career opportunities, I know that not having a proper healthcare system is a deal-breaker because I want my family to be treated properly when they are sick no matter what kind of income we have.
https://www.theguardian.com/business/grogonomics/2019/jul/27...
He didn't sell meth to afford cancer treatment, he sold meth to preserve his ego and avoid taking money from his ex and his former business partner, to whom she was married, who had become wealthy from the business that he had thrown a fit and demanded to be bought out from years before.
Or find a chemist who was tempted by Breaking Bad but found the ethical problems and risk profile unsatisfactory, who would jump at the chance for a little profitable humanitarian patent infringement.
Which leads to an interesting HN startup idea (or at least a Cory Doctorow novel): SciHub, but for drugs…
Nice try, buster. The medical profession is one of the most intensely regulated that exists. There is simply no opportunity to sell "best effort gallbladder removal by a student who took some years of medicine in Guatemala". You would be instantly jailed for a very long time.
Even if, overall, the availability of such a service would save much more lifes than the current situation. Americans painted themselves into a corner: they asked the state to guarantee the quality of medical services while allowing providers to run for profit. What you get is an out of control lobby spiral that optimizes for more regulation that makes it even harder to compete, pushing competitors out of the market and the prices and profits of the incumbents soaring.
In Japan I had no insurance, but my shoulder bothered me so I walked in to see my doctor the next morning (no appointment, $100), he scheduled an MRI for the next day ($300), and two days later I paid extra to talk to the radiologist($75) to see the damage up close. By the time I saw the surgeon the next week, I already knew I should do physical therapy instead of surgery. In the US this would have taken many weeks and thousands of dollars.
Meanwhile, back in Seattle, a doctor said "take this paper to the emergency desk to get a scan". Bad idea, that cost me $5500 and 8 hours of imprisonment. I couldn't leave after the scan, I waited hours longer for the doctor on duty to give a diagnosis (for a scan?), and of course she billed me separately for that.
The many weeks part is not true, the $ part is pretty much random and unknown.
Every time I've gotten injured, it has been a next day appointment, or I just walk into urgent care, and an MRI/Xray scheduled a day or two later.
The imaging clinic my doctor uses provides a complete price sheet before any services are given, saying exactly:
1. How much the overall bill is
2. How much they will be billing and reimbursed from the health insurance company
3. What the patient's total will be
> Meanwhile, back in Seattle,
I'm also in Seattle, find a better clinic! (Also ERs are overkill for 99% of things, sucks if you get injured after Urgent Care hours though...)
It wasn't a big deal for me to be robbed like that, but for most working people a surprise unnecessary $5500 bill would be a real problem, so it's infuriating.
You mentioned this twice, but unless you left out some major details you were never actually imprisoned. If you demand to leave it's almost always a felony to stop you.
It was especially frustrating because I’d been asked to show up to the morning appointment fasted, and of course there was no food in the ER, but I guess it was more important to run up the tab.
I’d prefer a Mexican hospital any day.
this meme that the US has the best and brightest in everything and nobody else holds a candle is both hilarious and depressing. it is now costing people their lives and creating financial ruin, but it seems that US health parasites are still pumping it.
If the patient truly qualified for outpatient total knee replacement (orthopedic surgeon was out of Cancun in less than 24hrs per the article), the cost of this procedure would have been around $11,677 in the US at an ambulatory surgical center. Per the article, the cost of the procedure in Cancun was..."but at Galenia, it is only $12,000". I will definitely give credit where it is due, as the inpatient cost in Mexico would be far cheaper than in the US.
Disclaimer: I am a medical student, so please keep my biases in mind. I have no skin in the game, and I totally get that prices in the US are abhorrently high. Please read the following articles to gain a better understanding:
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.... https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144
Source: https://www.eurekalert.org/pub_releases/2019-03/hfss-nir0313...
EDs don’t have competition like outpatient surgical centres do.
The continuity of care is way better if you can keep the same doc once you get home.
Earlier this year she had a minimally invasive heart valve replacement (instead of opening all the chest they did via a smaller cut on the side). She was walking out of the hospital 4 days after the surgery.
We paid about $6500 USD which included everything. The mechanical valve, surgery, hospitalization, etc.
Some people pay a lot less than that since the price is according to a socio economic background check the hospital makes.
The US healthcare system just gets weirder and weirder, almost everything has been tried except fixing it.
Here we are 15 years later where they fly in surgeons and pay the patients.
Anyone want to build a system to connect hospitals overseas with insurance companies/patients?
[1] https://victorycasinocruises.com/day-cruise-central-florida/
I'm glad for the nhs.
This is what happens when most of the actual health care cost is going to fat administrator paychecks.
The more likely answer is: Everyone else is paid less and everything else costs less.
The extra costs in the US will be some combination of total nonsense, marginal (you should get some compensation when errors cause you harm) and very real (e.g. Replacing HVAC filters on schedule, having someone go through lab results for the last month's infections and figure out which antibiotics to use the next time when you can't wait for results).
This illustrates perfectly the point I (and most everyone on Europe) tries to get to Americans and often they - for some weird reason - refuse to understand: healthcare can be cheaper and better to everyone (yes, this means that universal healthcare can and is cheaper on the taxpayers in most of the EU than for American taxpayers... with ours being universal), if you just understand that the middle man you created by wanting the state out of it, is getting most of the money.
It's really so simple to understand...