We should look back to a time before national one-size-fits-all healthcare regulations that, based on crude generalizations, regiment a complex industry at great cost to innovation, and monolithic central-government-administered programs with no end user price incentives.
Also like I said, other countries get to utilize medical innovation produced in the US at subsidized rates.
And yes, for-profit healthcare should be allowed. Healthcare workers aren't all volunteers. They're doing it for money. The same applies to investors. Having laws limiting investment to philanthropy and taxpayers is totally destructive.
Healthcare costs are going down in cosmetic surgery, unlike other healthcare fields across the developed world. Cosmetic surgery is driven by price conscious consumers and profit-motivated practitioners. Self-interest is a powerful motivator and ignoring that leads to misguided bans on for-profit healthcare and inefficient, rent-seeking government-run healthcare bureaucracies and government-permissioned private industries shielded from competition by regulatory barriers.
>>Also we're paying for a lot of bad habits like overeating and not exercising. Lots of preventable diseases go into that mix, I dare say it's the majority of expenditures. There is virtually no governmental or social efforts being put into stopping those preventable diseases.
Agreed. I think health outcomes are mostly a result of non-healthcare factors. Having safer, denser and more pedestrian friendly cities would go a long way in improving health for example.
This is not normal. Go to any medical clinic in Europe, and it's no different from the tech sector. One office admin, lots of doctors and nurses.
And it's not cheap either.
If we cut hospital administration costs to Dutch levels (as a %-age of GDP) we could save about $140 billion per year. It's not nothing, but it's also only about 4% of total U.S. health expenditures. As noted in my response to a sibling post, all profit in the system amounts to another 6%.
So even if you cut out all profit,[1] and reduced administrative costs to Dutch levels, you get a 10% cut. It's not nothing, but it doesn't even get you 30% of the way there to cutting our costs to rich-OECD country levels (as a %-age of GDP). You still need to find another $875 billion or so to cut.
[1] Which is of course unrealistic, because drug companies in the EU make significant profits too, and most countries like Germany and the Netherlands have private service providers who make profits.
I thought the uninsured rate was closer to 10%. Some googling suggests 8% or 9%. This is short of 33%.
Of course many are insured but under insured, or insured but paying (or in I guess 66% of cases having their employer pay) for massive amounts of waste. There are entire industries like medical billing which don't strictly need to exist.
If the 23% are already paying, why do they need a subsidy from someone else's employer? I guess there is an affordability issue and rising costs ... but this is true for everyone, even those who mask it by going through their employer.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Then again perhaps the level US healthcare is considerably higher and it would mean lowering the average quality and availability of novel treatments.
If, for example, someone has a life threatening illness like cancer, they would gladly sell most of their stuff to pay to get their health back. Your health is more valuable than a garage full of Ferraris.
Taking care of that wealth is important. It baffles me how people can smoke sigaretes. It's like cleaning your Ferrari with a scouring pad.
Bad
Maybe you should consider that everyone deserves some wealth in general.
wealthy, adj. having a great deal of money, resources, or assets; rich
most people are not wealthy.
Health is not wealth.
You deserve access to life-saving health care you can't afford, even if you don't "deserve" to be rich.
If something isn't done, health insurance will become an empty promise. Even when people have it, it will be to expensive to be truly useful. There are already segments of the population where this is happening.
IMHO, that is massive wealth transfer: collecting all the premiums from working people and transferring it to the health care industry.
Paying for healthcare is, by contrast, not a wealth transfer because it’s payment for receipt of goods and services. As I outline in a response to a sibling post, profits account for just 6% of health spending. The rest goes to paying staff, for supplies and equipment, etc.
Which is also why cutting healthcare expenditures is a pipe dream. If you look at many places, the local hospital is the biggest employer. Nurses in the US make double or more what they make in the UK. Maybe we do a bunch of unnecessary tests, but we lay for lab techs to do those unnecessary tests. Real reductions in healthcare expenditures will require cutting salaries and cutting jobs, and that’s politically impossible.
Yes, some costs come down when insurance actually pays. But this still doesn't bring costs down to amounts that we see in Canada.
More and more no one can pay for healthcare anymore. Perhaps it will cost $3 trillion the first year but costs will drop as prices standardize and we start to see care become predictable. The alternative is prices that continue to rise with more and more bankruptcies and, eventually, more deaths due to lack of care. Even the insured cannot continue to afford these rising costs.
Wealth transfer... from where? The federal budget seems plenty big. $700 billion was transferred to banks staring in 2008, $4.6 trillion was paid out in eight years. I'd prefer a proactive solution, perhaps it will cost less in the end then our current plan to do nothing and fight what little regulation has been put in place.
Total domestic hospital profits (including more than just public companies) is about $74 billion per year: https://www.modernhealthcare.com/article/20180104/NEWS/18010.... Insurance companies are $25 billion annualized: https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... ($7 billion per quarter for health insurers). The link above shows $100 billion in drug company profits worldwide; about half of revenues are in the US, so let’s say $100 billion in profits domestically. That’s $200 billion for the US healthcare industry, including non-public companies in addition to publicly traded companies.
Total US healthcare spending is $3.5 trillion. Profits account for just 6% of that spending.
To reduce healthcare spending to the same levels as the rich European countries like Germany or France we’d have to cut spending about $1.25 trillion. Cutting healthcare industry profits to zero (and note that there are for-profit hospitals and drug companies in the EU and they don’t make zero profit!) would reduce healthcare expenditures by just 1/6 of the amount required.
Edit: oh yeah, and marketing. So much health industry money ends up in marketing. Something almost completely unnecessary under single-payer as well.
As to cost savings, you can’t use insurance industry revenue because that includes money spent on services. And a lot of the “paper shuffling” does need to exist under single payer. Most universal healthcare systems aren’t nationalized systems like the UK NHS. Germany for example has mandatory membership in Public health insurance organizations for those making under 60,000 euro. There are 100+ of those. Then 15% of the population has private health insurance. Care providers are mostly private. So there is still medical billing that needs to be done. Most EU countries are similar in that regard, and unlike the UK NHS.
As to marketing, now you’re talking about a drop in the bucket. Pharma industry advertising adds up to just $6 billion per year.
But people who advocate for this position (which, again, I believe in) all too often live in a fantasy world where we can magically switch systems and pay less. If we keep paying US medical personnel their prevailing wages, there is no way we’re going to lower costs.
Nurses and doctors are too popular in the US to ever even suggest that we reduce their wages to European levels.
Providing effective and low cost chronic care is an unsolved problem everywhere.
I can’t say that I support any and all entitlement schemes I’ve ever heard for chronic care, is why I was singling our acute care, where I do, but you’re right that I was mixing up arguments.
But of course when you provide low cost acute care, and don’t cover chronic conditions, there’s strong pressure for chronic problems to wait until they’re acute and harder to solve, and for chronic patients to use the acute system very inefficiently.
It is indeed a hard problem.
Yes, but some of this is funny money. Like when you go to the hospital and get charged $50 for a tablet of aspirin. I can see a coordinated national system to be far more efficient than the system we have now of fake list prices where some parties get a negotiated real price
Its not one guy digging a ditch and charging too much. Its that for every 6 people digging, 5 are racing behind them filling it back in and all of them are charging us for the "service".
First, the location and timing of accounting profits is not the same as economic profits and the return on capital.
Second, what do you think the point of single payer negotiation with healthcare providers is? The NHS in britian negotiates prices on behalf of the entire country. This system in the US would massively move producer surplus over to consumer surplus by reducing prices through negotiating power.
Lastly, healthcare outcomes in the US are terrible and prices are astronomical compared to Europe, do you think it's a coincidence that their systems are centralized while ours is distributed? The US system massively favors capital returns over service cost and quality.
Am not saying the system is problem free, but I've had multiple surgeries done for free, whereas in the U.S I'd most likely go bankrupt.
Also the point about waiting, not only did I not have to wait, but are you seriously comparing this to a system where I don't have to wait if am wealthy, but can wait until I die if am not?
> A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical.
Also the studies that are invoked for that proposition don’t distinguish between bankruptcies due to medical bills and bankruptcies resulting from reduced income due to health issues.
Your link makes no mention of mortgage or home loans. If they are included in the debts at bankruptcy, it's not in the least surprising that medical debt is "only" 12%.
The 12-13% was unsecured debt (which would exclude mortgages, which are secured by the house).
> This past year, the U.S. Department of Justice (DOJ) responded to a request by Sen. Charles Grassley (R-IA) by examining 5,203 bankruptcy cases from the files of the U.S. Trustee Program. The filings occurred between 2000 and 2002, the same time frame as the filings studied by Himmelstein and colleagues. The DOJ reported that 90 percent of filers had medical debt of less than $5,000. Of those reporting medical debts, those debts accounted for only 13 percent of total unsecured debt. The DOJ summarizes the evidence against Himmelstein and colleagues' thesis as follows: “The conclusion that almost 50 percent of consumer bankruptcies are ‘medical related’ requires a broad definition and generally is not substantiated by the official documents filed by debtors.”
The study is a little old, but the “medical debt is the leading cause of bankruptcy” trope is also old.
Never heard of it being the leading cause of US bankruptcy btw. My distinctly European perspective is it's problematic it's a possible cause at all.
Using this definition, everything is paid for, and nothing is free except sunlight. This is obviously a useless definition.
“Paid for by [someone else]” is “free”. There is no other useful definition of the term.