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Comment by magduf | Hacker News Reader

The US medical system is a complete disaster. Basically, the government doesn't pay for anything; only private insurers do. And they try to avoid paying for as much as they can get away with. On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.

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> Basically, the government doesn't pay for anything; only private insurers do

The US government does spend huge sums of money on healthcare.

Medicare and Medicaid are 21% and 16%, respectively, of total healthcare spending as of 2018. [0]

That's 37% of the total.

Given that total healthcare spending is about $11,172 per capita, that's $4,133.64 per capita. [0]

The UK spent £2,989 per person in 2017 in total. [1]

It's not correct to do so, but using today's GBP to USD exchange rate that's roughly $3850.

This puts US per capita government spending alone (keep in mind it's Federal + state) in the same ballpark as the UK's entire healthcare expenditure per capita.

> On top of that, the actual cost of care is far, far higher than in other developed nations for the same procedures, due to many systemic problems.

Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).

[0] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

> Sure is. This is a huge issue and IMO the issue to solve. But sadly, no candidate is really digging into why costs are so much higher outside of administrative overhead (which is real, but eliminating it doesn't solve the problem).

Has anyone estimated the impact of costly lawsuits->higher professional insurance costs->higher prices->higher medical insurance prices vicious cycle ?

That's a huge talking point among the right, yes.

Yes, but it's mostly not a huge issue in terms of overall costs. Many states already cap med-mal liabilities.

Currently, Virginia is capped at $2.4 million. https://law.lis.virginia.gov/vacode/title8.01/chapter21.1/se...

Sounds like a lot on first glance, but if you're young and lose a lifetime of income, or need a lifetime of assistance/follow-on care, due to negligence, it's a drop in the bucket.

> Specifically, physician salaries plus diagnostic tests comprise 4.04% of GDP in the US, compared to only 2.3% in the UK.

https://www.sciencedirect.com/science/article/pii/S001429212...

If you read more, I believe diagnostic testing comes out to 0.5% of GDP in the UK vs. 2% of GDP in the US, a far bigger effect than the difference in salaries.

So yes, there is some indication that lawsuits can lead to more tests and thus wildly higher testing costs.

I wonder if this is also leading to doctors to favoring newer medications that should be "the best" versus cheaper generics that would be more cost effective for a particular ailment.

Speaking of which, the way drug approvals and patents work also increases costs, and there are perhaps some small tweaks like permitting foreign first-world drug approvals to count in the US as well that might also help keep a lid on costs.

That is the rational for ‘tort reform’, to make these numbers more predictable.

>>The US government does spend huge sums of money on healthcare. >Medicare and Medicaid are 21% and 16%

Ok, I misspoke there, but the US government does not spend anything on you if you don't qualify for one of these two programs.

"Basically, the government doesn't pay for anything; only private insurers do."

That's not true. Poor people can get Medicaid, old people can get Medicare, and there are also various other ways of getting one's health care expenses subsidized by the government if you're poor or have medical reasons for not being able to work.

Just to be clear:

I'm for 100% state-funded medical care, but it's simply not true that "the government doesn't pay for anything; only private insurers do". The government does pay for quite a lot, even if many people in the US don't qualify for such aid.

They absolutely should qualify for such aid, in my view, but my opinion doesn't change anything. Some people qualify, some don't, and the government does pay for some, and private insurance does not pay for absolutely everything in the US. These are just facts.

If you're poor and you live in the South (and certain other states), you can NOT get Medicaid. Unfortunately this decision was left up to each state.

And even in states where you might be eligible, it's not going to help you (or the public) if you haven't enrolled.

Tricare for active and retired military and their families. Whatever the Federal government does for health care which I assume is some kind of government-managed insurance pool. Not sure how state, county, and city workers are covered (might be through private plans, might vary state to state).

Lots and lots of people already have "government healthcare". Just not enough.

You're focused on the trees, not the forest. The prior commenter is right: Unless you are very poor (and get Medicaid) or old (and get Medicare), most Americans receive no government assistance for healthcare.

That's just false. The US federal government spends over $1,000,000,000,000 on healthcare per year. Only Social Security is a bigger expenditure. It's almost twice what it spends on the military. It's 8.5% of its humongous GDP. That's a larger percentage than most European countries. Germany's the only country I'm aware of where the government spends substantially more of the country's GDP on healthcare than the US.

It should be noted, however, for spending a much larger percentage of GDP they are still only providing coverage to about 1/5 of the population while most other countries you're discussing are covering 100% of the population.

It should also be noted that they are covering the age group with the most medical issues. The other age groups have lower healthcare costs.

> Basically, the government doesn't pay for anything; only private insurers do.

The US government spends about the same on healthcare as many other governments, which makes the terrible standard of care even more confusing.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

The US is a disaster. Even if everyone in the country caught the virus, and 2% of the population died from it as a result, we'd still be in the same exact situation because there's a majority of people who believe that reality is biased and that some people need to suffer. There would be a huge part of the population who would see the lack of government response (due to a lack of funding and leadership) as a fundamental reason for why we should reduce the role of government influence in these situations.

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