US spent more on health care in 2022 than 6 countries combined with universal
statnews.com
statnews.com
Average physician salary in the US: $352,000[2]
That’s a big chunk of the difference. Simply changing who pays for your healthcare won’t close that gap.
[1] https://www.erieri.com/salary/job/physician/france#
[2] https://weatherbyhealthcare.com/blog/annual-physician-salary...
Physicians per 1000 people:
Germany: 4.25
France: 3.27
USA: 2.61
One of the major reasons the U.S. has low physicians numbers is because med school is just so expensive. You either have to pay a ridiculous amount of money upfront, but more importantly, need to figure out how to pay for your existence for nearly your entire 20s where you’re studying and not earning, or you need to take massive student loans.
That’s just too much of a ln upfront burden or risk for large chunks of the population to take.
Doesn't the US also require that people study medicine as a second degree? That can't help with the costs...
e.g. Here in the UK you can go straight from high school to study medicine at university.
How can they be more restrictive when they are licensing way more doctors? USA is at the bottom of the developed world in number of physicians per capita but also pay the most. The only plausible way that can be true is if USA is the most restrictive in the developed world, like requiring way more years of schooling than necessary or limiting residency spots or limiting how many schools are allowed to educate doctors or making it hard for immigrants to become doctors etc.
Japan has less doctors, but they are also among the healthiest in the world so maybe they don't require as many for that reason. But USA is at the other end of the healthiness spectrum so you can't use that explanation there.
The cost of employee is around an additional 22% of Salary in France but around an additional 140% in the US [1] (401k, SSA, Health Insurance, etc), which brings the total spend much higher in the US.
[0] - https://www.internago.com/how-much-does-it-cost-to-employ-pe...
[1] - https://www.sba.gov/blog/how-much-does-employee-cost-you
Those 22% you mention is extra cost for employees, on top of the gross salary (in Croatia that's called gross1, while the actual total amount for employees is called gross2)
Holy cow, really? Is this a case of over-diagnosing things, or are virtually half of Americans legitimately struggling with multiple health issues?
There isnt much incentive in the US to prevent disease, doctors make their money from visits fees, procedures, etc. Not saying they purposefully make people sick, but I think there is some Darwinism in a system like this -- a hospital system that keeps people healthy would wither and go bankrupt because hospital systems dont get paid to keep people healhty, they make most of their money when people get very ill.
what usually causes this also causes a bunch of other chronic issues. So, yeah.
Life expectancy rates in the US were going down before COVID. Chronic illness.
The numbers aren’t looking good. Unless you’re trying to make money on healthcare. Healthcare income goes up when health goes down. Capitalism.
Far more than a super majority of those with high cholesterol are due to lifestyle. At my least yearly doctors appointment I asked about the genetic case. My doctor, in his mid-40s, said he had only had a few patients with that in his career. I've listened to lipid PhDs lecture and they talk about it being rare but present.
We cannot change the genetic case. But everyone else can be affected.
I was talking with someone recently who changed her diet. In a matter of weeks her LDL cholesterol dropped 50 points.
Can you provide any basic literature on how large of an effect can be achieved through lifestyle alone? It sounds like my vaguely recalled ~15% is way, way off.
(I do wonder how statins are so easily justified if lifestyle is so effective, but pharma profits/lobbying may explain that.)
Instead we as a country are glamorizing obesity, which has become a bizarre and deadly trend in the USA, we should attack it like we did smoking.
Even my local doctors office is advertising how you can be 'healthy at any weight' - talk about gaslighting, no you cannot.
Without a doubt the 'healthy at any weight' campaign is directly or indirectly funded by food companies and drug companies - neither of them which want thin and health populice.
The body positivity movement, plus sedentary lifestyles, plus the increasing cost of healthful foods, the time it takes out of your day to exercise, almost mandatory amounts of sitting in a car daily… there’s a lot of factors in modern American life that are just bad for our health. It’s not just the money spent on healthcare.
in many cases, when looking at total life spending, things that kill you earlier actually can reduce total life spending (smokers are a great example) because it means you don't incur the three knee replacements and bouncing in and out of hospital for the last 2 years of your life and spend the last 2 weeks dying in an ICU. Having a heart attack and dying on the surgical table is pretty cheap in terms of total healthcare spending.
Obesity is still cost-positive, but it's a lot less than you think from numbers like "X% of total medical funds spent on obesity" - you are going to substitute around 50-75% of that cost in cancer treatment and knee replacements instead (see table 2).
https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/do...
anyway, one of the problems is that obese people are massively stigmatized and shamed. they are already treated worse (and receive worse medical care, etc) than others, for every moment of their lives, they have constantly-reinforced negative body image, which is psychologically unhealthy to impose on people. And the point of "healthy at any size" (when not taken to an absurd extreme) is to get people to at least feel like they aren't so far gone that it's pointless to make better choices, because starting to make better choices are the foundation of starting to climb out.
This is usually met (even here, in past discussions) by some variety of "good, they should feel bad", and "well, I was fat and it helped me!", but that's basically a riff on "my parents spanked me and I turned out fine". Not only is that probably not a medically-supportable opinion (stress and fear are themselves powerfully negative causative factors that place actual physical damage on the body over time), but not everyone's brains work the same in the first place. What inspires you to improve might just reinforce someone else's depressive spiral, a lot of obese people have very negative body image ("good", says the peanut gallery).
Black Mirror wasn't wrong, people love having an underclass to look down on, and obese people are a very visible and very socially-acceptable underclass to punch down on. A "steelmanned" view of HAES, when not taken to ridiculous extremes (and I'm not saying nobody does!) is that it's simply asking that we not go full Black Mirror on shaming fat people, but frankly I think a lot of people don't even agree on that much, or that it would be a good thing. "It's for their own good" etc.
The whole reaction to the idea of HAES, itself, is a microcosm of the social problems around obesity and self-image - how dare you feel good about yourself? Why aren't you going through every day in a haze of shame like you deserve to? It's for your own good!
While obesity is a huge issue and a huge cost factor, there are more obese countries with nevertheless a tiny sliver of the US medical budget - even after adjusting for life expectancy.
Some issues could be resolved completely if attended to early, but instead the patients suffer until they have no choice.
If it were free/cheap to visit a doctor then more people would go, which would cut down on long-term suffering.
and doctors don't even try to solve that problem anymore - they just push pills to counter the bad diet and bad lifestyle.
You can point to activity levels, but weight is about food consumption, not activity levels, and (eg) Aussies are a pretty car-reliant culture too. Pretty much any way you can argue that the US is "unique" - it's not, we are a culture exporter and some other place has inevitably picked up some of our habits.
Americans aren't even uniquely fat anymore. There are other populations (like aussies) that are getting close to our obesity levels and they still don't 5x their healthcare spending. And the idea that obesity makes up even a simple majority of total healthcare costs (as it would need to be for this to be the factor that 2-5x's healthcare spending) is generally ridiculous.
(also, paradoxically, a lot of things that we think of as unhealthy actually reduce total life healthcare spending, because US care is heavily weighted towards end-of-life care. It's cheaper to die of lung cancer at 40 than to have three knee replacements and spend a month in the ICU at 80, and US health care is heavily weighted towards the latter because of medicare, everyone else struggles to get affordable access to the system.)
Like it would be interesting to see an attribution of what specifically americans are eating so differently vs everyone else, and the caloric/macronutrient balance and total inflow/outflow, and total life expectancy (and total spending) changes. I suspect it's just a "how much of it" more than anything, but the "gosh americans just eat like shit, that's why!" really doesn't justify 5x per-capita expenditures on the face of it, in the way people try to use it. The rest of the world drives cars and eats like shit, and eats too much too, in varying proportions.
But to go back to spending - it's really hard to argue that it's any one thing. It's everything. Everyone at every layer is bleeding everyone else. Americans are a bit unhealthier, but we also have for-profit hospitals (even non-profits make a "profit", it just goes into real estate investments), for-profit insurance, doctors who make $400k because they need to pay off $300k of loans from for-profit education, drug and device manufacturers who have no cost containment before approvals, a political system that tolerates evergreening and similar practices, an "access problem" for delivering basic care before it escalates into expensive problems (even "preventative care" often still ends up costing), etc etc.
That is really the problem and why the system cannot be reformed. Medical care is at the nexus of every single "unsolvable problem" of the US political system, from patents to education to farm-lobby and environmental regulation, and it involves a million taking hands that after a true reform will no longer be able to take. There is a lot of people who have become reliant on the revenue streams from this rent-seeking/unproductive activity, and they will lobby heavily to make sure they can keep taking.
1. Where “western diets” go in the world we see healthcare costs go up.
2. The US fits the bill for about 90% of the global R&D costs on healthcare. Many universal healthcare systems only fund existing methods.
3. The US is more unhealthy than most other places. This can be observed with higher percentage of the population having chronic illnesses.
People wake up, go to an incredibly stressful workplace and use up all possible productive hours of the day, come home extremely tired, pop on the incredibly stressful news cycle and get permanently angry as they eat their TV dinners, then fall asleep in their chair as the news continues to unsettle and disturb them even in their most peaceful moments. I've seen this over and over again, it's how a lot of people live here.
There's a million places a resolution to this type of issue could start, but damn it's gotta start somewhere!
Most doctors are never taught to deal with lifestyle. It’s sick care with things like medications and surgery. Doctors office visit won’t address this for most.
I agree - it won't come from doctors - there is no financial incentive to keep people healthy.
and even more so, patients don't even want to hear it, they want the magic pill instead.
What if people just never had most of those issues that require treatment?
In a healthy individual, cholesterol intake is not related to blood cholesterol levels (beyond some reasonable threshold, like not eating a tub of lard in one sitting).
I have many friends who are doctors. There is the salary they make, and then there are all the extras. Some have used their salary to buy the equipment in their office, and charge thru for equipment usage (added money on top of salary.)
Some have used their salary to buy the building used for their medical practice, and charge thru the facility fee (added money on top of salary.)
I agree both are "investments" but it is a non-traditional investment where you have a huge edge and a ready customer.
Politicians pushing single payer or similar such state owned entity are just looking for power and influence.
Also I don't think you can come up an example where transitioning from private to state operated enterprise has improved the quality of service. Tragedy of the commons/OPM etc.
I mean, it absolutely will.
Well, look at all the other countries where universal healthcare has been implemented.
> The government essential funds colleges educations (through loan guarantees and grants etc) for tens of millions of students - has that driven down the cost of college?
Look at all the countries with free university. Yes, the cost is lower.
> or did it have the opposite affect?
Fixed fees and a single payer obviously would have that effect, like everywhere else it's been tried.
Oversimplification. Most countries that have universal healthcare do many other things in addition that you aren't accounting for. The US healthcare system is not the same as Europe's but its not single payer.
>Look at all the countries with free university. Yes, the cost is lower.
See the above.
>Fixed fees and a single payer obviously would have that effect, like everywhere else it's been tried.
So now you're starting to get the idea. It's not just single payer. Never was.
Edit: I do love the deliberately obtuse comments from Americans on political topics like education, healthcare, gun control, etc. It's hard to believe intelligent people honest hold these absurd views.
I'm not saying single payer wont work. I'm saying single payer on its own isn't a solution because so much more is broken that isn't broken elsewhere.
If students were given grants, and universities were given grants, and that was all the money on the table, what pressure would there be to increase the cost of tuition?
None - and we know this because the more the system was privatised and deregulated, the more fees started shooting up.
Forced debt is slavery. Whether it's medical debt, educational debt, or rentier landlordism, it's the deliberate creation of unnecessary scarcity to reduce the personal agency of most of the population.
What is most baffling to me, as someone who isn't from America, is how expensive even the most basic tests are.
A CT or MRI (which are admittedly expensive machines) scan shouldn't cost >$1000, and it probably doesn't anywhere else in the planet.
[1]: https://www.npr.org/sections/money/2019/03/12/702500408/are-...
> Baker estimates that the salaries of the roughly one million doctors in the U.S. account for about eight percent of total healthcare spending.
> What is most baffling to me, as someone who isn't from America, is how expensive even the most basic tests are.
If you understand the former, then why is the latter baffling?
The cost of any tests includes labour...
I feel like this is the crux of the US's issue. We have medical care deserts and for many people the hospital is the only way to get something taken care of. This is where the US is different from many other wealthy nations. We really don't get economies of scale at all. We have cities, but a lot of our major cities juet have nothing like the population of other nation's major cities.
If I may ask a personal question, why?
https://en.wikipedia.org/wiki/List_of_countries_and_dependen...
I don’t think this is it. European cities aren’t that big compared to American ones. So Spokane is larger than Geneva. The problem is there isn’t much in terms of healthcare between Spokane, Boise, and Minneapolis.
In Geneva's case, it is composed of several different named cities/towns/etc and those taken together are bigger than Spokane plus the municipalities that comprise its urban area.
And Spokane is a small case. There is nothing comparable to the Seattle metro in Switzerland. The closest you get is Paris in France or Milan in Italy.
I have no connection to the company other than as a satisfied customer.
This is exactly the attitude as to how American costs are out of control. If American healthcare budget was halved (which is still much more per person than other nations), then physician salaries would be 16% of the total. If American healthcare budget was a quarter of its current total (in line with many other nations spending), then physician pay would be 1/3 (32%) of the entire spend!
Clearly, if American healthcare is going to see a 1/2 or even 3/4 cost cut as the proponents of universal/single payer healthcare predict, then physician pay must take a similarly massive cut.
Just as you can find reasons why physicians cannot take a pay cut, so too can every slice of the pie claim that their slice is valid and uncuttable.
Why does just about every doctor in every universal system make dramatically less than their American counterpart? Is their expertise worth less?
A lot of areas already have trouble attracting doctors at all because they can’t compete with the money offered by bigger richer cities. If you want cheaper doctors, something else will have to give, or supply will just plummet.
Most of those doctors European doctors probably got their degree with almost no tuition paid. If I wanted to become a doctor I could start now, and finish in 5 years with zero debt. It wouldn't be an "investment" in any more than my own time and effort.
But I think this shows that the healthcare is just one part of a large interconnected system of things. It's not easy to change into a french or UK or scandinavian healthcare model with great savings if doctors expect to make $300k/year because they made an investment. So single payer universal healthcare might need more doctors and nurses trained with tax money? But when I go to a university to get my tax-funded MD, that university is most likely a public institution too. You wouldn't have a university taking a huge cut of that money.
On the other hand: a US resident dr makes what, $60k? That's comparable to European doctors. I wouldn't make $100k for quite a few years. The first "residency" period here would proabably be more like $50k or even less. But with zero debt that doesn't sound horrible.
US healthcare spending 2023 [1]: $4.7 trillion, 16.6% of GDP, $12555 per capita
France healthcare spending 2023 [2]: €0,34 trillion, 12% of GDP, $6630 per capita
How many physicians can you hire or pay better with an additional $4.x TRILLION?
[1] https://www.oecd.org/unitedstates/health-at-a-glance-United-...
[2] https://fr.statista.com/outlook/co/health-indicators/health-...
That line forgets the size of the populations. US population is 333 million; France is 65 million.
How many more physicians can you hire with an additional $6000 per capita? That is a relevant question.
> That’s a big chunk of the difference.
The math disagrees with you.
Are you confused as to the meaning of 'big chunk'?
It by no means implies a majority or even close to a majority.
If you are confused about my previous comment, I added the 40% to 50% example to demonstrate the likely overall contribution of salaries to costs.
This appears to be a random pseudonym account so it's unproductive to phrase it in this way, because it requires a lot more credibility to back it up.
A simple counterexample: I clearly think 10% is fine, and I've met at least a few dozen people who share a similar view. Which suggests it's a common enough sentiment among HN readers.
I've met at least a few dozen people who share a similar view. Which suggests it's a common enough sentiment among HN readers.
Like who?
It appears to reinforce my point, in that it never defines 'large chunk' to have any specific range of values. Certainly not anywhere near a majority.
> Like who?
Some of the human individuals I've met and talked with throughout life.
This seems like ignoring the question, so the opinion is noted, but it doesn't sound convincing.
I still stand by my belief.
Is there some rationale behind the seemingly incredible agitation, and bizarre attempts at deflecting direct questions?
Otherwise this just seems like a self-parody.
If you'd please review https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here, we'd appreciate it.
France is one of the less efficient in europe due to having a dual system, the universal part is very efficient (5% of budget spend on operational costs), the other part, operated by competing organisms, loses up to 20% of their budget on marketing, plus the general operating cost of having a multi tier for insurance coverage.
So, just keep in mind with these types of news, it might be more economical system overall when you look just the numbers, but it's not like everything is working great in EU either...
Are you in a city, perhaps? That is not universally true across the US, in my experience.
You also factor in a percentage of their salary incase you need to exit them (maybe doesn’t apply to doctors). I’d assume the states is still ahead but not as drastic as the shared numbers
I think it's basically a fantasy to imagine that the US could have affordable healthcare if only the system was reformed. Rationing of various kinds is the norm in single-payer systems, because everyone wants the insanely expensive new drug when it's their health and someone else is paying; I don't think that America can do much to control their healthcare spending if they aren't willing to engage in a serious conversation about what they don't want to pay for. Even Medicare covers tons of stuff that I wouldn't get from my universal single-payer system.
We also need to consider hospital, ER and ambulance costs.
In this case, having a single universal plan can greatly reduce those costs.
https://www.pgpf.org/blog/2022/11/how-much-does-the-united-s...).
The US population is so indoctrinated with baseless propaganda that it will take a century for it to move to a better model.
The overall point though is not to sit on the laurels and try to hammer in "one right way" of doing it, but to iterate until you find a legislative healthcare framework that works for your country and benefits most.
The lack of progress in US on health care front is an indictment of its political rigidity first and foremost.
The numbers are inflated because you get charged hundreds of dollars for an aspirin tablet in an emergency room and thousands for a 10 minute ride in an ambulance. What is particularly sad is that to the rest of the world this is absolutely insane but if you try to explain this to Americans they'll tell you they don't want no stinking communism. It's fascinating how deeply indoctrinated this nation is.
Development and financing are the big killers. Play with some numbers on a spreadsheet—they get big.
I used to be one of those people. We immigrated to the USA when I was very young, so as I grew up I went extra Right/libertarian, thinking that would make me "more American" somehow. I now realize that this is very common in US immigrants.
It was the US health system that showed me the undeniable faults in pure libertarianism. It all seems so obvious now:
In a government run health system, dollars put into the system which do not end up going to patient care is called waste, it is seen as a negative and we work to minimize it.
In a privatized for-profit health system, dollars put into the system which do not end up going to patient care is called profit, it is seen as a positive and we work to increase it.
It's that simple. For-profit-all-the-things is not ideal. The main lesson I learned is that stubborn ideological purity is fraught with issues, no matter the ideology.
For one thing, if you go through the exercise of examining the parts of the healthcare system and ask yourself "how much is the state involved in this", I think you may come to a different conclusion. I don't know what to call our trash heap of a system, but libertarian seems obviously not it.
On my part of the exchange, might I suggest that what you see as government involvement could also be called "regulatory capture"? [0]
What I mean is that the monied interests now have major influence on the government which regulates them, so they create "regulation," with the goal of perpetuating their own profit centers.
How can I do better from your point of view? If not libertarianism, what should we call the ideology or ideals that led to this healthcare system with an ever increasing chain of profit centers?
Libertarianism is about liberty, or individual freedoms. Are you free to purchase any drug or test or service or device that you want from whoever you want? Of course not, the state is heavily involved in making these decisions for you.
To help identify what the heck I am talking about here, here is ChatGPT Classic's take on "libertarianism vs capitalism vs crony capitalism vs anarcho capitalism" [0] I found it very good reading.
What I realize now is that I was only holding on to one aspect of "libertarianism."
> Free Markets: Supports the idea that a market free from government interference naturally leads to efficiency, innovation, and wealth creation.
If I may be introspective for a moment, I believe that the reason that I may have used libertarianism instead of capitalism, is because how polarizing "capitalism" has become in the US discourse. I feel like readers would assume that if I am making light of capitalism, then I must support communism or some equally obsolete ideology.
[0] https://chat.openai.com/share/c4f4cedf-a995-4cc5-8feb-268c7c...
Even some of the insurance systems are non-profits. It doesn’t take shareholder profit motive to make money evaporate.
In this case... while my specific terminology may be lacking, if we zoom out and just compare the US healthcare system to other countries' systems, we demonstrably see lower per-capita spending and better patient outcomes. [0]
If we could agree on those facts, can you help me use the correct words to describe the issue?
[0] https://www.commonwealthfund.org/publications/issue-briefs/2...
Is it all shareholder profits? Employee salaries? Re-investments into research? Marketing and sales budgets? Defending from liability lawsuits and liability insurance? Taxes? Construction workers that charge more for building hospitals than they do in other countries? What the hell is going on here?
The fact that the US spends more on healthcare isn't very interesting to me on its own. It doesn't really say what the US can do about it, moving to a single-payer system can reduce prices due to the government's bargaining power, but it can also increase prices and decrease quality due to no competition and no reason for anybody to care about efficient spending. If consumers have no choice, they will choose the option you provide, no matter how bad it is. A breakdown on what exactly the US spends more on would be far more enlightening.
If more money flows into the healthcare system, more money must flow out of it, and where exactly those outflows are is a far more interesting question for me.
Still, that's only 20%. Would single payer reduce the other 80%? If so, how?
For example, most doctors don’t help people avoid heart disease. Instead they watch for it or things they can treat with drugs that can lead to it. Then try to help people manage it that. I’m not blaming doctors, it’s the system.
If we targeted health care and generally good health over the course of our lives, cost could radically go down. And people would have far fewer issues.
</rant>
The reason is the same reason that smokers actually saved the health system money (source: https://www.nejm.org/doi/full/10.1056/nejm199710093371506). People who live longer use more and more expensive healthcare.
And there are people who specifically aim to be elected to kneecap government services.
[0] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
The headline says exactly what it seems to say. It does not imply any normalisation per capita.
I’m not sure how the headline is misleading in any way.
This headline: the US is spending 6 times what comparable countries are spending on healthcare
Yes - it's very misleading
It seems like a totally straightforward headline to me. There’s no mention of per-capita, no mention of some sort of multiplier.
It actually seems like quite a generous headline to me, given that it is talking about just the US government (when most of our healthcare system is privately paid).
Second of all, reality isn't that the US spends 1.5 times the money. The reality is that the US government spends 1.5 times the amount that these other governments spend.
But somehow in the US people still need to buy private insurance. Even though all people in the other countries get universal healthcare for less public money than the US already spends on healthcare.
It's meant to illustrate how cost inefficient the healthcare systems in the US is.
Yes, that's exactly the point: to compare the US with a similarly sized block of nations.
And from that we can conclude that this block of nations can service universal healthcare to 330 million people without additional private healthcare insurance.
So for less TAX money than the US they get universal healthcare for the same amount of people, while US taxpayers pay more but still have to buy insurance on top of what the government spends on healthcare.
Is it fair to include Germany here? I thought the German system required everyone to have private insurance through their (breadwinner’s) employer. But I’ve only heard this via self-employed people complaining of having to pay €300 a month in health insurance. To me it sounds more like the American system than the UK one of everything just being free and state-funded. But as I say, I only know through hearsay.
If you're employed, your company pays for half the insurance cost, be it private or public. This means that it's expensive for self-employed people.
If you are self employed, you can choose to stay in the regulated system. However, since you are now both employer and employee, you have to cover both sides of the fee. For many self employed people, switching to a private healthcare provider saves them money, because there the fee, depending on some factors, is usually lower - it does no longer depend on the gross salary, but on the insuranced person's personal circumstances. However, private healthcare provides are to some degree also state regulated; there is a minimum set of service they are required to provide.
The cases of regular employees that don't go with state regulated healthcare providers are low. The cases of self-employed people that don't go with private healthcare are low. If you make enough money, you can start calculating wether switching to the private sector is benefitial to you. But it is impossible not to have health insurance, and it is impossible to go bankrupt because of health related costs in Germany.
And here, if you adjust for GDP, the effect disappears. And in fact, in rich countries, it is normal for healthcare expenses to go up in proportion to GDP since health is a basic need and not a solved problem. That is, rich countries can give food and shelter to their entire population but there is no panacea.
It doesn't mean it is good for the US, but it is a dubious statistic to pick when you want to highlight a disfunctional healthcare system. Try life expectancy instead.
Sometimes I completely understand, sometimes I somewhat understand, but in this particular case? There is a good exchange of ideas going on.
Yes, I know the first rule of HN club, but this is a deserving topic.
On one hand when my mom had eye problem that required spending 2 weeks in hospital and surgery, she didnt have to pay for it except for some simple things that were cheap
On the other hand im paying not small amount from my every salary for health care and due to wait time or quality I still often go to private med (except for basic sickness where doc can give me a week or two "sick leave")
Also Ive been pissed off when I had serious surgery (at private med) and my insurance didnt cover it (but ok, thats insurance not univ. health care)
All of that makes me feeling like im paying a lot for mandatory health care and things like insurance
And at the end of the day I must go and pay for private health care. At least my mom didnt have to pay.
I feel like im getting scammed. I'd rather manage my own money and how I want use it
Your “how I want to use it” is completely out of your control and based on when you fall sick, get injured, need advice, etc. Nonenof which are choices you make. So even an extremely efficient entirely private system doesn’t allow you to either manage your money nor allow you to choose how you want to use it.
You could take insurance, but again, you’re neither managing your money nor choosing how to use it.
Medical expenses are not like buying a toaster that you can decide to put off or buy whenever you want or never if that’s what you prefer.
Also, in any modern decent society, if you choose never to eat toast no one is concerned. However, if you’re dying on the street because you aren’t paying for medical care society will step in. So there’s also a burden you’re imposing on society based on your choices that are not involved in most non medical situations.
Some.
Not all medical cases need instant contact. Proof? Months or years long wait times.
Also for me 99% of the medical expenses are around 10-20% of what I pay every month. Meanwhile those medical expenses arent regular.
>Your “how I want to use it” is completely out of your control and based on when you fall sick, get injured, need advice, etc. Nonenof which are choices you make.
So how people do it with cars?
Cars break often, especially when poorer people must use used cars
They often rely on them to get to work, so they not always can delay fix endlessly
You just have backup of just in case money.
>. However, if you’re dying on the street because you aren’t paying for medical care society will step in. So there’s also a burden you’re imposing on society based on your choices that are not involved in most non medical situations.
Thats the reason.
> This means the U.S. government spent more on health care last year than the governments of Germany, the U.K., Italy, Spain, Austria, and France combined spent to provide universal health care coverage to the whole of their population (335 million in total), which is comparable in size to the U.S. population of 331 million.
They lumped together six countries to get something with a similar population and use that as the comparison. Of course you may argue that the US is too exceptional to compare, this wasn't addressed.
In what sense?
Honestly, I'd like to hear from Canadas and Australians about the rural experience. They have the same density problems and I think their solutions are nore relevant. That said, I'm not really a fan of the outcomes from Canada, so who knows maybe high population, low density is just a bad hand for a country in this context.
Note this is in no way a defense of the US system, which is messed up six ways from Sunday.
And yes, there is. At least in comparison to the US system: "Universal" means everyone gets a basic level of care.
... Rations? There are no set limits, though they might not build another MRI machine if the existing ones aren't being used enough. It isn't like health insurance doesn't limit your care: They just tell you they won't cover x or y. And your denial of care will be different than what your neighbor gets in the US instead of everyone being treated nearly the same.
My drugs are covered in general. And when I purchase them, most are fairly cheap compared to the US.
Wait times definitely exist in the US as well, especially if you are waiting on a specialist, who likely isn't in your area unless you live in a big enough city. At least when I have wait times here, I get paid time off work if it is necessary.
Mental health is included.
Acupuncture isn't actual medicine.
Dental and vision aren't included here: Vision isn't generally too expensive (my partner and I both wear glasses) and dental has a discount. I think these should be included, though. Still better than dental insurance in the US - at least i can afford a dentist here. The dental is included in some systems (looking at you, Brazil).
In short, the complaints are the same in most places. Especially in the states.
That is simply untrue, the only thing reminiscent of "wait time" is the actual scheduling of an appointment - ie call the office and they pencil you in for next Thursday or something. Or if you actually walk into an ER with something trivial.
https://www.washingtonpost.com/wellness/2023/10/30/medical-a...
That's not too bad. Until you start counting people who never get to a doctor because their insurance doesn't cover costs.
Now after I've seen that doctor once? Now I can make almost same day appointments and I have access to staff nurses for basic questions, etc. But yeah the wait for specialists can be long. It's usually not for generalist specialists. Like I saw a neurologist within a week, but the really specialized neurologist I got recommended out to was a 3 month wait.
That's an extremely dismissive take on a practice that has been around for an extremely long time.
"Alternative medicines", which itself is a dismissive name, get thrown out way to quickly in the west.
My argument wasn't that alternative medicines must be just as effective because they're old. My point was simply that hand waving anything that isn't western medicine is a very close minded view in a community that is so often pushing for equality and open mindedness above all else.
Also: if the gov't buys as a "single buyer" it has a lot of purchasing/bargaining power. The system in the US is (lobbied) to not give the govt any power, and put it all in the hands of the market (insurances, etc).
It's be said many times: never let a capitalist come near your healthcare system.
You guys want a free lunch, expect free lunch quality.
How exactly is it unscientific garbage?
Don't get me wrong, the data I've seen showing Americans are one of the most unhealthy populations in the developed world is clear. I'm saying the article is unscientific, not that the American people are healthy, or have great health care service.
The US GOVERNMENT (not the US as a whole) spent more on health care ($1.8 trillion) to provide non-universal healthcare than 6 European countries with a combined population similar to the US did ($1.2 trillion) to provide universal healthcare.
The article's premise being, it costs the government significantly more per person, and 50% more in total to run a non-universal healthcare system serving a subset of the population, than it does a universal healthcare system which covers everyone.
As a whole, the US spent $4.5 trillion (private+public).
"The United States perfoms better than the OECD average on 29% of indicators"
https://www.oecd.org/unitedstates/health-at-a-glance-United-...
Most European nations hover around 8-12% of GDP.
Eyeballing an average of 25% obesity among the EU countries with the US having 36%, means the US has 44% more obese people per capita.
While that doesn't explain all of it, it surely is a significant contributing factor.
[1]: https://worldpopulationreview.com/country-rankings/obesity-r...
So it’s probably shaving off a few years of the most medically expensive parts of a person’s life.
Surely they wouldn’t figure out a way to produce even less nutritious, less satiating, more flavorful (and therefore calorically dense) foods, would they?
Also cigarettes and alcohol don’t crowd out healthier alternatives on retail shelves the way that unhealthy foods crowd out healthier ones.
Drugs like Ozempic don't just work on obesity, but they look like they may also work on addiction in general. There's also the second order healthcare costs of obesity that people don't think about - knee replacements for example. I think you're underestimating how much money would be saved in healthcare by reducing obesity rates.
If the US could improve their food, or Europe could get rid of smoking, it would be a big jump in health outcomes for either.
[1]: https://worldpopulationreview.com/country-rankings/smoking-r...
It has not gotten better since.
We spend more via taxes than any other country spends total... and then we tack private spending on top of that. We've picked the least efficient, worst aspects of both types.
lobby + pure capitalism is creating a system where anyone who has more money can push ideas to make even more money and use an excuse that this is a free market balanced by supply/demand, because pushing many millions to lobby their ideas is not trivial or almost impossible sometimes.
(Even beyond that, bizarre idea. “Oh, I think I’ll go for a _designer_ MRI scanner” said no-one ever; by and large, the expensive bits of health care don’t have a lot of choice involved.)
We did vote for Obama who gave us the ACA. And a number of states have banned surprise billing from out-of-network doctors. And hospitals are now required to post prices, but they ignore that
So there has been change in the last 20 years, but clearly we're spending more than ever.
That said, the US system is pretty much the best in the world if you're wealthy.
At the end of the day, it's completely in line with the American cultural norm of promoting the material success of the successful. It's why some of the world's best doctors are in the US, why people on this website think half a million USD "total comp" isn't that crazy, why the US has such a dynamic startup ecosystem, and so on ...
When you consider that, it all makes sense. I wish Americans were more upfront about this being their culture though, and others in the world more understanding that this is what they are collectively trying to achieve, rather than an abberation. I'm not passing any judgment, just observing -- though anyone is free to of course.
All in all west european health care, particularily british, looks like east european health care used to - but indeed without the bribery and arrogance that plagued that system. At least not at the same level, yet.
Not to mention that it is extremely expensive. You pay for public health care and on top of that for private health care without a tax deduction. So if you are a worker you are likely stuck waiting in long queues only to be sent home with a misdiagnosis. Your employer provided insurance will cover at most one or two visits to a GP per year and that's about it.
The NHS is indeed collapsing, but my understanding is that this is a combination of (1) underfunding, (2) Brexit, which caused many healthcare workers from the EU to leave the country, and (3) an incompetent, corrupt, far-right government that hates public services and would like us to move to a monstrously inequitable but profitable US-style system (but know they can’t say that out loud).
In the context of comparing total government spending, that's a really important caveat.
> (3) an incompetent, corrupt, far-right government that hates public services
Isn't that a problem with a fully government-run system in general? Preferences and motivations in leadership change over time. If the people are dependent on the government program to function they're also at risk of being helpless if and when the government stops running the program well.
That is a risk. At least in the US you can be certain the consistent goal of the private healthcare system is to part you from your money. :)
Whether that's worth all the downsides it can cause, I'll leave that up to the reader to decide...
I really really wish the british public would reflect more on understanding how corruption works, because "government that hates public services and would like us to move to a monstrously inequitable but profitable US-style system" is precisely that.
Constantly demanding higher taxes to patch the system is one of the means the public is steered towards wanting it to be privatised, yet many fall for it.
> Brexit, which caused many healthcare workers from the EU to leave the country
Turns out european workers were not in demand because they were cheap, but because they had critical expertise. Allowing people to come in and work on equal terms and equal pay meant attracting the best and the brightest. Now the system attracts the desperate, willing to work for nothing and providing quality comensurate with pay.
And this is reflected in all areas of life in the UK, private or public. The number of times I had to correct my lawier, solicitor, doctor, mechanic, plumber, and electrician, is ridiculous. Take this as a cry for change as I love this country.
For example, instead of just publicly funding hospitals (you know how the Government can issue bonds at lower cost than private finance can borrow, before even thinking of profit margins) the Tories introduced Private Finance Initiative (PFI) schemes, which were then massively expanded by Blair, which up to 2017 (I think which is around when they finally stopped entering into new PFIs) the UK Government had paid private companies more than £308 billion for what amounted to £59 billion of actual capital investment.
Many of these PFI schemes were wildly profitable for the companies, and the public have to pick up the pieces for the ones that fail. At the same time, care quality was often inadequate, even for the ones making profits.
And that’s just one of the “privatisation by stealth” methods, there are a bunch of others (the NHS is too popular to overtly privatise).
This was all with NHS and I have the exact opposite experience. The staff were always very professional and friendly and the facilities well equipped.
The issue is that the staff that looked after you was probably 2-3 times more than what should have been.
My issue was also taken care of. So well that i will have to go private in a foreign country to fix the damage they did. At least i am alive and well. The smiles they gave were nice too.
Seriously, google reviews of hospitals and read the horror stories. Old people with bowel loops kept on chairs in waiting rooms for 26 hours are my favourite. I know how bad it hurts because the friendly, smiling, professional staff nearly caused my such issues.
One of the big factors driving the lower costs of healthcare in other countries isn't the cost savings from socializing it, it's the fact that the US essentially subsidizes the entire drug research industry and the rest of the world doesn't have to pay for that like we do.
So even with single payer healthcare, we're still gonna have to be the nation that shovels all the money into the drug industry. I don't personally see a problem with that per se. We are a rich country. We should pay the lion's share. But the cost shouldn't be so directly passed on to consumers in the form of insane drug prices. Switch to a prize system in exchange for taking stuff off patent or something, e.g. the federal government buying the patent whenever something new comes out for an extremely high one time price, then let the generics market go nuts with it. That would bring down consumer prices without eviscerating drug company profit margins and destroying their incentive to innovate.
Federal research grants that end up as patents held by US universities and pharma companies.
No, they meant 4. The same medicine I'd pay $25 copay (with insurance kicking in another $70 or $100) cost $4 out of pocket overseas.
This is because single payer systems overseas negotiate down prices. The US does. not. This effectively means that the US is subsidizing the drug industry.
Kind of like the argument Europe is benegiting of US military spending and would be overrun by the Russians if it weren't for the US...
They are. The US should pull out of NATO and save a bunch of money; the EU is wealthy enough to provide for its own defense.
I agree so, that Europe should be less dependant on the US, we sure shoupd have a very solid and competitive defence sector supplying the various European armed forces.
I agree that the US defense industry likes the status quo, and lobbies congress to keep the money flowing.
I agree that the US gains considerable influence over Europe via the current arrangement.
I don’t think it is a great idea for European countries to be US client states.
Why is this a bad point of view?
And yes, the idea of the US leaving NATO is so bad it is only loughable, the only ones happy about that would be Russia and China. US influence is not limited to Europe so, NATO activities stretch to Afghanistan (past tense), Iraq (same), Ukraine, Africa, the Balcans...
As bad as NATO intervention was during the war on terror period, and boy was it bad, tue alternative would be either Chinese or Russian dominance in those regions. And that would be even worse. NATO, human rights and all that is a different topic so.
If NATO is such an equal alliance, why is US the only "partner" that e.g. has (a lot of) military bases, running on their own laws, in other "partner" countries.
Edit: And my point of view definitely isn't from American exceptionalism. I oppose my country's (Finland's) NATO membership and watch in horror how there's now going to be 12 bases in Finland that are essentially under pure US control (Finnish laws don't apply there, or even to the US personnel outside the areas, and Finland has no say in US military coming and going as they like).
Agree on the bases thing, some of the CIAs kidnapping flights went through Rammstein in Germany and nobody did anything.
Not much I can say about Finlands NATO memebership, I am actually neutral on that. Or rather fall into the group of people that see NATO expansion to former Warsaw pact countries as something Russia could be less than thrilled about. That being said, only the future will tell if NATO membership is agood thing for Sweden, Finland and co.
Being a NATO member defenitely doesn't make a nation a US vasal, se way EU membership doesn't make a nation a vasal of Brussels. And yes, I know opinions differ on that one as well.
Brussels at least has the pretence of the member citizens having (some) democratic control, although I find EU so antidemocratic by design that this is indeed mostly a pretence. And EU e.g. sets quite tight limits of how the member countries can structure their economies.
That's a very sensationalistic take. No military bases will be established. The agreement between Finland and the US is about prepositioned stockpiles for use in case of war. Since the stockpiles belong to the US government, it is natural that they demand unrestricted access to warehouses holding their stuff.
Also a foreign country positioning weapon stockpiles is a bit questionable for sovereignty in itself, and I find it quite wild to use that as a rationale for giving up the country's rule of law in the areas. You think USA would be happy to have Finnish military areas within their borders because there happens to be Finnish weapons there?
And defense agreements that establish exceptions from local laws are nothing out of ordinary either. For example, the agreement between Finland and Sweden stipulates that visiting forces are excluded from customs procedures related to weapons, explosives and other dangerous goods.
The Finnish-American one is much more detailed and goes into weeds like excluding vehicles transported by the US into Finland from car tax and VAT. :) It's common sense, but countries that are ruled by law must have these things written down.
My hunch is that the word "base" is avoided because the public opinion on even NATO bases is split at best, and I'm quite sure US bases are significantly less popular.
Pharma companies charge different prices for drugs in different markets. Markets with single payer systems usually restrict expensive drugs (either not permitting them or restricting their use to fewer cases) and/or cap prices. Some countries don’t honor pharma patents. Together these controls may make the drug unprofitable in many markets. Someone has to pay full price to make the drug research net profitable, or the pharma companies reduce research into stuff they lose money on.
It happens that the US market is favorable for pharma companies to recoup R&D costs by charging more than most anywhere else. This is possible because of the US regulatory environment and heavy lobbying by pharma.
This is what is meant when someone says that the US “subsidizes” drug costs for the rest of the world.
Note that I am not saying this is a good system; I’m just attempting to describe it.
> It takes a lot of money to bring a drug to market. Those costs have to be recovered and there has to be a net profit
A friend of mine who works in this industry explained how they come up with drug pricing and whether they decided to bring a drug to market. It's pure capitalism, of course--and why shouldn't it be?
It's a bummer, though, to think of the drugs that could have really, really helped some people but weren't lucrative enough to bother selling. Oh well!
> or no one would do it.
On the other hand, that's sort of like saying "There has to be a net profit in going to the moon or no one would do it" or "there has to be a net profit in selling flood insurance or no one would do it". Neither of those net a profit, but sometimes does it all the same.
The more serious problem, is that reforming the machine that is the US health care industry is going to cost a LOT of jobs. That is going to make any kind of meaningful reform very difficult.
The job loss from transition to single payer is a tougher problem, but I would rather just rip that bandaid off than keep a lot of unnecessary insurance jobs around.
This isn’t entirely true. The US does pay more for drugs but a lot of this money isn’t spent on research. In fact pharmaceutical companies spend far more on advertising than research:
https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...
Fixed that for ya.
---
OECD Health Statistics data show the U.S. spent $1,055 per person on “governance and health system financing administration” in 2020, compared with the OECD12 average of $193 per person.
A 2021 study by McKinsey estimates hospital administrative costs at $250 billion and clinical services administrative costs at $205 billion, representing 21 percent and 27 percent respectively of 2019 NHE spending in these settings.16 A 2014 study by Himmelstein and colleagues comparing hospital administrative costs for the U.S. and five comparator countries found that the other countries spent 42 percent less than the U.S. on hospital administration.
---
https://www.commonwealthfund.org/publications/issue-briefs/2....
Your $1,055 in administrative costs is not even close to "The largest cost of healthcare in the US is all the admin associated with it.", in fact it is less than 10%.
---
Administrative Costs [total] : About 30 Percent
Salary and Wages for Physicians and Nurses: About 15 Percent
Prescription Drugs: About 10 Percent
Medical Machinery and Equipment: Less Than 5 Percent
-
Administrative Costs of Insurance: $1,055 per person on “governance and health system financing administration” in 2020, compared with the OECD12 average of $193 per person.
Administrative Costs to Providers: A 2021 study by McKinsey estimates hospital administrative costs at $250 billion and clinical services administrative costs at $205 billion, representing 21 percent and 27 percent respectively of 2019 NHE spending in these settings [aka 48% in sum, troupo]
---
The math is not that hard.
You: no, it's 10%, math is not hard
I see it's hard for you. Good bye