I can not be bothered by whatever stupid shit Ben Carson says, because that guy is not achieving anything politically, and his dumb-fuck ideas will never impact me, or anyone else, in any way. It’s too bad I can’t say that about all of the Republican field, however, because one of those assholes is going to win the primary.
There are many valid reasons to call our system crappy brutal and evil:
[ul]
[li]It leaves 1/6 of the country uninsured[/li][li]Of insured people, it leaves such high copays, deductibles and loopholes that there is no guarantee you actually have coverage when you need it[/li][li]Health care is the #1 cause of bankruptcy[/li][li]Due to narrow networks, people are never sure if they are covered. Is the hospital covered but not the doctor, is the doctor covered but not the hospital? Is the procedure you thought was covered not covered? Other countries do not have this issue.[/li][li]Tons of red tape makes it hard for you or your doctor to determine what care to get[/li][li]We waste endless labor hours on administration[/li][/ul]
And we manage to do all this while spending 2x as much as any other nation.
Also medical R&D makes up $130 billion a year in the US. Of that, about 50 billion is public spending, about 80 billion in private spending.
If our health system were as efficient as Israel or the UK, we would save 1.5 trillion a year. Even if you could prove conclusively that this would cut private medical R&D (it shouldn’t impact public R&D), it is still a good deal. If we lost $30 billion a year in private medical R&D but saved 1.5 trillion a year in spending, that is a great deal. If you don’t think it is a great deal, then send me $1,500 and I will mail you $30 back, then you can brag about your $30.
Plus under the savings from a working health system, we could increase government funding for R&D via tax credits, subsidies, grants, research rewards, etc. etc. to make up for the loss.
Also here is a list of physicians per 1,000 people in OECD nations. As you can see, the US is in the lower third (not the top). Nation with far cheaper and more humane systems have more physicians per 1,000 people.
If you want our system to be cheaper you need to do two things:
- Stop providing medical care that provides little/no health benefit (30-50% of all health spending in the US doesn’t actually make people healthier)
- Find a way to provide health care that offers a health benefit (the remaining 50-70%) for cheaper. Example, heart surgery costs 100k in the US but 2k in India. Find a way to do it for cheaper. Medicine that costs $200/month in the US may cost $70/month in France.
however doing those 2 things requires taking on the rich powerful industries that control this country. No political group is going to do that anytime soon so we are stuck with a brutal, evil, overpriced system that victimizes people when they need help.
Right, they are old and have greater medical needs. Of course they should get more out the system than they put in.
colour me confused. Elsewhere you state you have insurance. I’m suspecting that the reason you have that insurance is to cover you against those times when your medical needs outstrip your ability to pay. Are you saying that isn’t how it should work?
Anyway, to an outsiders eye USA healthcare is a clusterfuck of horror. It should be a public service, essentially free at the point of delivery and funded by taxes or other capped and means-tested contributions. You know, like the other 99% of the first world (that have better outcomes than you and spend less of their GDP than you)
People like you claim it can’t work in the USA (but never specify why) or that it will be too expensive (but never address the fact that everyone does it cheaper than you) or that your research and drugs industries will implode (but handily ignore the governmental and philanthropic advances in medicine)
Health care should occupy the same place in the government remit as education,
armed forces, police and judiciary, roads and infrastructure. I’ve never heard anyone come up with a decent argument for why it should be treated differently to those things and I suspect you won’t be the first.
Massive props to Wesley for actually making the argument I was going for and would have made if:
- This wasn’t the pit
- I wasn’t responding to Stringbean
- I was smarter
Those industries are exactly those who would benefit from Carson’s plan. Hundreds of billions more as health insurance premiums and HSA investment accounts. Wall Street will love his plan.
No, it’s brutal, evil, AND expensive.
Those most in need are least likely to have quality insurance, meaning they are the ones least able to access what is needed.
The same way every single other first world country, AND some second tier countries do. Don’t you get it? DOZENS of other countries cover ALL their citizens for less per capita and get better results. That’s why the system is crappy, brutal, and evil - we’ve been shown better ways to get the job done and yet our society refuses to use a better system that costs less.
Or… we could simply eliminate the health insurance industry. Or greatly reduce it.
I’m not interested in what the majority of Americans “believe”, I’m interested in facts and evidence. Those are that a lot of other nations do it better than we do, for less money, based on results.
We’re “special”. Keep in mind that’s the same word reserved for people who are mentally disadvantaged/challenged.
No, if most elderly had to pay out of pocket for their care they simply wouldn’t get it because they couldn’t afford it.
Actually, the average American does not have significant retirement savings. Many people in my generation expected to have company-paid medical benefits in retirement, only to have that rug pulled out from under them. In other words, promises were made to them that weren’t kept, promises that affected their long-term fiscal planning. But I guess it’s their fault they weren’t psychic, right?
Hundreds of thousands? Try millions - because catastrophic illness and injury can cost that. I have a nephew who at 24 suffered a head injury that cost several million dollars in treatment. Yay, he’s alive, physically OK… but with permanent brain damage. He will never be independent again. That can happen to anyone because accidents can and do happen to people. Could you cover that cost? Could you cover living in a sheltered environment for decades out of your insurance + savings? If no, then no, you are not adequately covered for all contingencies. You are only fooling yourself.
If you are injured or ill the insurance company will do anything and everything to try to get out of paying your claim - that’s how they stay in business. Compare to single-payer where they determine you’re ill or injured then proceed to treatment without having to argue about whose paying or dragging anyone into court. Much saner way to do business if you ask me.
Yet… you are using “high satisfaction” (which isn’t even true, but whatever) as an argument to keep the jacked-up US system instead of adopting one of the many alternatives other nations have demonstrated are more thorough in covering the population, generate better outcomes, and cost less.
So… is or isn’t “high satisfaction” a reason to keep doing something or not? Or should we make such decisions based on facts and evidence?
In other words - the NHS or what Germany has. Basically, single-payer with an option to buy additional coverage on top.
Wait - you DID just say you were in favor of that!
The evidence, based on the results from many other countries, contradicts that statement.
Actually, there is a vocal segment of the US that is actively trying to privatize education, and would like to privatize police, roads, and other infrastructure. Not entirely sure about the armed forces (maybe they’d like to hire them out as mercenaries to raise some additional money) and judiciary (although some places like Chicago that’s already bought and sold almost openly.
I’m sure some in the Temples of Mammon drool over the prospect, but the clear headed and brutally realistic amongst them may not. The ACA would never have happened if it truly threatened the fiscal well being of our health insurance…ah…“providers”. And there are indications afoot that they still have a solid business plan, and have “gotten used to it”.
Would it be wise to wrench that back into its previous shape? Even when there is a powerful political element opposed, one that could be expected to revisit that change at the earliest opportunity? And has already succeeded once, in the face of all the opposition that you could muster?
The opportunist might crave the chance to grab some profit and run for the hills, but the prudent management mavens? Not so much.
I’ve never met a Medicare beneficiary who thought it was “free”.
And I worked for Medicare for the better part of two decades.
It is, and that’s on a good day.
Lots of middle income countries have or are developing UHC. Much of Latin America is pushing for a UHC system or already has one. I don’t know what the quality is, but once a nation can afford it it seems one of the first things they push for aside from things like infrastructure, cleaning up pollution, universal education, etc is a UHC system.
The problem to me isn’t that we don’t know how to fix our system. Our system could be fixed if we wanted to. But due to a mix of plutocratic interests controlling the system, lack of courage ont he part of politicians and a fear of change by the public I don’t see it happening.
IMO, the best bet is to push for meaningful reforms on the state level. Single payer is a good idea, but that alone won’t fix our system. A single payer system in the US would still cost far more than the multi payer system in places like the Netherlands, Israel, Germany, etc.
I think the ACA did 1/4 of the health reform this country needs. It was a start, but who knows if/when we will get the reform we truly need. Maybe we will do what Canada did, have some states pass meaningful reform and set a positive example that’ll domino to other states and eventually the federal government. But who knows. The pharma industry, medical device industry, hospital industry, AMA, etc is going to fight tooth and nail against meaningful reform.
Vermont tried, the economics don’t work. You can’t go from our system to single payer because people are used to a certain level of care that can’t be provided with single payer. ACA is the bst possible UHC system the US can create.
I like the idea of universal HSA accounts better though.
I don’t.
Accounts work ONLY if you have decades in which to accumulate funds. My nephew at age 24 wasn’t going to have anything near what he needed if he had had to depend on a HSA account. That system is going to screw anyone with a birth defect, anyone seriously ill or hurt as a child, or adolescent, or young adult.
It also provides a perverse incentive to forgo preventive treatments and routine check ups to save money against catastrophe - which is more likely to happen if you don’t use prevention and checkups. People will go to the doctor sicker, making treating serious illnesses harder.
I keep hearing that the US “can’t”. WHY NOT? If everyone else can do this, why can’t we? Why are we so specially inept and evil? We actually are not that different than anyone else, unless it’s in stubbornly clinging to ignorance and a bad system.
Single payer systems got off the ground when there wasn’t that much health care to buy. As new, expensive treatments and drugs were developed, the government systems could decide what to add and under what terms, and since they also just HAPPENED to ban advertising, the public were none the wiser. If we really wanted to wage ideological warfare against single payer systems(something a Republican President should consider), we’d have drug companies run ads all over the internet in those countries for the drugs currently unavailable. That’ll screw with 'em.
But I digress. Most Americans with health insurance have pretty good coverage. It’s not always consistent and there are often gaps(although ACA closed most of those), but it’s a lot more likely to cover crazy expensive treatments. So if you go to single payer, you take a lot of that stuff away, or you just can’t afford it. And you can’t take stuff away from Americans.
Like I said, Vermont tried to provide single payer. The economics just don’t work out given the cost of health care these days, and it’s not as simple as just bargaining down prices. The newest generation of biopharma drugs are five to six figures for a treatment course. There’s just no way to pay for all of that for everyone.
And you’ll never get unions to give up their cadillac plans.
I think the above is quite possibly the most ill-informed four paragraphs on this subject that I’ve yet read, and that is saying something. I really don’t think that anyone with this mindset is open to consider doing things differently.
Is there any evidence or metric that would convince you that UHC systems in comparable nations are better and cheaper?
Yes, I’d be interested in knowing what treatments are unavailable under, say, the UK NHS that are readily available in the US.
Now, people might have to wait for non-emergency things… but that ain’t going to kill you. Sorry if you need to wait an extra two months to get your knee replaced.
There’s also the issue of profit motive in the US system leading to over-treatment, which brings its own pile of problems. There’s a couple of doctors in my area that are being dragged into court for performing unnecessary open-heart surgery on dozens of people who should not have been operated on. I think that sort of abuse-for-profit is less likely under a single-payer system.
Give me a metric that shows that single payer is better than multi-payer other than cost.
My point is we don’t need single payer, we need reforms to drive down costs. There is tons of waste in the current system. The ACA is similar to the plan in the Netherlands. I think they have exchanges and private plans compete to get customers. However in the Netherlands they only spend 10% of GDP on coverage, nobody goes bankrupt, I doubt they have narrow networks, etc. So we could have a working system w/o single payer, we just need reform for how expensive care is and how we provide too much of it because our incentives are bad.
FWIW, William Hsiao when he designed Vermonts health plan found that a public option would provide 2/3 of the cost savings that single payer would. Single payer would drive down costs by 24% over a decade, a strong public option would drive them down by 16%.
I have no idea why states aren’t pushing for a strong public option. Probably because hospitals, pharma, medical device industries, insurance companies and the AMA don’t like it.
Also single payer basically just means expanding medicare to cover everyone. I don’t think that would be uber controversial, as medicare is a well liked system.
A strong public option, a medicare buy in option, state single payer, etc. are all forms of health reform that should be possible soon. Economically Vermont’s system would’ve saved money had they gone through with it. Had they funded it by just continuing to collect insurance premiums but redirecting those funds to a single payer system and slowly transitioned to a tax based payment system I think that would’ve gone over easier.
However single payer would be so controversial that any problems would be magnified 100x by the media. So it would have to be a very well run system to not fall apart and set health reform back.
Too much testing and over prescribing of drugs is definitely an issue, although that’s a tort problem as well as a profit motive problem. Single payer systems deal with that issue as well by not allowing big settlements. Tort reform and single payer go hand-in-hand.
As for treatments unavailable, NICE denies drugs all the time for failing to meet cost/benefit estimates base on quality life years remaining. Yes, a number is actually put on people’s lives.
And an example of a drug refused:
The economics of Medicare-for-all don’t work. As an earlier poster pointed out, Medicare is funded by the majority paying for the minority. If it has to entirely fund itself for everyone, it doesn’t work. Medicaid-for-all has always been the realistic way to think of single payer. Medicare is a special circumstance since it’s paid for by all but only the elderly get it.
Uh, yeah. Hence the name, “Medicare for all”. You see, the idea is to take the basic structure of Medicare and alter that central fact, making it “for all” rather than just “for the old”. Don’t hesitate to ask questions, we are here to help.
Which is known as Medicaid. “Medicare-for-all” is propaganda. Medicaid for all is the reality of single payer.