I strongly disagree. I won’t join the debate over what portion of America’s exorbitant healthcare bills are due to our litigation obsession, but medical malpractice is intended to address two problems and does an unusually bad job of solving each of them.
We want bad doctors to change their ways or be dismissed. Yet malpractice suits have almost the opposite effect. Whether a malpractice judgment is rendered often has very little to do with physician or surgeon competence and much to do with happenstance or lawyer cleverness. And because huge malpractice settlements impact an entire hospital and its staff, doctors are strongly incentivised NOT to report actual malpractice by their colleagues.
When a breadwinner is disabled or killed by medical calamity (regardless of whether the calamity is due to malpractice or not) it makes sense that his family be compensated, but that is what ordinary Life and Casualty Insurance is for. Obviously the family needs the money equally whether breadwinner’s leg is cut off by a surgeon or by a streetcar. Some can’t afford casualty insurance? When you rent a car you’re asked if you want to tick the “Extra insurance” box. There should be a similar No-Fault Insurance option offered in hospitals.
And malpractice judgments are intrinsically unfair! If my leg is cut off by mistake I’ll get much less in my settlement than Tom Cruise would get but we’d be charged the same price for the original surgery.
CT scan? Googling I see $1200 as the average cost in the U.S., but my CT brain scan was $29. (The top-ranked doctor who examined me wanted me to save my money but hypochondriac(?) Septimus insisted on the scan.) I didn’t get the $29 CT scan in a flea-bag clinic in Khlong Toei, BTW, but in the best hospital in North Central Thailand — you’d think you were in a 5-star hotel.
Right there is part of the problem with American healthcare. That average price for a CT scan of $1200 is extremely flexible. I was charged $4000 for each of two CT scan pics.
All the hospital pricing is totally at the whim of the hospital. The same way with the pharma industry. Yes they all have real expenses but their pricing seems to be very loosely tied to their expenses.
I was going to comment that I am glad I don’t live in the hellscape known as Libertopia that this post calls to mind… and then I remembered that even in Libertopia, liberal access to the court system is the proposed solution to eliminating government regulations, perhaps like having medical licenses and whatnot.
I think those are not very accurate statements. American companies bring many drugs to the market because America is the largest developed country. On a per person basis, America is not the heaviest lifter.
America does pay more for research per person, but does not appear to produce proportionately more research. America pays more for every aspect of healthcare, without commensurate results and research is not exempt from that trend.
America does indeed have a lot of MRI machines per capita. Far more than what is considered necessary. I don’t see how that is related to research costs, but it is in fact indicative of one of the big cost drives in the system, duplication of effort. It is not a good thing.
And saying that other countries pay less for healthcare than the US because of the US research spending is wildly inaccurate. US healthcare costs are over 3 trillion dollars per year. This is more than twice as much as the average developed world costs, adjusted for population. If the US costs were normal, they would be more than 1,5 trillion less.
The entire worlds biomedical research budget is 20 % of that. 300-odd billion. The US overspends on health care by about 10x its total medical research budget, public and private so no, that is not the reason for overspending.
Everyone else can do it, why can’t you? I mean do you imagine wanting the best possible healthcare is unique to the US? Other nationalities just shrug and go “Hey, my kid died you win some you lose some” ?
The fact is, every nation has a rising cost curve due to more expensive technologies. It is a factor in every healthcare system. Other systems costs have just risen slower than the US while providing it.
However, people with free at the point of delivery heath care seems to be healthier than the US, so clearly that intuition is wrong. And you are already the most ferocious restrictors of care, with millions of people reduced to emergency care only.
Generally the way it is done in the developed world.
I don’t think you understand how healthcare works economically.
To be fair, US healthcare costs dwarf the military budget. Waste in US healthcare dwarfs the military budget in fact.
I believe the average cost to a government of providing healthcare to 100 % of the population is about 3900 per person per year. Currently the US government is spending about 4500 per person per year on the government funded part of US healthcare, covering about 28 % of the current population. (Medicare, Medicaid VA etc)
So the basic answer is about 15 % less than the government is currently spending on it. A saving equal to very roughly 1/3 of the current US military budget. Of course in practice there are likely to be confounding factors. Medical personnel in the US have huge college loans and get paid more than most other countries. That is about 2 % of the difference. On the gripping hand, the US enjoys a massive advantage in the economics of scale.
No. Cost of living is a factor, but the US is way out of the line. Countries that have lower costs of living provide care to 100 % of the population for much less than the US spends. Countries with a higher cost of living also provide cover to 100 % of the population for much less than the US does.
No. You *spend more on research than other nations. But you spend more *on *every aspect of healthcare *than other nations. This does not yield better results, and your spending does not in fact produce more research than other large developed nations, per person.
Healthcare is not magical. How much does the government spend on reimbursement of the providers and associated bureaucracy for high schools?
There are a few issues of perspective that crop up again and again in health care discussions.
Part of the resistance to the concept is that in the US, being without healthcare is a real possibility. It is a realistic thing to fear. In Europe, being without healthcare is like fear of goblins. It feels medieval, and its pretty hard for Europeans to get into the mindset where that is an actual possibility you have to deal with. You can see it in the internet discussions, where the Americans are the ones constantly worried about not having healthcare. Europeans don’t parse that mentally as a real fear, and start to look for ulterior motives. Americans who have healthcare live in a world where not having healthcare is a very real possibility and they see or hear of it often. Consequently, they are not all that interested in risking their own or their family’s healthcare. Or doing major changes when they have something that is working because politician’s say it’ll be better. Their perceived alternative is not just something that would work better, but the possibility of nothing at all. That is why they have a low threshold for taking scare stories onboard.
In general, the system Americans have grown up with and use as their mental base for what is normal and how things work is an exceptionally distorted outlier. Taking it as the normal state of things leads to a number of mistaken assumptions and intuitions about what is normal and how things work.
This is part of another issue: Healthcare as a scarcity resource. To Americans who have been living with expensive healthcare, it is very much a scarcity good. To Europeans, it is not. Sometimes that is like a desert dweller trying to comprehend tap water “You can’t possibly have unlimited drinking water. Water is valuable, people would drink it all up, or fill tanks with it until you ran out” Americans sometimes come into these discussions with the idea that free-at-the-point-of-delivery healthcare will mean far more demand for it. Its valuable! Whereas Europeans see actually getting people to go to regular checkups as more of a problem.
And last: Many Americans have limited understanding of the alternatives out there. Most Americans know about the UKs NHS and the Canadian system, and assume any issues those systems may have are representative of all UHC systems. I’ve seen a lot of intelligent, otherwise well-informed posters advance arguments that just fly in the face of how things work in the rest of the world. There also seems to be little awareness that Health Care Economics is an actual field of economics and used quite a bit in other systems. These things lead to discussions rife with misunderstandings.
No it was a little podunk hospital in rural Alabama. I went to the emergency room, finally got in, had the CT scan, waited a while and was finally told that my gall bladder needed to come out. I had a room overnight and some pretty good drugs on board so I could sleep. My wife was told by 2 different nurses and a friend of ours not to let the surgeon operated on me. He was known for fucking people up. We left the next morning for Birmingham.
The bill was over $10000 for the emergency room, CT scan, good drugs, and an overnight room. The itemized bill showed 2 scans for $8000.
Add to the story, they didn’t submit the bill to the insurance within 45 days, insurance refused to pay and the hospital wanted me to pay the $10,000. I told them that their incompetence was not my problem. They gave the bill to a collection agency. I politely explained the whole thing, and told him I wasn’t going to pay. Do what you want I have an ex wife that already wiped out my credit rating so I really don’t care. The collection agency settled with the insurance company for the total of $500. I got letters from the hospital, collection agency, and the insurance stating it was considered paid in full.
What you are saying makes sense to me. One of the things that I believe has held back the universal healthcare is that companies and unions agree on the idea that companies should offer healthcare as an incentive. I have worked at companies where people claim they would retire early but the costs of private healthcare prohibit it.
The unions look at the healthcare plans as one of the things they have negotiated for and have produced for their members. If there is healthcare for all that detracts from the value of union membership.
BTW how does England, for example, handle the costs of healthcare for the unemployed poor?
Employment is not a factor. The system is centrally funded and it copes with demand, some times well other times not so well.
It’s this simple; if you are unwell you either go to the emergency room, or see your doctor ( I can see my doctor by appointment (a week) or just turn up and wait - it will be a while. Not all GPs allow you to just show up). I believe recently some hospitals have started to ask for ID to indicate UK nationality.
I am growing fond of using “basic education for children” as an example of how heath care is delivered in Beveridge UHC nations.
Healthcare is delivered to the unemployed poor in much the same way as basic education is delivered to their children. I.e. their employment status is not a factor, except it could be relevant to the area where they live.
While we’re on the topic of personal experiences, when I lived in London for a short while, I planned a trip to tropical areas in which it was recommended to have some sort of vaccine or another.
Anyway, made an appointment with a GP, for which I had to wait roughly a week, and then that doctor referred me to the London School of Hygine and Tropical Medicine, as the GP didn’t handle that particular vaccination. Took maybe another week or two to get that appointment. I showed up, got the shot, and I think I might have had to pay like ten pounds or something pretty nominal.
Did my trip, came back to the US, and I had to have a follow-up shot to make the vaccine the most effective. Luckily my GP in the US could handle the shot, but just had to wait a couple weeks to order it. I think I ended up paying about $300.
Tell me again how American insurance plans are so superior.
According to the Centers for Medicare and Medicaid Services, Medicare and Medicaid spending was almost $1.2 trillion in 2015 and they cover around 55 million people with Medicare and 70 million with Medicaid. So $9,600 per person - about the same as non-government spending on health care. Spending numbers from here, coverage numbers also from various places on cms.gov. (Medicaid numbers are difficult to determine since it’s a shifting set of people.)
I’m guessing that if congressmen and senators had to follow a law that gave them the same healthcare as the average American has access to, you would start to see some changes.
*"Mr. Pogue, your late aunt, working as a canteen lunchlady in 1980, had a number of medical conditions which killed her as you know — yet 40 years ago she paid $2,000,000 for a healthwise guaranteed pay-out plan, and continued small contributions until the day of her death; she refrained from taking out more than a small amount since she wanted to pass on this plan to future generations and nothing would have saved her at that point.
The total of her contribution over the last 40 years came to $2,300,000; after taxes, administrative costs and her few withdrawals this is reduced to $1,900,006. In real terms this is worth about $600,000 in 1980 dollars.