The lines usually trotted out in these conversations are that, first, since we spend more in preventative or early care, there are a lot more cases which stay in the “mild” ranges. And second, we have lower built-in costs such as lower salaries for all hospital personnel (medical, technical, administrative), lower amount of administrators, etc. Things get more complicated when you’re dealing with two different organizations (for example, a private insurer and a hospital, or two hospitals which are part of different networks), but in general, both the assumption and the reality is that organizations which are physically close will have protocols in place for when they need to share information or shuttle a patient around.
As a physician, I believe you also paid a much higher proportion of your salary in malpractice insurance and office staff for all the paperwork than your counterpoint in Europe. Can you or someone confirm or dispute this?
I have been in the 50% who do not require much medical care, but I expect in a few years I will require more. Old people simply require more medical care. This is our social contract.
I’d be surprised. Certainly in the UK there are hot debates at the moment (or perhaps better to say, hotter than usual, since it’s a perennial) about the linked issues of funding for both medical (NHS) care and social care, which goes through a separate funding route and includes means tests at various points. But common to both is the increasing pressure on the system of people living longer with various degrees of dependency on either or both forms of care and support, and it’s certainly said that a very high proportion of cost is attributable to a small proportion of the population, for still a relatively short period of any one patient’s lifetime.
I don’t have exact figures to hand, as to which percentage of cost is attributable to which percentage of patients. There may be different approaches to collecting the data in the first place (as in the British distinction between medical and social care) that make comparisons difficult.
It may also be that there are different attitudes, both among patients (people leaving it much later to consult doctors - there’s still a generation whose default is “mustn’t bother the doctor”) and doctors being more cautious about the benefits of “heroic” medical interventions towards the end of life.
I’d be very surprised if it was wildly different, for most all healthcare systems you’ll see most of the costs being spent on a small number of very sick people with huge costs associated with their treatment.
Those sorts of costs bear no relation to their ability to pay, nor to their ability to save for it. That sort of asymmetry of needs and ability to pay is exactly why healthcare does not work according to pure market forces. A typical citizen will never be able to cover the costs of prolonged cancer treatment, or a transplant, or multiple other complaints.
So the answer to you is, we don’t avoid it…rather we design our healthcare systems to absorb it.
Most health care and cost is incurred in the last year of life. By definition, this is a small part of the population.
However, if we could avoid this last year, medical costs will plummet everywhere 
I have an idea. All we have to do is buy a bunch of rural “farms” and send old people to frolic their last days in joyous harmony. They can help take care of all of the dogs that also get sent there to play.
I assume you are not implying we take the sick outside and shoot them to save on costs.
There are no death panels. Some US insurances have lifetime caps - one person will only have x $ spent on them for their whole lifetime, so if they are born with a serious illness, the cap and therefore the insurance runs out at age 8.
That’s not how it works in Europe. Solidarity principle means that healthy and sick people pay into the pool and the costs are covered from that pool.
As for “severely ill”, it’s actually three sub-groups:
-
People with a severe, non-curable but treatable illness. Like Stephen Hawking or little kids born with Cystic Fibrosis. They need treatment, often expensive, their whole life. The community pays.
-
People who are healthy most of their life, but suddenly get a serious illness like cancer or need expensive treatment after an accident. They are treated, often expensive, but recover. If they continue tow rok, they pay into the pool again.
Catching some of treatable diseases with regular screenings and making it as easy as possible to see a doctor makes the treatment cheaper, too. (A stitch in time saves nine - it’s almost always cheaper to treat a small problem right away than a big problem later)
- Old people, who get almost inevitably at least a few of severe old-age-related diseases. Often no longer curable, but expensive. This, too, is paid for by the community.
The costs of nursing old people who are not medically really ill but need assistance are done in Germany with a seperate insurance.
From what I hear from both policital experts and different health insurance companies is that there is hard data from thousands of cases each year. Because the screenings themselves cost of course doctors time and the insurances re-imburse them. So in the discussion between doctors and experts and health insurance about which screenings in what intervals are useful to catch x % of which disease, which in turn has a y% of succesful treatment if caught at stage 1, but only 10% if caught at stage 3 (pancreativ cancer is a common example), it’s all evidence-based on past figures.
And once the discussion about which screenings are necessary has been done, the second round is health insurance and psychologists on how to make sure that a greater % of the population actually makes use of these screenings: how can people be motivated to see their doctor? (Again, a common example is pancreatic cancer, where guys don’t want a finger up their ass even if it saves their lifes - so doctors searched for a different screening, by finding chemicals in the bloood). So some health insurances offer clients to pay money if they attend a seminar on healthy eating or do sports and go to all screenings: there’s proof that it’s cheaper.
I think some US insurance companies are also talking about that: wasn’t there recently a question about using the data from fitness trackers as evidence for lower health insurance rates?
Because if somebody says they quit smoking to get lower rates for private (individual risk) insurance (not just a one-time bonus), how do you prove it? How invasive into personal privacy and data is a company allowed to be in the interest of preventing fraud? And how should discount rates be allowed for that reason, since there is never a guarantee, only a statistical probability, that eating vegetarian diet, jogging 3 times a week and not smoking means you get neither cancer nor heart attack?
Screening for skin cancer early stages used to be privately paid, until it was approved several years back. Mammograms are still under discussion because of false positives and the treatment not having a high enough success rate. For another screening, changing the intervals is being discussed. All as new evidence is being evaluated, new treatments and new screening methods come to light.
I wanted to add: several years back, there was a ruling by the EU high court that private health insurance companies, whether offering full insurance for not-mandatory-insured people, or additional insurance, were prohibited from charging women a higher rate than men.
The reasoning by the insurance companies (I believe this is still allowed in the US?) was that women if pregnant and giving birth had much higher doctors and hospital costs, as data showed, which men never would incur, so it was fairer to make the women pay for it and save the men costs.
The court decided that children are the future of society, that it takes two to make a baby and discrimination against women is not allowed in the EU charta, so stop it. Rates rose a bit but not as much as companies had complained before.
A Spanish physician working in his own private practice will have some office staff and will have malpractice insurance. One working for a third party (worker’s healthcare company, public healthcare system, employee at a hospital), which is 99% or more of medical practitioners, will not have any of that; their employer may (or may not, the public healthcare systems don’t so much have insurance as discretional funds they can use to solve problems). I understand we’re also a lot less likely to file a complaint than Americans, and if we do seek reddress we’re a lot more likely to prefer arbitration to litigation. Other UHC countries will have a higher % of medical practitioners who are their own employers, but no country is as fond of lawsuits as the US.
The lack of UHC in the US may itself be a driver for malpractice litigation. If someone goes through a medical procedure and it goes wrong, triggering the need for more medical care to redress it, the cost of the additional medical care may push people to litigation to recover that cost.
In UHC countries, where the cost of additional medical care is already covered, that financial incentive to sue the doctor is absent.
Direct out of pocket cost are covered, yes. But indirect or secondary costs aren’t (taking an unpaid leave of absence, paying for a hotel to stay close to your hospitalized loved one, paying for relief caretakers…).
Mind you, the bureaucracy associated with not having UHC is such an enormous irritant that I can see how it would make Clare of Assisi litigious. “What do you mean, you couldn’t operate my torsioned ovary because you’d opened up for an appendecectomy and un-torsioning ovaries wasn’t covered?”
Sadly the UK is becoming increasingly litigious with the advent of no-win-no-fee lawyers.
This money comes directly from the healthcare budget, so it means that there is less to spend on granny’s new hip.
This is something that is missed in the “US healthcare is expensive due to lawsuits” talk. There is also, “there are so many lawsuits because US healthcare is so expensive”.
In the US, if you are injured, you face long and uncertain costs with many tack-on effects, like having had this injury is your insurance cost for the rest of your life now greater? If you have an opportunity to recover those costs through a lawsuit, you are going to take it. And since you don’t know the entirety of those costs, you are going aim high and sue for a lot to ensure you are covered for every eventuality.
Under UHC there is much less incentive to sue for more than the direct consequences of your injury, knowing that there aren’t these tack-on effects.
The Yaris is a bad example because superminis are a tiny, tiny fraction of the US car market. The Yaris captured a huge fraction of it but was still a niche vehicle. In 2010 (the earliest year I can find figures for), US Yaris sales averaged about 4,000 per month, while the Corolla averaged 25,000 and the Camry (admittedly, one of the best-selling US vehicles perenially) nudged 30,000.
Used 2007 Yaris sale prices are also going to be artificially depressed because of the huge boost in small car sales volume over the next two years (i.e. the Great Recession). That didn’t make as much of a dent in Europe or the UK because fuel prices were already high. You’d do better to compare used Corolla or Honda Civic prices for, say, 2010, I think.
The problem there is that the Corolla hasn’t been sold in the UK since the mid-2000s. We do have Honda Civics, although I believe that the European and North American versions of that car have major differences, more than just hatchback vs. sedan. But I compared them anyway, and the price difference for 2010 Civics seems similar to that of the Yarises above.
Yeah, that’s one of the unmentioned downsides to Obamacare; for a lot of employed, middle class people, our insurance suddenly became drastically more shitty than it had been just a year or two prior, and we pay more for the privilege.
I mean, I’ve been working for 20 years, and in the first 11, I NEVER had a deductible- it was always a combination of co-pays and some kind of percentage (almost always 80/20, at the insurance company’s negotiated rate, which is lower than list).
Post Obamacare, I’ve always had a relatively high deductible, as well as co-pays and the percentage… once the deductible is taken care of.
The 2-Gb meant two gigabytes of data; the phone is 4G for data like everybody has.
It is last year’s model – there were other, fancier ones offered for a higher price but I just wanted something for a few years until 5G takes off.
Another factor considered was coverage. The company is Verizon which has the most coverage here in the far west. There are other companies that offer the same deal – 3-Gb data – for about half price, but coverage is not so good.
The difference may seem minor if you’re an urbanite, but I travel the hinterlands a lot.
Pretty sure we don’t avoid it. It is fundamental to the concept of healthcare. Most people are not very sick at any time.
It is like saying that most fire insurance payments are to the small percentage of people ehose houses burn down. Yes, that is how it works.
Note that the US system sluices the really expensive ones over to the governments dime, through Medicare and Medicaid.
Pretty sure thats all covered here.