# Healthcare Myths in America **URL:** \ **Category:** Great Debates\ **Created:** [November 27, 2018, 9:28pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179 "2018-11-27T21:28:14Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [December 5, 2018, 6:44am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/41 "2018-12-05T06:44:16Z")
> [@puddleglum](#): > > How do you get from spending 9 grand a person to spending 3 grand a person. The salary of doctors and nurses would have to be slashed. For nurses the average salary would have to fall by $40,000 per year to reach the Italian average. For doctors it would have to fall by $150,000 a year. The ratio of U.S. healthcare spending per capita to Italy’s is not 3 to 1; it is 3½ to 1. [Cite.](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#U.S._dollars._Not_inflation_adjusted) Per capita U.S. healthcare spending is twice that of Netherlands but Netherlands has average yearly compensation for specialists of $253,000 compared with $230,000 in U.S. [Cite.](https://www.careeraddict.com/top-5-countries-with-the-highest-paid-salaries-for-doctors) And please remember that “per capita” spending numbers reflect division by all the people in a country _whether insured or not_. If the denominator in the U.S. arithmetic excluded people who lack proper access to health care, the U.S. figures would be even more out-of-line with the rest of the world. (Some of the extra U.S. spending is for insurance clerks whose job is to _deny_ healthcare to some Americans.) Finally, is anyone talking about slashing U.S. healthcare spending by a whopping 66%? To the contrary, in another thread the worry is about a $32 Trillion _increase_(!). If the anti-UHC forces cannot decide whether it is a _huge increase_ or a _huge decrease_ in healthcare spending that most concerns them, I’m afraid it’s hard to take them seriously. ---
**Author:** ![Mijin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mijin/32/9369_2.png) [@Mijin](https://boards.straightdope.com/u/Mijin)\ **Post date:** [December 5, 2018, 7:00am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/42 "2018-12-05T07:00:22Z")
> [@DrDeth](#): > > No it’s not. Look, the USA isnt Denmark, a tiny Euro nation. What works for many other nations doesn’t work on the grand scale of the USA. Nobody does this but the US. If someone floats the idea of high-speed rail in a small country, they don’t jump to “We ain’t China!” – you do some analysis of the costs and requirements and maybe decide it isn’t for you on _that_ basis. Pointing out differences between countries is pointless; you can shoot down any proposal if that were sufficient reason in itself. > [@](#): > > That doesnt mean we can’t watch and learns but honestly saying “well, 12 other nations that I have cherrypicked out of a list of 200 do it like t_hat_, so \*that \*must be the very best way.” Is just as bad. Who is cherry-picking? Go anywhere in the developed world and show me examples of _less_ bang per buck. I’ll wait here. If you think that comparing the US to _developed_ countries is unfair, then OK: I’ll concede that the US’ spending of $4 trillion a year has delivered better health care than, say, Mali’s. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 5, 2018, 7:26am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/43 "2018-12-05T07:26:41Z")
> [@Mijin](#): > > Nobody does this but the US. > > If someone floats the idea of high-speed rail in a small country, they don’t jump to “We ain’t China!” – you do some analysis of the costs and requirements and maybe decide it isn’t for you on _that_ basis. Cite? And that’s not at all what I said. It’s fine to say “The USA should have high speed rail, and here are the reasons:…” But telling Americans “you should have High speed rail as Japan has and it works well there” is pointless. Dont tell Americans (or Canadians , telling Canadians they should do XXX becuase America does will get you a _very polite_ beer bottle over the head) (or French or Germans or Russians) that we should do something because other nations do. America is much larger and populous than any other western developed nation. We are unique. Just tell us why. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [December 5, 2018, 7:28am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/44 "2018-12-05T07:28:39Z")
> [@PatrickLondon](#): > > To which the short answer is “Because everyone else will pay for yours”. Well, I’m fine with cutting someone’s Medicare tax in half if they promise to die before they hit 65. Which would have made a great C. M. Kornbluth story, I think. ---
**Author:** ![Mijin](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mijin/32/9369_2.png) [@Mijin](https://boards.straightdope.com/u/Mijin)\ **Post date:** [December 5, 2018, 10:14am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/45 "2018-12-05T10:14:24Z")
> [@DrDeth](#): > > Cite? Cite of what? A negative? > [@](#): > > And that’s not at all what I said. It’s fine to say “The USA should have high speed rail, and here are the reasons:…” But telling Americans “you should have High speed rail as Japan has and it works well there” is pointless. I think you have misheard or misinterpreted what most people are saying in this context. It’s not about emulating other countries. It’s just a response to the idea that single-payer is unworkable: clearly it’s very much workable as it works in all manner of countries around the globe. If you want to focus on \*why \*it’s better, and not the \*evidence \*that it’s better, then sure I’d welcome that. It broadly comes down to being (demonstrably) cheaper, plus allowing full coverage of a nation’s citizenry: Just as we’d be appalled if crimes against poor people were going unpunished because few people could afford “Police insurance”, so it’s appalling that in one of the wealthiest nations many people continue to die, become destitute or endure curable conditions in their daily lives because of lacking health insurance (or insurance companies failing to pay up). ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [December 5, 2018, 10:31am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/46 "2018-12-05T10:31:36Z")
> [@puddleglum](#): > > How do you get from spending 9 grand a person to spending 3 grand a person. Economies of scale kick in, and preventative care saves huge amounts in the long run. > [@](#): > > The salary of doctors and nurses would have to be slashed. Are you looking at gross salary or net income? Because under UHC nurses and doctors don’t have the high insurance costs associated with practising in the US. Student loans are covered, for instance, for doctors taught in the UK. There’s no need to pay for healthcare insurance either. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [December 5, 2018, 10:36am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/47 "2018-12-05T10:36:42Z")
> [@DrDeth](#): > > Dont tell Americans (or Canadians , telling Canadians they should do XXX becuase America does will get you a _very polite_ beer bottle over the head) (or French or Germans or Russians) that we should do something because other nations do. America is much larger and populous than any other western developed nation. We are unique. > > Just tell us why. It’s that “Denmark does it better” or “Germany does it better”, it’s that Denmark AND Germany AND France AND the UK AND Australia AND New Zealand, and Etc., and Etc., all do it better. You have to wonder why the US is the only one that _doesn’t_… and it’s not because we’re getting better results because we aren’t. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [December 5, 2018, 10:43am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/48 "2018-12-05T10:43:25Z")
> [@Quartz](#): > > Economies of scale kick in, and preventative care saves huge amounts in the long run. [No, it does not save huge amounts of money.](https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html) That doesn’t make it bad, but it’s not a magic asterisk that will slash costs. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [December 5, 2018, 12:12pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/49 "2018-12-05T12:12:40Z")
> [@XT](#): > > … One issue is that we have a huge gap between the majority who get fairly decent healthcare and those who essentially get none. That gap is going to cost us, no matter how you slice it, and it will also mean that health care will have to be spread out (or expanded) to cover literally millions that it’s not covering today. No, the gap is not going to cost you, not if it follows the single payer model. The flaw in your argument is that it regards “the majority who get health care” as some kind of monolithic bloc. So if 80%, say, “get health care” and 20% don’t, it seems to stand to reason that it will cost proportionately more to get that to 100%. But that’s not how health care works in the US. Not even close. Those who “get health care” all have varied and different coverages, with different premiums and different benefits, often from multiple sources, almost always requiring a contribution of their own funds, resulting in a system of absolutely staggering complexity and burden of paperwork, most of it dedicated to bureaucracy like assessing premium amounts and coordinating and adjudicating claims – that is, standing between the patient and his caregivers and often preventing the caregivers from actually giving care. And you’re actually paying for that. Far from being a monolithic group that “gets health care”, the millions of Americans who do more or less get health care comprise a system of millions of different health care coverages, practically each one different in some way from another, the whole of it dedicated to the first principle of rationing health care for the financial benefit of the insurer and the detriment of the patient. _ **That’s** _ the burdensome crap that gets thrown out the window, allowing single payer to more cheaply and efficiently provide unfettered uniform and universal services to everyone. > [@puddleglum](#): > > How do you get from spending 9 grand a person to spending 3 grand a person. The salary of doctors and nurses would have to be slashed. For nurses the average salary would have to fall by $40,000 per year to reach the Italian average. For doctors it would have to fall by $150,000 a year. As **Grim Render** notes in post #17, this first of all attributes a greatly disproportionate part of the costs to salaries. Moreover, most doctors in private practice don’t generally have “salaries”, they have fees which generate income, and the income comes from the difference between fees and expenses. No doctor could reasonably object to lower fees if their expenses are correspondingly lower, because they don’t have to maintain an army of clerical staff to do massive amounts of insurance paperwork and chase insurance companies for payment, which often seems like trying to get blood out of stone. This is a central part of the efficiency of single payer. > [@puddleglum](#): > > As long as we are talking about medical cost myths, medical bankruptcies are not 50% of all bankruptcies, [they](https://www.nejm.org/doi/full/10.1056/NEJMp1716604) are actually 4%. Other countries have medical bankruptcies, for example in [Canada](https://www.ic.gc.ca/eic/site/bsf-osb.nsf/vwapj/Redish-Sarra-Schabas-2006-ENG.pdf/$FILE/Redish-Sarra-Schabas-2006-ENG.pdf) 15% of bankruptcies in people over 55 are medical bankruptcies. No, just no. Regarding medical bankruptcies in the US, your cite is behind a paywall so provides zero information, but [here is a whole set of articles](http://pnhp.org/news/the-myth-that-medical-bankruptcies-are-rare/) on the subject including a summary of the one you cited. What one can conclude from these papers ([as indeed Snopes did](https://www.snopes.com/fact-check/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/) when they tried fact-checking some of this stuff) is, for one thing, that this is a complicated and controversial area in which each side has been trying to spin their own view of the statistics. However, it’s self-evident that if you have serious health problems and your insurance won’t pay (don’t tell us this doesn’t happen a lot), or you don’t have insurance, or are faced with huge deductibles and co-pays, that you will encounter potentially major financial issues. These are things that simply can’t happen under UHC, such as in Canada, notwithstanding your misleading cite. The basic fact of the matter is that in Canada, **nobody is forced to choose between treatment and bankruptcy. No one is forced to choose between health care and feeding their family.** But these are constant ongoing challenges for millions in the US. As for your cite, it doesn’t say what you claim it does. It says that 15% of bankruptcies in Canada for those over 55 **are attributed to medical reasons – that is, health reasons** , a category which notably includes factors like the inability to work, and the costs of lifestyle changes unrelated to actual health care. This is why conservative organizations like the Fraser Institute misleadingly cite the simple statistic of higher personal bankruptcies in Canada, without mentioning that they’re talking about bankruptcies from all causes, and also forgetting to mention that personal bankruptcies – which are essentially a protective mechanism for the filer – are much harder to get in the US than in Canada. So the whole argument you’re making is just misleading spin. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [December 5, 2018, 12:34pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/50 "2018-12-05T12:34:19Z")
> [@Lord\_Feldon](#): > > [No, it does not save huge amounts of money.](https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html) That doesn’t make it bad, but it’s not a magic asterisk that will slash costs. I clicked on a couple of the links in that article and that article only seems to look at the US. It also doesn’t seem to include the costs of people not being treated. Taxes lost and whatnot. And they’re rather blithe: > [@](#): > > They found that this probably would have saved about $3.7 billion in 2006. That might sound like a lot, until you realize that this was about 0.2 percent of personal health care spending that year. It’s a pittance — and that was with almost complete compliance with recommendations. Umm… that’s still $3.7 billion. But then it’s the NY Times, which seems to have descended to the level of the Daily Mail. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 5, 2018, 1:26pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/51 "2018-12-05T13:26:06Z")
> [@JcWoman](#): > > Another issue with our current system that is under-appreciated (IMO) is what I recently had driven home - our health care insurance really REALLY needs to be disconnected from employment. I have pretty good insurance through my employer, as do many millions of people. But I recently changed jobs, which resulted in (long story short) having to go 7 FULL weeks without my doctor-prescribed medication for my arthritis. I got by, barely, with over the counter Alleve, but it was not fun and my pain levels still made it hard for me to sleep well. > > We should NEVER have an interruption in our medical care simply because we change jobs. Sorry to hear that. Did you have Cobra? I agree with you, by the way. There are a lot of holes to plug in situations where people move between states or change jobs. In your case, what exactly caused the 7 weeks? Were you without any coverage at all, or was there a problem with just your arthritis meds? ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 5, 2018, 1:38pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/52 "2018-12-05T13:38:03Z")
> [@Ann\_Hedonia](#): > > Pre ACA, there was some low cost “insurance” that was sold mostly to low income hourly employees through major employers. For around $100 a month you got doctor visits with a small copay,free eye exams and glasses and all sorts of routine healthcare. > > And these were among the plans that were eliminated with the ACA. And most of the people that had those plans loved loved loved them. But the catch is that these plans had a ridiculously low yearly maximum benefit of around $2000. I believe that they may have originally been designed as a bridge plan to be used in conjunction with a real insurance plan to cover the deductible. > > But people that had never really gotten sick and hadn’t read the fine print honestly thought they had awesome insurance that had been taken away from them. Even though these plans weren’t even technically allowed to be called insurance. Because they didn’t provide any. That was one of the good things about the ACA. It standardized to some extent what plans could offer. In any event, the ACA did tremendous good on many fronts, including putting limits on these small-a\*\* plans. ---
**Author:** ![JcWoman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jcwoman/32/2889_2.png) [@JcWoman](https://boards.straightdope.com/u/JcWoman)\ **Post date:** [December 5, 2018, 1:49pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/53 "2018-12-05T13:49:13Z")
> [@survinga](#): > > Sorry to hear that. Did you have Cobra? I agree with you, by the way. There are a lot of holes to plug in situations where people move between states or change jobs. In your case, what exactly caused the 7 weeks? Were you without any coverage at all, or was there a problem with just your arthritis meds? I didn’t use COBRA because I had no gap in coverage. The delay in getting my medication was entirely dealing with the bureaucracy. The new insurance plan required a new prescription, then a prior-authorization, delays from mis-communicating with my doctor’s office which I had to intervene to get corrected, and internal processing time for both of those, then they forced my medication over to their specialty pharmacy because it’s on their Tier 3 list so there were more delays while the specialty pharmacy worked through it’s internal bureaucracy… …ending with a final 4-day delay because when I was finally able to schedule the shipment (they will only mail the meds to you), nobody at the specialty pharmacy informed me of that fact until I called THEM (for the seventh time). I actually posted about this experience a couple weeks ago in the Pit forum, because I needed to rant. Several people with diabetes or diabetic family members chimed into the thread to say that they encounter this exact problem with their insulin. Going without my meds is extremely inconvenient and aggravating. Theirs is life-threatening. And this is when you have “good” insurance! ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 5, 2018, 1:52pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/54 "2018-12-05T13:52:31Z")
> [@DrDeth](#): > > No it’s not. Look, the USA isnt Denmark, a tiny Euro nation. What works for many other nations doesn’t work on the grand scale of the USA. > > That doesnt mean we can’t watch and learns but honestly saying “well, 12 other nations that I have cherrypicked out of a list of 200 do it like t_hat_, so \*that \*must be the very best way.” Is just as bad. > > I am in favor of single payer, but telling me Denmark has it ain’t gonna win me over. What works for a nation of 5 Million, isn’t necessarily a good plan for 300 million. The one area where America is extremely different than other countries is politics. We have a political party that is against doing anything even remotely single-payer. So, when people argue for single-payer in the US, they do so essentially by waving a magic wand in the political sphere. You can’t get single-payer in this country. It will never happen. And wishing it so is basically a fantasy. And all of the above is why we should stick with our basic system we have in place, and embrace incremental changes at the state level complimented by incremental fixes to the ACA. The authors of the ACA knew what they were doing, and put something in place that we can build on to help finalize the achievement of UHC as well as tightening on the costs front. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 5, 2018, 1:57pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/55 "2018-12-05T13:57:48Z")
> [@JcWoman](#): > > I didn’t use COBRA because I had no gap in coverage. The delay in getting my medication was entirely dealing with the bureaucracy. The new insurance plan required a new prescription, then a prior-authorization, delays from mis-communicating with my doctor’s office which I had to intervene to get corrected, and internal processing time for both of those, then they forced my medication over to their specialty pharmacy because it’s on their Tier 3 list so there were more delays while the specialty pharmacy worked through it’s internal bureaucracy… > > …ending with a final 4-day delay because when I was finally able to schedule the shipment (they will only mail the meds to you), nobody at the specialty pharmacy informed me of that fact until I called THEM (for the seventh time). > > I actually posted about this experience a couple weeks ago in the Pit forum, because I needed to rant. Several people with diabetes or diabetic family members chimed into the thread to say that they encounter this exact problem with their insulin. Going without my meds is extremely inconvenient and aggravating. Theirs is life-threatening. And this is when you have “good” insurance! I have an insulin-dependent member in my family, and this would be deadly if it happened to us. Glad to know you got your own situation resolved. But yes. It’s inexcusable to have this. I think there are situations like these that are “gaps” in the healthcare quilt of the US, that need to be dealt with. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [December 5, 2018, 2:56pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/56 "2018-12-05T14:56:34Z")
> [@DrDeth](#): > > No it’s not. Look, the USA isnt Denmark, a tiny Euro nation. What works for many other nations doesn’t work on the grand scale of the USA. Scale is supposed to make things cheaper. Is it harder to set up a a system for 300 million (USA) than it is for 300 thousand (Iceland)? Of course it is, but it’s not 1,000x harder. We have 1,000x the resources at our disposal to make it happen, and 1,000x the market share to push around whoever we need to, in order to get our costs in line. I have been involved in pricing, on the finance side, for over 20 years. Big customers ALWAYS press for better prices than small customers, and they pretty much always get it. Except here. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [December 5, 2018, 3:26pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/57 "2018-12-05T15:26:48Z")
> [@septimus](#): > > The ratio of U.S. healthcare spending per capita to Italy’s is not 3 to 1; it is 3½ to 1. [Cite.](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#U.S._dollars._Not_inflation_adjusted) Per capita U.S. healthcare spending is twice that of Netherlands but Netherlands has average yearly compensation for specialists of $253,000 compared with $230,000 in U.S. [Cite.](https://www.careeraddict.com/top-5-countries-with-the-highest-paid-salaries-for-doctors) > > And please remember that “per capita” spending numbers reflect division by all the people in a country _whether insured or not_. If the denominator in the U.S. arithmetic excluded people who lack proper access to health care, the U.S. figures would be even more out-of-line with the rest of the world. (Some of the extra U.S. spending is for insurance clerks whose job is to _deny_ healthcare to some Americans.) > > Finally, is anyone talking about slashing U.S. healthcare spending by a whopping 66%? To the contrary, in another thread the worry is about a $32 Trillion _increase_(!). If the anti-UHC forces cannot decide whether it is a _huge increase_ or a _huge decrease_ in healthcare spending that most concerns them, I’m afraid it’s hard to take them seriously. The OP was talking about slashing healthcare spending by 66%. He said the only reason that US healthcare costs are not what Italy’s are is leeches. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [December 5, 2018, 3:36pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/58 "2018-12-05T15:36:42Z")
> [@Quartz](#): > > Economies of scale kick in, and preventative care saves huge amounts in the long run. > > Are you looking at gross salary or net income? Because under UHC nurses and doctors don’t have the high insurance costs associated with practising in the US. Student loans are covered, for instance, for doctors taught in the UK. There’s no need to pay for healthcare insurance either. The US is so big that many health insurance systems are larger than other countries populations. Medicare has more recipients than the population of Canada, Medicaid has more people on it than the populations of the UK, France, or Italy. If economies of scale mattered the US would have much cheaper health care than the rest of the world. Preventative care only saves money on an individual level, system wide preventative care [costs](https://www.nytimes.com/2018/01/29/upshot/preventive-health-care-costs.html)money. One of the reasons the US spends so much on healthcare is there is so much preventative care. Malpractice insurance costs physicians 3.2% of revenue. Switching to a system like New Zealand would be a great idea but the amount of cost saving would be small. Since doctors and nurses make well above median income, any switch to government payed healthcare would mean their taxes would skyrocket and more than make up for any savings not having to pay for health insurance. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [December 5, 2018, 4:06pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/59 "2018-12-05T16:06:03Z")
> [@wolfpup](#): > > As **Grim Render** notes in post #17, this first of all attributes a greatly disproportionate part of the costs to salaries. Moreover, most doctors in private practice don’t generally have “salaries”, they have fees which generate income, and the income comes from the difference between fees and expenses. No doctor could reasonably object to lower fees if their expenses are correspondingly lower, because they don’t have to maintain an army of clerical staff to do massive amounts of insurance paperwork and chase insurance companies for payment, which often seems like trying to get blood out of stone. This is a central part of the efficiency of single payer. > > No, just no. Regarding medical bankruptcies in the US, your cite is behind a paywall so provides zero information, but [here is a whole set of articles](http://pnhp.org/news/the-myth-that-medical-bankruptcies-are-rare/) on the subject including a summary of the one you cited. What one can conclude from these papers ([as indeed Snopes did](https://www.snopes.com/fact-check/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/) when they tried fact-checking some of this stuff) is, for one thing, that this is a complicated and controversial area in which each side has been trying to spin their own view of the statistics. However, it’s self-evident that if you have serious health problems and your insurance won’t pay (don’t tell us this doesn’t happen a lot), or you don’t have insurance, or are faced with huge deductibles and co-pays, that you will encounter potentially major financial issues. These are things that simply can’t happen under UHC, such as in Canada, notwithstanding your misleading cite. > > The basic fact of the matter is that in Canada, **nobody is forced to choose between treatment and bankruptcy. No one is forced to choose between health care and feeding their family.** But these are constant ongoing challenges for millions in the US. As for your cite, it doesn’t say what you claim it does. It says that 15% of bankruptcies in Canada for those over 55 **are attributed to medical reasons – that is, health reasons** , a category which notably includes factors like the inability to work, and the costs of lifestyle changes unrelated to actual health care. This is why conservative organizations like the Fraser Institute misleadingly cite the simple statistic of higher personal bankruptcies in Canada, without mentioning that they’re talking about bankruptcies from all causes, and also forgetting to mention that personal bankruptcies – which are essentially a protective mechanism for the filer – are much harder to get in the US than in Canada. So the whole argument you’re making is just misleading spin. I do not attribute most of the difference in spending to salaries, just said that in order to meaningfully cut healthcare spending healthcare salaries would need to cut. To get anywhere near Italy’s spending they would need to be cut drastically. The idea that the only cut needed to healthcare spending is paperwork and insurance is a myth. In order to actually get healthcare costs in line with the rest of the world, there needs to be cuts in salaries, cuts in administration, less use of specialists, less use of technologies, and fewer drugs prescribed. Each of these changes will be difficult to achieve. [Here](https://www.aeaweb.org/articles?id=10.1257/aer.20161038)is a non gated version. [Here](https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/?noredirect=on&utm_term=.f5caca99945d)is a summary. It finds that less than 5% of bankruptcies are due to hospital bills. Most of the bankruptcies in the US attributed to medical bills are because of a loss of work. This is the same reason as in every other country. More people go bankrupt in the US than the rest of the world mostly because we have the most generous bankruptcy laws in the world. When the rules for bankruptcies were tightened in 2005 bankruptcies fell by 90%, which is unlikely to mean everyone suddenly got healthier. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [December 5, 2018, 5:41pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/60 "2018-12-05T17:41:54Z")
> [@puddleglum](#): > > I do not attribute most of the difference in spending to salaries, just said that in order to meaningfully cut healthcare spending healthcare salaries would need to cut. To get anywhere near Italy’s spending they would need to be cut drastically. The idea that the only cut needed to healthcare spending is paperwork and insurance is a myth. In order to actually get healthcare costs in line with the rest of the world, there needs to be cuts in salaries, cuts in administration, less use of specialists, less use of technologies, and fewer drugs prescribed. Each of these changes will be difficult to achieve. > > [Here](https://www.aeaweb.org/articles?id=10.1257/aer.20161038)is a non gated version. [Here](https://www.washingtonpost.com/blogs/post-partisan/wp/2018/03/26/the-truth-about-medical-bankruptcies/?noredirect=on&utm_term=.f5caca99945d)is a summary. It finds that less than 5% of bankruptcies are due to hospital bills. Most of the bankruptcies in the US attributed to medical bills are because of a loss of work. This is the same reason as in every other country. More people go bankrupt in the US than the rest of the world mostly because we have the most generous bankruptcy laws in the world. When the rules for bankruptcies were tightened in 2005 bankruptcies fell by 90%, which is unlikely to mean everyone suddenly got healthier. What this tells me is that you didn’t even glance at the cite I provided, and apparently didn’t read what I wrote carefully enough to comprehend it, since you appear to be repeating yourself. The “Economic Consequences of Hospital Admissions” article that you think is such a decisive refutation is right there in my own cite, as the second featured article. I’ve already explained and cited why placing undue emphasis on those kinds of narrow micro-analyses are irrelevant spin. The big picture is not complicated: in a very fundamental sense, the US health care system makes individuals directly responsible for the financial costs of their health care, whether it’s covered by insurance or not, whether the insurance is subsidized by their employer or not; no matter how you cut it, the cost of health care one way or another comes out of individual resources because either the individual or their employer has to pay for their insurance, their insurance has to be convinced to provide coverage in each and every specific case – which they sometimes may refuse to do – and the individual himself has to kick in his own money. Because of this fundamental fact, it’s extremely easy for an individual to become saddled with overwhelming and potentially catastrophic health care bills in the case of serious and/or chronic illness. This is not a matter of surprise or debate. And to repeat, since you seem to have missed it, in Canada nobody is ever forced – ever – to choose between medical treatment and bankruptcy or financial ruin. Instead of individuals being directly responsible for the financial costs of their health care, the costs of their health care are entrenched in national policy and culture as fundamentally a shared communal responsibility, a citizen’s entitlement from the common wealth. No one ever faces catastrophic medical bills because he got sick, or indeed typically any medical bills at all. No one is forced to choose between health care and feeding their family. This is not a matter of surprise or debate, either. [Previous page](https://boards.straightdope.com/t/healthcare-myths-in-america/825179.md?page=2) [Next page](https://boards.straightdope.com/t/healthcare-myths-in-america/825179.md?page=4)