But people will have paid vastly different amounts in taxes. If people pay vastly different amounts and receive the same benefits that means people who pay less are being subsidized by people who pay more.
Yes, it places where prices are decoupled from services higher wait times result because people are consuming more. In most other countries tax rates are higher than they are in America and the subsequent deadweight loss is higher though this varies by country.
I would be shocked if this were true. How do you not file claims or monitor for fraud or make sure processes are covered. What country do you live in?
The country with the most efficient health care system in the world Singapore has profit in it, as does Switzerland which has the most efficient system in the West.
The US is a large and diverse country and our government has a problem containing spending, for instance the US government pays the same amount of GDP on healthcare as Canada but only covers half the population. Why should we expect the government to suddenly start being good at saving money on healthcare ?
And if we have the same insurance plan, with the same premiums, and you get cancer and I don’t, how am I not subsidizing your treatment? Should your treatment get cut off because you are benefiting more than I am?
Same thing, just on a larger scale to spread the risk out even further.
Most countries, between taxes and healthcare, pay less than we do, it seems.
You should be shocked. If there aren’t claims to be filed (because in UHC, you don’t need to get claims approved, turned in and remitted), or fraud to be perpetuated (because in UHC you don’t have go game the system in order to not die from preventable disease), you don’t have to make sure processes are covered, (because rather than dealing with several insurance companies, each with dozens of plans where some would cover a procedure, and some wouldn’t, rather than a UHC where things are covered universally).
So, your shock should be less about how other countries run it, and more about how badly we do.
Why can we not model the singapore or switzerland model? Is it because the US is inferior to them in some way? Is there a reason that other countries can easily do, and have done for decades, something that is simply out of reach of the US?
I am quite certain this is not true. A person’s consumption of health care is often dramatically lower or higher than other people. People who have chronic illnesses por whose manner of death is one subject to a lot of treatment consume much, much more than someone who does not have chronic illnesses or whose manner of death is relatively swift.
I’m 45 and have barely consumed any health care relative to my contributions - I have literally never in my life spent the night in a hospital since the day I was brought home from being born. If my family history is any indication my likely cause of death will be heart disease that will kill me relatively quickly, before I can eat up much in the way of doctors’ efforts.
That’s fine, because in Canada, I’m not being taxed for health care. I’m being taxed for health insurance. I pay house insurance, too, and in all likelihood I will never get anything back for that at all, but if my house does burn down I won’t be homeless; I pay for the peace of mind and risk aversion. Health insurance is the same; maybe I won’t collect and it’s probable other people will use it more than I will, but if I do get very ill or am badly hurt, I won’t have to choose between treatment and financial solvency.
It’s simply a given that insurance is a bet you’re probably going to lose - that’s the point of it. Not being insured and losing that bet has a vastly worse outcome than being insured and losing that bet.
I see what you are saying but I don’t see the problem. Your argument may just as well be applied to paying taxes for education, courts, police, military defense, roads, etc.
Thats not actually so. First off, waits in America are not necessarily shorter than average. Page 8, table 3. Notice how in most countries it is easier to get same-day appointments or seen after hours? The US is a bit above the middle, in specialist access, pretty much average in long waits for surgery, and dead last in financial barriers to medical care.
If your postulate was correct, the US would have significantly lower waiting times, and free-at-the-point-of-delivery nations would stick out as higher. Results do not bear this out.
It is the tapwater analogy again. Just because water is freely available does not actually mean that people spend all their day drinking water. Often, we would rather have people go to the doctor a bit more often, rather than wait for a long time.
I live in Norway. Why would we file claims? Everyone is covered. Why would anyone try to defraud anything? They are covered. What would they gain? Processes are covered if they are medically necessary.
People do actually pay co-pays up to a point which the medical secretary receives, or you do it electronically mostly. Also I am in the private sector, so we do send out bills twice a year, it occupies maybe two workdays per year for one person.
But the extent of our bureaucracy is asking someone their name and finding their journal.
Sometimes this discussion is like trying to explain tap water to a desert dweller who has grown up thinking of water as a very expensive scarcity good. The tap water can’t be free people would drink until it was gone! We MUST have a complicated system for buying water expensively and thirst-insurance, its the only way to allocate it!
Why does this link between size, diversity and cost only apply to the US? Why don’t we see it between say, Iceland, the UK, Australia, and Germany ? We know population density matters, we can see that inside countries as well, but beyond that?
You are postulating a link that does not seem to have any real-world support.
Switzerland does have a for-profit insurance system. Switzerland is generally number two in costs in the world, only beaten out by the US most years. They are also the country with the highest private spending on health care.
Switzerland is only in the top 30 for maternal mortality and infant mortality (CIA world factbook) They do score well for life expectancy but as the WHO says “Health care quality is high -although not exceptional” Efficiency and the financial burdens it places on low income population in particular remains a challenge.
It is nowhere near the top two most efficient healthcare systems in the world, or the west. In fact it lists “efficiency” as one of its top concerns, which is reasonable given how much money it overspends without commensurate results.
Singapore does have a high efficiency, but it is a city-state. When you have the advantage of being able to cover a large percentage of your country with a single hospital things are a mite easier. If you check, you will find that despite different health care systems, its stats resemble other city-states such as San Marino, Andorra etc. more than any of them resemble full-sized nations.
What these two places, Singapore and Switzerland, do have in common is that they are places where a very high fraction of the healthcare spending falls on the private citizen. For that reason they are often talked up by the far right. I have no doubt that if San Marinos system had a greater share of the money being paid by private citizens, that would have been the favored system.
With respect I feel you are a bit stuck in the US perspective on healthcare systems. The things you assert as cause-effect relationships don’t work that way in the rest of the world. You should perhaps spend some time familiarizing yourself with how other systems work
I am not convinced. Certainly, that is true for some people. There will be outliers in both the sudden death and the long, lingering one directions. I am, however, questioning how many they are in a population. The average lifespan is about 82. That means the majority of people get well into the “consumes a lot of care” window.
Thats because most countries government provide more services than America does. Above and beyond healthcare.
I wouldn’t recommend it. Singapore’s system is based on compulsory savings from payroll deductions. Thats basically a tax except in a form Americans will like even less than a tax, and with the added feature that your savings can run out.
Switzerland system is administered through for-profit insurance, and most years come in as the second most expensive in the world. With some cost-related issues for sections of the population. Basically, if you are going to change system, it gives you the least actual change.
But it is absolutely the choice of the insurance companies.
I am not actually advocating for either of those systems. I would rather a Canada style myself. I just don’t understand why people point to other countries as examples of things that cannot be done.
I am simply asking what is the reason that the US would not be able to adopt one of those systems, if that is what we wanted?
We claim to be the bestest, greatest, awesomest country on the planet, and yet we are unable to do what pretty much all others have done decades ago.
Well, we all know the real reason is that we don’t want to. There’s a sizable portion of Americans who will give a lot of reasons as to why this won’t work, or that’s not how it should be done, but at the end of the day they don’t need it and fuck anyone who does. They just know how shitty that sounds and so they make up excuses.
I have been following healthcare in the US since I lost employer coverage and had to buy my own.
I have concluded that the US cannot adopt any other system because they all let the government intervene in the sacrosanct relationship between the doctor/hospital/drug/insurance and the patient[del]'s wallet[/del].
That is true but it scales. The more people pay in taxes, the more they seek to avoid taxes. If people are going to be paying an extra 20% that is going to affect a whole lot more people than the current 2.9% medicare tax.
The US is a hybrid system where about half the people are covered by the government and half are covered by private systems so you get situations where a veteran can die after waitin months for an appointment at a VA clinic but anyone can be seen in half an hour at the local Urgent care. The aforementioned Switzerland has a profit motive and has the shortest wait times in Europe while the about to be mentioned Norway has no profit motive and the 22nd longest wait times in Europe despite spending the most government money per capita in the world.
People do not spend all day drinking water but in places where water is cheap they water their lawns more, wash their cars more, and take longer showers then in places where water is expensive.
You would file claims so that the government knows how much to reimburse the hospital for doing the procedure. If the government does not reimburse by the procedure then they must know how many doctors of each specialty are needed. Who determines what is medically necessary? In many countries that is done by a government committee but in other places by each insurance company. It still needs to be done. Perhaps you don’t have medical fraud in Norway since it is a country full of honest people but in America there is a massive amount of fraud. It is estimated that the US loses 60 billion dollars a year in Medicare and Medicaid fraud. That is almost twice the entire budget for Norway’s healthcare system.
It doesn’t apply just to the US but it is seen most clearly in the US. As the number of stakeholders in any program multiply so too does the cost of paying those stakeholders off and changing a system. If you look at the projections for how much Medicaid was going to cost, they were off by a couple orders of magnitude.
Switzerland is the secondranked healthcare system in Europe by the Euro consumer Index and its healthcare costs are in line with the rest of Europe. Since health care spending as a percentage of GDP rises the richer a country gets, Switzerland tends to have high spending because of its high GDP. However, like the US it is a rich and multicultural society and its healthcare system is close enough to the US system that it would be possible though not likely to change the US system to be more like it and subsequently cheaper and better.
We are the best country in the world, but do we claim to have the wisest politicians, the most efficient bureaucracy, or the most competent government? What makes the US great is not its government.
The government is in the healthcare system up to its elbows. The government tells us who can provide healthcare, what they can provide, what insurance must cover, what they can charge for that coverage, how the coverage is paid for, and a myriad of other things. In my state it is illegal to build a hospital without permission from a government board.
And if they are not paying insurance premiums, their net take home will be largely unaffected.
Please cite where I can get a hip replacement with a 1/2 hour wait at urgent care.
The point there is that the govt is not reimbursing by procedure, like they do in the US, instead, patients are treated with the procedure that is most necessary for their condition. The doctors are generally paid salary, rather than on commission, so they don’t need to remit payments or any of that. So, in the US, we have an insurance company deciding if a procedure is worth while, and will only pay if they feel it is, vs a system where it is your doctor who decides if it is medically necessary. Do you really feel that the US system is better? Do you really feel that the insurance company is a better arbiter of necessary medical procedures than your doctor? If so, well, you’re defending the right system then, but I would disagree. I would rather my doctor be the one making my medical decisions, rather than some penny pinching accountant, but opinions differ, some people juggle geese.
Same with fraud. In the US, if you are sick, and cannot afford treatment, you have to game the system in order to not die. This means that we have to spend quite a bit of time making sure that only those who are deserving of it can receive treatment.
The amount of time and resources we spend ensuring that those who cannot afford to continue to live do not receive treatment to save their lives could easily be freed up and retasked towards saving those lives.
It is entirely a failure of the US system that doctors need to waste any of their time on these things. They are not in any way inherent to medicine.
By what metric do you call us the best country in the world? We just covered that it is not in healthcare.
As the govt is by the people, for the people, and of the people, I would argue that the govt IS the people. If our govt isn’t great, how can you claim that the country that it represents is?
It doesn’t seem to work out like that though. There does not seem to be more tax avoidance in for example Denmark than in the US. It seems more reasonable to suppose that visibly getting a return on your money affects how willing people are to pay tax.
We, first off I believe the public systems cover about 28 % of the population. And before Obamacare there used to be about, what, 10 % uninsured? The spending is roughly half and half public/private, but that is because the most expensive patients get sluiced over on the governments dime.
Second, I think emergency waiting room times in the US are on the order of hours.
Also, for the underinsured and uninsured, the bill from the emergency room might well ruin them. And they might be out of luck if the problem is something that will require ongoing attention. All in all, I don’t think its a good setup.
And still has shorter waits than the US for appointments and after hours care. However, we spend 9,7 % of GDP on healthcare. That is pretty much middle of the pack. That translates to more money because our GDP is high.
The fact that a large share of this is covered by the public purse rather than leaving huge, unpredictable costs that can mean life or death to the individual is not seen as a negative. To put it mildly. You will notice the US and Switzerland both doing badly there.
On waiting times in general, it is somewhat distorted by the fact that here the patient can choose which hospital they want to be treated at. In practice it often turns out that the patient will prefer a local hospital close to their home, family and social support network rather than going somewhere far away for shorter waits.
The fact is, conditions that are not urgent are by far the most common. One of the reasons insurance-based for-profit systems struggle to keep up with non-profit ones in results is that they allocate resources somewhat more based on ability to pay/financial resources rather than medical urgency. Not totally based on ability to pay, but it is a factor and not a small one.
Medical need is by far the most medically effective way to allocate resources.
And that means longer waits for the more common and less urgent issues, and shorter for the urgent ones. Not to mention a greater assurance that urgent issues will not be denied coverage or postponed due to coverage issues.
Also, in general, Nederland is considered to have the shortest waiting times in Europe. It is a healthcare dimension where Switzerland does well though.
And the problem is? They get more water, and its cheap. It is not actually a scarcity good, is my point. Coming at water supply with the perspective that its an exceptionally scarce and expensive good leads you to regard tap water in the same way as someone heavily invested in the US system sees UHC systems.
Well, I must confess that I simplified a large system a little.
However, K9bfriender is quite correct about the way it works in the public sector. The doctors are salaried, and what is medically necessary are determined by the physicians. The hospital doesn’t get reimbursed, they have a budget. The hospital knows how many specialists are needed.
Reimbursing after the fact for every procedure sounds like a paperwork nightmare.
It is, in some cases possible that claims, or something resembling that, can get filed in the private system. If a patient has chosen a private hospital for surgery. However, that hospital will be eligible to be chosen because they’ve won the bid for a batch of those surgeries, so they will have been paid long before being chosen by the patient. Bills may get issued to patients form non-covered foreign countries (That can happen in the public sector too sometimes). And sometimes people get admitted to private hospitals on insurance.
In general, post-treatment billing isn’t something that anyone is employed to do. It is an occasional extra for some secretary.
This is where I am seeing that we look at this from different perspectives. The whole concept of claims and reimbursements that is such a huge part of the US system and consumes so many man-hours is something we avoid as far as possible.
If you have a country where starvation is common, and people risk seeing family members starve to death, do you wonder that they have more food being stolen than one where food is plentiful?
We have less of a problem with fraud because there is less to gain by it.
Also, you ship massive amount of money around through a number of hands in a series of confusing bureaucratic systems that often do not interact well, and sometimes seem designed to be impenetrable. That is a far, far better setup for fraud.
Well, it is just under 2 % of yours. So that would indicate that our healthcare spending is 1 % of yours. But your population is not 100 times ours, that would mean a population of 500 million people. Do you see how that illustrates how much money bleeds away in your system, beyond fraud?
[quote=“puddleglum, post:50, topic:776528”]
Switzerland is the secondranked healthcare system in Europe by the Euro consumer Index and its healthcare costs are in line with the rest of Europe.
And that link says " *It does not claim to measure which European state has the best healthcare system *". It just measures consumer friendliness. Sadly, did you see who is number 3 ?
Some years it is number 2 after the US, and some years it drops down to 4, but it is always in the top. Also, like the US, it is in the top in both $ per citizen and % of GDP.
Actually, it is healthcare spending in number of dollars per person that rises with the GDP. We covered that with Norway. Average percentage of GDP, plus large GDP equals a larger spending measured in dollars. That is why we look at spending both in terms of dollars per person and percentage of GDP. The US and Switzerland score very highly on both, indicating that yes, the systems are expensive.
They are expensive because they have the same flaws. Switzerland just has a few more brakes in the system. It is considered attractive because it is the one system that leaves a lot of room for private insurance to make money.
Why do you think it is that this is the system insurance companies talk up?
Nice that a prominent Republican has finally acknowledged that the Democrats were right.
Of course, the fact that pharma stock prices dropped because Trump made noises about reducing drug prices is not the same as actually reducing drug prices. We’ll have to see how that plays out.
That stat looks…really strange. Iceland has 209 crimes per 1000 people, and is the most criminal nation in the world? Scandinavia the most high-crime region of the world on crimes per 1000 people? Low-crime nations include Russia, Mexico and Bulgaria?
Car thefts are more frequent in Norway, Auto thefts more frequent in the US?
Number of prosecutions per million people 19 times as high in the US, but Norway has more drug offenses and embezzlements?
I recognize some of those stats, like murder rates but others look… suspect.
Again, Trump isn’t your ordinary Republican. He sees that the USA is over paying and his natural instinct is to get a better deal not shrug his shoulders and say that’s how we’ve always done it.
One of my bigger gripes with GW Bush is when he said we couldn’t import drugs from Canada because we don’t know if there dangerous or not without FDA approval. I’m pretty confident that Canada fully vets the drugs being sold there and that they are safe.
People are currently paying a lump sum for coverage, if we switch to a percentage tax then half of the people are going to be paying more and half less. Those who will pay more will try to avoid the tax.
[QUOTE
Please cite where I can get a hip replacement with a 1/2 hour wait at urgent care.
The point there is that the govt is not reimbursing by procedure, like they do in the US, instead, patients are treated with the procedure that is most necessary for their condition. The doctors are generally paid salary, rather than on commission, so they don’t need to remit payments or any of that. So, in the US, we have an insurance company deciding if a procedure is worth while, and will only pay if they feel it is, vs a system where it is your doctor who decides if it is medically necessary. Do you really feel that the US system is better? Do you really feel that the insurance company is a better arbiter of necessary medical procedures than your doctor? If so, well, you’re defending the right system then, but I would disagree. I would rather my doctor be the one making my medical decisions, rather than some penny pinching accountant, but opinions differ, some people juggle geese.
[/QUOTE]
In every system there is a way to determine how much to cover. You can have insurance companies do it or you can have a government panel do it. I don’t trust the government to do it and I don’t trust the insurance companies either, but at least with the insurance companies I can choose to switch if I don’t like what they choose instead of having to move to a new country.
Fraud is not sick people seeking care they are not entitled to. Most medical fraud is a doctor setting up a clinic that sees 50 people a day and billing Medicare for 100 people a day.
If people are sick and can not afford treatment they can be declared indigent and the state will pay for their care or they be put on Medicaid and treated that way.
Total amount of awesomeness.
Every country has bad things about it, even the best country.
