# Let's say US Nationalized Health Care is considered - What are the real world costs & issues? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 22, 2016, 8:19pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763 "2016-11-22T20:19:41Z")\ **Posts on this page:** 17\ **Page:** 3
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 23, 2016, 8:23pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/41 "2016-11-23T20:23:34Z")
> [@Nava](#): > > “Iberia”? What’s the capital of that, Andorra la Vella? Iberia does not have a capital. It refers to the nations of the Iberian peninsula, Portugal and Spain. Like the term “Scandinavia” refers to Norway, Denmark and Sweden, or “The British Isles” refers to the UK and Ireland. > [@puddleglum](#): > > In order to fund healthcare at the current cost, you would need to double the money generated from the income tax. Since this is not really possible, the most likely way would be the implementation of a value added tax. This is like a sales tax but it is added at every point along the way from raw material to final sale. This would mean a much higher burden on middle class taxpayers, similar to what they have in Europe. I think the point is that healthcare at its current cost isn’t sustainable. And we can assume that a more normal cost would apply. Occams razor would indicate that as well, along with general health care economics theory. So no European taxes without European benefits. [quote=“Martin\_Hyde, post:35, topic:772763”] The way we train doctors is definitely part of it. I think you’re usually about $250,000 in debt when you’re done with all your education. [/QUOTE I don’t think remunerations for medical personnel is a big driver of costs. From memory, it accounts for about 6 % of the difference in costs between the US and the rest of the OECD. > [@Martin\_Hyde](#): > > I’m not “absolving” anyone. I’m trying to focus attention on the biggest drivers of cost, and I don’t believe it’s the insurance companies. While the insurance companies may not be the biggest direct adders of cost, one of the biggest drivers of cost is the US excessive bureaucracy. The number of insurance companies with their separate systems, coverages and forms add considerably to that. > [@LSLGuy](#): > > It’s invalid to look at the Medicare prices and assume the industry could survive if that price was expanded from 16% of customers to 100% of customers. Medicare customers, being generally over 65, consume about 400 % as much healthcare as the average 18-65. That is why they’ve been sluiced over on the governments dime. However, you should be looking at what they cost in other systems. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 23, 2016, 8:32pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/42 "2016-11-23T20:32:51Z")
If done correctly, or even just not horribly, we don’t have to raise revenue from anywhere. The US spends as much per patient on healthcare administration as the UK spends per patient on all healthcare expenditures. Total UK healthcare spending - including private supplemental plans and expenditures - is less than $250 billion per year. That’s to cover 60 billion people from cradle to grave, other than very small drug copayments (I think 5 pounds is the normal patient cost now). Medicare alone - which provides _partial_ coverage for roughly the same number of people - costs $600 billion annually. ---
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [November 23, 2016, 9:08pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/43 "2016-11-23T21:08:27Z")
> [@Really\_Not\_All\_That\_Bright](#): > > That’s to cover 60 billion people from cradle to grave, _coughs modestly_ You do us too great honour, Sir > [@puddleglum](#): > > In order to fund healthcare at the current cost, you would need to double the money generated from the income tax. Since this is not really possible, the most likely way would be the implementation of a value added tax. This is like a sales tax but it is added at every point along the way from raw material to final sale. This would mean a much higher burden on middle class taxpayers, similar to what they have in Europe. Presumably no longer buying compulsory insurance premiums might go some way to off-setting that. ---
**Author:** ![doubleminus](https://avatars.discourse-cdn.com/v4/letter/d/5daacb/32.png) [@doubleminus](https://boards.straightdope.com/u/doubleminus)\ **Post date:** [November 23, 2016, 9:44pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/44 "2016-11-23T21:44:39Z")
It’s true that the difference between that US and W. Europe is 17.5% vs 11% of GDP. However, the _average_ quality of care in the US is significantly lower. US is #38 in life expectancy, just above Cuba. While some of the best care around could be found in the US, the lower 2 quintiles have dismal care or sometimes not at all. I hear many stories, admittedly anecdotal, from professional people getting third-rate attention and treatment. Even trivial improvements, like computerizing all records, and having most doctors and clinics being able to input and consult data are very patchy. These happened in other countries a long time ago. Here in Israel, although the medical system is being starved for funds, we consume only 7.8% of GDP and are #8 in longevity, although we have immense differences in income and culture between groups. Singapore is even better - 4.9% of GDP, #3 in longevity. However they are also very rich, with a $85K GDP/capita by PPP. The system in the US is so thoroughly broken, that it is not enough apportioning who gets rich by it. Of course that the medical-industrial complex is the primary villain, but also the Congress. Even Obama, emphasizing the insurance angle, let off the hook the (mostly Democratic supported) abovementioned complex. What is sad, is that only people having lived in other Western countries can fully understand and feel the awfulness of the US “system”. In many ways a lot of money is wasted to internal friction. It somehow reminds me that economists analyzing the fallen Soviet Empire, found _value subtracting_ enterprises, i.e. the raw materials being worth more than the manufactured goods. 2 other remarks: One is the indentureness of employees to their employer (slightly alleviated by the ACA) - and the dependence of young adults on their parents. The second is that most personal bankruptcies are health-cost related, and AFAIK this was the case even in the extreme years 2008-2009. This is compounded by the fact that the average American has almost no net savings. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [November 23, 2016, 10:01pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/45 "2016-11-23T22:01:22Z")
> [@Evan\_Drake](#): > > _coughs modestly_ You do us too great honour, Sir … The Sun would truly never set on an Empire large enough to contain such multitudes. And so well cared-for. 'Tis truly a wonder to behold. 🙂 ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [November 24, 2016, 3:20am UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/46 "2016-11-24T03:20:22Z")
> [@Grim\_Render](#): > > Iberia does not have a capital. It refers to the nations of the Iberian peninsula, Portugal and Spain. Like the term “Scandinavia” refers to Norway, Denmark and Sweden, or “The British Isles” refers to the UK and Ireland. Andorra and Gibraltar are also on the Peninsula and also have UHC, and each of the four has a different system. If Portugal and Spain’s happen to be similar to each other, they arrived to them by different and independent pathways. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [November 24, 2016, 3:45am UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/47 "2016-11-24T03:45:07Z")
> [@Grim\_Render](#): > > Iberia does not have a capital. It refers to the nations of the Iberian peninsula, Portugal and Spain. Like the term “Scandinavia” refers to Norway, Denmark and Sweden, or **“The British Isles” refers to the UK and Ireland**. You may want to be careful about making that statement in a pub in Ireland… ---
**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:** [November 24, 2016, 9:36am UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/48 "2016-11-24T09:36:59Z")
> [@Northern\_Piper](#): > > You may want to be careful about making that statement in a pub in Ireland… Yes, the preferred term is the Atlantic Isles, which includes Iceland, the Scillies, and the Faeroes. ---
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [November 24, 2016, 10:08am UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/49 "2016-11-24T10:08:20Z")
On the other hand, I have never _ **once** _ heard anyone on earth refer to ‘The Atlantic Isles’. Compton MacKenzie. an English writer born Edward Compton who became a famous Scottish writer who helped found Scottish Independence as a movement ( before the mid-20th century it was more a few arm-waving loonies ) once forced the unspeakable de Valera to acknowledge they are the ‘British Isles’ geologically. Dev vaguely wanted something like ‘The British Isles & Ireland’. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 24, 2016, 5:11pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/50 "2016-11-24T17:11:26Z")
> [@Nava](#): > > Andorra and Gibraltar are also on the Peninsula and also have UHC, and each of the four has a different system. If Portugal and Spain’s happen to be similar to each other, they arrived to them by different and independent pathways. Andorra and Gibraltar are not included in the Iberian countries because they are not countries. This is much the same as how the Ålands are not a Scandinavian country, the Færoes not included in the Nordics, and the Isle of Man, Jersey etc not counted as countries in the British isles. Portugals health care system, the Serviço Nacional de Saúde, was created in 1979 and is based on the classic National Health Service model. Also known as the Beveridge model. In English, the Serviço Nacional de Saúde is generally translated as “National Health Service” and it is often abbreviated to “the NHS” in papers etc. The Spanish Health care system has through a series of reforms come to be a Beveridge style system. It is called the Sistema Nacional de Salud, which means the National Health System. It is often referred to in english-language papers as “the NHS.” Gibraltars system is based on the UKs National Health Service, which was set up after William Beveridges “Beveridge report” for whom this type of healthcare systems are named. These cluster quite closely together as similar Beveridge type systems. This is because they all derive their design from the same model. Andorra, as far as I remember, resembles the french hybrid model. > [@Northern\_Piper](#): > > You may want to be careful about making that statement in a pub in Ireland… I know a few people from Ireland, and no one I know have ever objected to their island being part of the British Isles? Are you thinking of Great Britain, which I believe they would object strenously to being included in? ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [November 24, 2016, 6:00pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/51 "2016-11-24T18:00:57Z")
To be pedantic, Beveridge’s contribution to the UK welfare state was the development of the National Insurance system for unemployment, retirement pensions and other financial benefits. The principle of a national health service was accepted across all parties, but exactly how to do it (run it as a local government service, single nationalised organisation, insurance-contributions based?) wasn’t agreed, and AFAIK he had very little to do with how Bevan and the Labour government finally settled it with the doctors and hospitals. The NHS as we have it is very much the child of its time - people had seen that unified national effort under government direction had actually worked in the direction of the war effort, so it wasn’t hard to persuade them it could work in dealing with the backlog of untreated medical needs. This was before today’s high-tech medicine, when the major public health concerns were to do with industrial pollution and poor housing, antibiotics were promising seemingly near-instant solutions to the most common diseases like TB, and after years of rationing, obesity wasn’t exactly a major health problem, and no-one yet understood about smoking. Plus, there was a well-established culture of not “bothering the doctor” unless you were nearly at death’s door anyway. So it wouldn’t necessarily fit as an off-the-peg answer to 21st century problems. As for costs, I did a back-of-an-envelope calculation. At the moment, expenditure on the NHS takes roughly 18% of government expenditure (though it’s nearly down to 7% of GDP and ought to be more). If you assume 18% of tax income is going to the NHS, that works out (roughly speaking) for most people to 3.6% of taxable income, plus 2% of income liable for National Insurance contributions, plus 2.5% of National Insurance liable income paid by employers - and everyone pays 3.6% on VAT-able items, and 18% of whatever duties are due on the alcohol, fuel, airport departures and any other incidental taxes and duties. Direct payments work out, for: - someone on the median gross household income - £950 p.a. (plus employers’ NI contribution £455 p.a.) - on £40k a year - £1734 p.a. (+employer £793) - on £100k a year - £4163 (+employer £2284) And yes, it is often said it is as much a cost control operation as it is a public service - national salary scales and other contract terms, national standard tariffs for courses of treatment (and \*not \*by item of service), national cost-benefit analysis. Of course, there’s nothing to say you couldn’t develop some of that with doctor’s professional organisations on an advisory basis rather than as a government imposition, but as to how effective that might be… ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [November 24, 2016, 7:16pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/52 "2016-11-24T19:16:41Z")
You need to subtract the amount Americans already pay for government healthcare… ---
**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:** [November 25, 2016, 12:48am UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/53 "2016-11-25T00:48:28Z")
> [@Caldazar](#): > > It’s not quite that dire. US Healthcare was about 17.5% of GDP in 2014, whereas a number of the larger industrialized countries ran at around 11.5% of GDP or so. So the US is running about 50% over. Clarification: The U.S. GDP per capita is quite high; it’s almost 50% higher than France’s GDP/capita (or 35% higher using purchasing power parity). _Thus any U.S. economic measure will appear higher when represented as percentage of GDP._ In dollar terms, 2x to 3x is a fair summary of U.S. health care per capita spending compared with other developed countries. Spending is 1.5x that of Switzerland, in 2nd place for highest healthcare spending. U.S. healthcare spending is split very roughly 50-50 between private spending and public spending. _Either_ spending type in U.S. exceeds _total_ per capita spending in all but a handful of countries. (U.S. “healthcare” spending includes salaries of private and public adjustors whose function is to deny care.) ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [November 25, 2016, 12:23pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/54 "2016-11-25T12:23:41Z")
> [@Grim\_Render](#): > > Andorra and Gibraltar are not included in the Iberian countries because they are not countries.? Andorra is not a country? Mother of God… ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [November 25, 2016, 12:29pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/55 "2016-11-25T12:29:00Z")
And Spain’s national healthcare system is generally referred to as “_Seguridad Social_” (Social Security), although the healthcare system is not managed at the national level any more and the tax by that name goes to fund multiple agencies, not only the one by that name. There is not an agency or organization called _sistema nacional de salud_; the name refers both to the previous situation where the system was managed by _Seguridad Social_ and to the grouping of the current 17 regional-level agencies. The tax is still collected at the national level; it gets distributed to the 17 agencies, but if you want to prove that you’re current in your payments or get your work history, you still go to the _Tesorería de la Seguridad Social_ (SS Treasury). ---
**Author:** ![astro](https://avatars.discourse-cdn.com/v4/letter/a/9dc877/32.png) [@astro](https://boards.straightdope.com/u/astro)\ **Post date:** [November 26, 2016, 2:42am UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/56 "2016-11-26T02:42:39Z")
Thanks to all responding for the education in how US Health care works. Your points were very informative and a little terrifying. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [November 26, 2016, 3:18pm UTC](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763/57 "2016-11-26T15:18:33Z")
> [@Grim\_Render](#): > > [QUOTE=Northern Piper] > > You may want to be careful about making that statement in a pub in Ireland… I know a few people from Ireland, and no one I know have ever objected to their island being part of the British Isles? Are you thinking of Great Britain, which I believe they would object strenously to being included in? [/QUOTE] I’ve met Irish who object to the word “British” being applied to them in any way, shape or form. Obviously, YMMV. 🙂 [Previous page](https://boards.straightdope.com/t/lets-say-us-nationalized-health-care-is-considered-what-are-the-real-world-costs-issues/772763.md?page=2)