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.
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.
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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.
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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.
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.
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.
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.
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.
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.
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’.
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.
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?
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…
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.)
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).
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?
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I’ve met Irish who object to the word “British” being applied to them in any way, shape or form. Obviously, YMMV.
