Which waits are dismal? I’m looking at the CT numbers, and it says priority 1 patients ( emergency) are not included. The longest average is 37 days, for people with a target of 28 days. People with a target time of 2 days had an average wait time of 1 day.
You are very likely correct that people in the US with health insurance or the means to pay have no wait time* - but that contributes to cost. I don't regularly get MRIs- but I get a mammogram every year. No symptoms, it's a screening mammogram. And I can always get an appointment within a day or two. Which means that the center I go to has enough technicians and machines to have enough empty spaces in their schedule that they can book a non-emergency on less than two days notice. That costs money.
And if you include the people with no insurance/poor insurance/can’t afford the copay/deductible who are not going to get that scan done until the ER does it because it has now become an emergency (which could be months or years) , the average US wait would very possibly be longer than the longest Canadian wait. But somehow when Americans are talking about the lack of waiting time, they never include those people.
This post is like a fractal of wrongness. Each individual part is wrong on it’s own, and the overall impact is even more wrong than the sum of it’s part. It brings a tear to my eye.
Again, there’s no such thing as free healthcare. Sensible primary healthcare systems are free (or nearly free) at the point of service, and are funded principally out of general taxation, which guarantees that every taxpayer contributes to an implicit universal insurance pool.
But it’s good to see that you’ve got your priorities straight. You are willing to embrace the appallingly bad U.S. healthcare system, which (below retirement age) is funded by what amounts to a massive payroll tax; a system that excludes many people without good jobs from the system entirely; a system that makes it difficult to change jobs, and makes things especially difficult for small businesses and self-employed entrepreneurs; and that costs at least twice as much as any other developed nation for worse health outcomes. You’re willing to embrace it rather than take the risk of the substantials reforms that could save everyone money and make everyone healthier, because that might allow some poor people or immigrants to steal a bit of healthcare that they don’t deserve. And that’s the important thing.
You have invented the car dealership. Dealerships allow manufacturers to sell more cars by outsourcing some marketing, inventory storage, and service. Sometimes middle men add value so eliminating them make the process less efficient.
Doesn’t Medicare as it is have an actuarial value of around 70%?
According to that 16% of all medical costs are paid by employers with another 12% as lost tax revenue due to employers buying private insurance. Combined that’s 28% of medical spending. Around a trillion dollars.
If you assume a Medicare buy in is $6000 a year on average and you add 180 million people to it then that’s 1.1 trillion dollars.
Problem is I doubt most people with employer based insurance would accept it.
The issue here is in understanding where a model that’s applicable for most types of private enterprise fails for healthcare. We all accept that we don’t run national defense like a normal private corporation, for obvious reasons. And every country other than the U.S. understands that there are equally obvious reasons why healthcare is also an exceptional case.
For most types of insurance, it’s perfectly acceptable that private insurance companies should assess prospective risk, and in competiting with one another to do this they add value. And we accept that it’s reasonable for riskier drivers to pay more for car insurance, and that good drivers should not be forced to subsidize bad drivers.
But apply the Rawlsian veil of ignorance to healthcare needs. Some random selection of people will be unlucky enough to get cancer, or need a transplant, or suffer from some chronic disease. If you don’t know whether you will be born as one of those people, what kind of healthcare system would you choose? Sure, there are some aspects of health that are somewhat under our control, but many are not. And even when sickness is a result of poor lifestyle choices, we generally don’t believe that a civilized society should allow people to suffer and die for those choices.
So the usual insurance model where private companies continuously assess people’s health prospects and exclude people who they know are likely to need healthcare doesn’t work. We all know that - that’s why we all agree with legislation that stops insurance companies excluding people with pre-existing conditions, it’s why we won’t every allow genetic screening for this purpose. But efficient assessment of prospective risk is the entire raison d’etre of private insurance in a free market economy. If we acknowledge that insurance companies should be barred from assessing prospective risk, then they have no sensible role in an efficient healthcare system at all. They are middlemen that suck money out of the system but add no value.
The sensible model for healthcare is that we all effectively buy into the principle of health insurance with a Rawlsian veil of ignorance before we are born, before we know if our individual likely healthcare needs will be above or below average, as part of our social contract. We all commit to lifelong membership of a single insurance pool to fund healthcare. And the simplest way to form a universal mandatory insurance pool is to fund the primary healthcare system from general taxation. Again, this is similar to what we all accept is necessary for funding national defense; and it’s the approach taken by every country other than the U.S.
Private corporations should certainly compete for the provision of healthcare, just as they do in the defense industry. They just have no appropriate role in the funding of healthcare.
However, in many states, laws prohibit buying cars from anyone but a dealership. (I.e., one cannot legally buy direct from the manufacturer.) Are you in favor of such laws requiring the use of middlemen?
It’s not just national defence that isn’t left to the market. Governments provide a lot of services because the private market won’t, or shouldn’t, because the profit motive isn’t appropriate: Police. FireFighting. Roads. Education (K-12).
We don’t call those “free” services. We pay for them with our taxes. But they are essential for our society and best handled by government.
Health care in most countries is just another service that is better handled by government, because of moral/ethical issues, and because studies of health care economics show that the market efficiencies just don’t apply to health care decisions.
The US spends about 4% of gdp on military. Most other western nations spend about 1-2%.
The us spends 18% of gdp on health care, vs about 8-12% in other wealthy nations.
I believe in the US we spend about 5-6% of gdp on education, mostly via public funds. No idea what other western nations spend but I assume it’s comparable.
The real issue is how expensive our health care is. If our health care was as affordable as Europe we’d save 6-8% of gdp a year.
Enough to balance the budget, offer free college to everyone, drastically increase spending on renewable energy and expand social security.
The issue isn’t military spending. The US spends 1-2% more of gdp on education than other western nations but we spend 6-10% more of gdp on health care. And our health care is worse, it’s just more expensive.
If we want to save costs we have to start there.
Free public college would cost about 80 billion a year. If our health care was as cost efficient as Europe and Japan we’d save 1.5 trillion a year.
The US does not run health insurance like a normal private corporation. Every state has a list of rules that only apply to health insurance companies that is as long as your arm. Employer health insurance costs are given special tax advantages which is not done for any other type of insurance. Because of the rules actual health insurance is banned in most places, and what insurers provide is prepayment of health care costs.
There are also many different types of funding for health insurance around the world. In some countries like Germany there is a combination of public and private insurance companies, in some like Switzerland there is compulsory private insurance. The most efficient health insurance system in the world, Singapore, is a mix of public and private insurance with mandatory HSAs.
Insurers can provide more services than just risk pooling. They can also negotiate with providers and monitor fraud. Medicare fraud costs the government at least 90 billion a year, unless the program is changed ten making medicare for all would likely increase that to 180 to 600 billion per year.
Every country has problems with their healthcare costs, for instance if Canada’s system was as efficient as South Korea’s system the could cut their spending in half and still live longer. The UK could cut their spending in almost half and live longer if their system was as efficient as Greece’s.
There is an interesting link between high US healthcare costs and high college costs. Lack of price elasticity. Items where the customer has little ability to reduce the purchase if the price is to high often lead to market failure.
Medically necessary healthcare is hard to refuse on cost. And in the US, parents normally see college as the ticket to success or at lest the middle class for their children, I think. Hard to refuse too. In countries with free higher education, I think theres often more rewarding non-degree life paths. So the pressure on getting a degree is less, and fewer people need to go to college.
Anyway…
You seem to think they are doing the same jobs. The problem with US bureaucracy is that it generates a lot of work and jobs that other systems just don’t do or do a minimal amount of.
Billing. Gatekeeping. Negotiation with insurers. Credit-checking. Liaising. Insurance bureaucracy, claims written, received, accepted or rejected, appeals. In-network and out-of-network. There is a fantastic amount of bureaucracy in the US system that won’t be replaced with government bureaucracy because its unnecessary outside of the US health care ecosystem.
No. First off because there seems to be no difference in the matter between nations that have had US military support and nations that haven’t. Sweden, Finland, Switzerland, doesn’t seem to be much of a difference between them and NATO countries.
Second, because the savings on a UHC systems are so large they dwarf military spending. The US spends, what, 5% of GDP on defense? Versus 1-2 % from other western nations. And the US spends 18 % on healthcare versus 9-12 % for the other nations.
Third because without the US spending in the pot, the other NATO nations or the EU still grossly outspends Russia.
Actually the number of Americans filching free healthcare on forged documentation in Canada, and getting prescriptions filled in Canada vastly outnumber the people going the other way.
On the subject of waits, its a fairly complex subject. Waits to see a GP, waits to see a specialist, wait at the emergency room, waits for elective surgery, waits for urgent surgery are all different. I believe its an area where Canada does not do very well, but sitting next to a kid not doing to well does not automatically make the US good. I believe overall the US is bit above average in waits, but not in the top. I think Denmark and Switzerland are the top.
Also, the uninsured and people putting off seeing a doctor due to worries about cost is not generally counted in US waits, except emergency room ones. If they were included, it is likely US waits would increase.
What kind of value would you say the US enormous overload of middlemen adds?
What kind of definition for “Efficient” are you using here? Because it sounds like you are only looking at costs.
Didn’t you in the post just above say to aim for a system like Switzerland? Where doctors make more than in the US? How much do you think doctors salaries matter in total anyway?
Well, its a good thing you don’t have the immigration of the UHC european nations then, isn’t it? Nations like the UK, Germany, Belgium, Norway, Austria etc, etc… Oh and yes, Denmark. All of which have higher net migration than the US.
You must not be from around here, snfaulkner. “Government is always the problem” is one of the four key tenets of American political thought, along with “Gunz is good,” “Tiny racially homogeneous countries like Canada or France can adopt solutions that wouldn’t work in the Biggest and Bestest Country on Earth,” and “I got mine already. Eat S**t, sucker!”
Note also that it is the private buying agent that will have incentives both
to establish an inflated price scale, to expand the total cost of healthcare,
and
to deny expensive care, as possible in* individual* cases.
I didn’t know where to begin on this. Fortunately I was immediately Ninja’ed by Babale’s excellent effort:
Why does anyone need forged documentation to fill prescriptions? That’s covered by employer offered private health insurance, not provincial insurance, at least in Ontario.
The forged docs are necessary to filch healthcare. All of the provinces have been upgrading the healthcards, to make it harder for non-residents to get healthcare, pretending to be Canadian residents.
Actually look it up and Mexicans are just a part of the millions of all the immigrants pouring in that then must be housed, fed, provided healthcare for, be enrolled in schools, and provide employment for.