I think the issue is not that USA spend twice as much as some other countries, the real question is why do you have such a low life expectancy compared to comparable nations. Yes you do have access to some great care.
So do you increase spending in prevention? We do is Australia with strong anti smoking laws, very strong road rules, exercise in schools and a good mental health program. By taking up these you can reduce the burden on the health system.
In Australia yes it would be covered if it was determined if the risks outweighed the benefits.
My conclusion is that the USA is too big with too many interest groups to operate efficiently.
Which is an example of what I mentioned earlier: single payer systems do in fact have to review claims. They aren’t just going to pay for any hip replacement for any person. The NHS doesn’t work that way either. There’s no reason we couldn’t do it that way, but you won’t cut costs if doctors are just trusted to prescribe whatever they feel is necessary regardless of cost and medical necessity. In the real world, doctors often go straight to the most expensive drugs and treatments. They order more tests than necessary. If the single payer system isn’t putting the kibosh on that practice, then not much money will be saved.
I would HOPE that if we did do single payer it would be on the Canadian model, with the states doing most of the administration. DC is not capable of managing such a system.
Depending on the grandma’s general state of health, Spain. And why shouldn’t we? My grandma’s recent skin graft was covered (she hurt herself against the side of her bed: no broken bones but the wound must have been a sight), my grandpa’s periodic polyp removals were covered, I know people who went ciborg as late as 93 (one of my mother’s neighbors).
Paying for me to get Lasik when my scrips were at less than 4 diopters? No way. Cosmetic, I paid for it. It was for my convenience, not because I needed it.
Paying for my then-in-her-80s great aunt who couldn’t see cars unless they were brightly colored? Yes, she was the first person to undergo eyesight-correction surgery in the country and it was covered as it moved her from “legally blind” to “normal vision with glasses”; her operation had been scheduled before the surgeon left for his training, and in turn it served for him to start training his team.
If that happened, then good for private health care. I’d just like to see an affordable workable health care system in this country. If a private system does that, then that’s great.
But I don’t think it’s likely. We have a private health care system now and it’s the problem we’re trying to fix.
Hip replacements, knee replacements, etc. are generally regarded as non-emergency and in Canada the wait for those procedures can be pretty lengthy as a result. Skin grafts sound like emergency treatment, and polyp removal sounds like routine preventive medicine. It seems to me that it would actually be barbaric to deny the elderly those services, but having a bad hip or knee and being elderly tend to go hand in hand. Heck, I’m only 40 and I have a bum knee.
Yeah, but you could get the worst of all worlds. THe private system still sucks, it’s just that the government failed to exceed even that low standard.
I think the biggest cost issue in the US is that people who receive services are not paying for them so they don’t know or care what something costs. If they had to pay cash for services, costs would fall immediately.
Just like when you are in a car accident and your insurance company arranges a rental car… you don’t care what the rental car costs so you are going to take the nicest car they will allow you to have.
Actually, “receiving services without knowing or caring how much they cost” is pretty much the defining characteristic of single-payer and other state-sponsored healthcare, which as we’ve seen is *more *efficient, not less.
Your choices with hip replacements seem to be that you are in extreme pain that you can’t kick with pain killers or you get the surgery. At least, that’s my mom’s experience. I don’t think it’s so far-fetched to think it might be done.
During the crafting of the aca there was talk of a public option tied to Medicare but it was shelved because it would out compete private insurance. The lower overhead and lower reimbursement made it 20-30% cheaper than private health insurance. People with a financial or ideological stake in private insurance helped shelve it.
A big fear I have with single payer on the state level is that too many sick people will move to that state and bankrupt the system. But that isn’t a failure of single payer, it is a sign people prefer the system.
That’s how a public option would perform in theory. In practice, there would have been issues that could have prevented it from competing. For example, the narrow networks are a fairly controversial problem with exchange plans. The public option was going to pay Medicare+10% rates. Would the public option have been able to get a decent network under those conditions? The private plans are paying a lot more than that to providers and they couldn’t get broad networks. The public option’s networks would have been even narrower. And with the low administrative costs, we’re assuming efficiency, which should never be assumed when it comes to the government. Finally, people often cite the success of Medicare, but Medicare doesn’t compete and it doesn’t have to even be revenue neutral. The public option would have had to survive only on the premiums it took in just like private insurance companies. They wouldn’t be able to run a program deficit the way Medicare does. So they couldn’t be as blase about fraud as Medicare is. Fraud could literally kill the public option dead if they failed to deal with it, just as it would kill any private insurance company if it got out of hand. And rooting out fraud costs money.
We’re not jumping off a cliff. If the worst happened and a public health care system doesn’t work, we can switch back to a private system. But it’s worth noting that no country that has switched to a public health care system has ever wanted to go back to a private system. The evidence is pretty overwhelming that public systems work better than private systems. Let’s face it, opponents of public health care are afraid it will succeed not that it will fail.
That has more to do with the politics of health care than the performance of health care systems. The NHS model, for example, is clearly the weakest on all measures but cost, yet as with most systems, even our own, there is a lot of resistance to changing the status quo. If things actually worked as you argue, then Britain would long ago at the very least have switched to a Canadian style system.
Life expectancy, infant mortality, cancer survival rates, deaths amenable to health care, waiting times… The UK tends to rank near the bottom in all of those categories, in many cases saved only by our even poorer performance. And that’s what I mean by politics. As long as UK politicians can raise fears of reform as “Americanizing” the NHS, voters will bitterly cling to that outdated socialist model. One of the good sides to ACA is that it might push us ahead of the UK across the board, and maybe then their denial will end.
“Near the bottom” of what? The UK ranks 27th in the world in life expectancy (assuming you include not-real-countries like Hong Kong and San Marino), and 15th in health care spending per capita. Compare, say, Germany, which is 22nd/7th. Or Canada, which is 11th/6th. Or Switzerland, which is 10th/3rd.
The UK performs poorly on such measures because it spends relatively little on healthcare.
Okay, I’ll concede that could be the cause, but given our own issues with the VA and the stream of similar stories that come out of the NHS, it seems to me like it’s a less than ideal model built for ideological considerations rather than practicality. No other free nation uses that model.
My grandma’s recent skin graft was covered (she hurt herself against the side of her bed: no broken bones but the wound must have been a sight), my grandpa’s periodic polyp removals were covered, I know people who went ciborg as late as 93 (one of my mother’s neighbors).