One reason: U.S. Wastes Health-care Funds: Administrative Costs Double Canada’s Rate.
However, it is not a zero-sum game. If people go for more preventative treatments, that can save money over the long run.
Also, this “basic law of economics” applies to private health insurance too. In the U.S., most people get health insurance through their employers (or elsewhere) and this also results in their use of health services being heavily subsidized to the point where the price incentive not to use the service is reduced or eliminated.
I should also point out that unless Canada’s health care system has really gone way down hill in the last 8 years since I left, my personal experience was that the health care system was not at all terrible and that most people were happy with it. In fact, I recall that when the conservative Reform Party leader said something about health care, he was jumped on for supporting privatization of the system and he immediately back-tracked and claimed that this was not what he was calling for…Supporting privatization at that point was political suicide. Hell, one of my roommates in Vancouver was a conservative’s dream-boy, a self-made entrepeneur who worked his ass off in business for himself, and no liberal…But, even he told me that he didn’t understand why the U.S. was not moving toward having a universal health care system like that in Canada.
So, even the worst two examples…and countries that spend a much lower percentage of their GDP on health care than we do…are not really as bad as they are made out to be, although they clearly have some problems.
I can’t answer for France, but I’ll give you my 2c from my perspective.
Health care price control is the concept of governments demanding that drugs or services are sold at a certain maximum price. If not, the drug is not allowed on the market. I think France has it, but we don’t. I pay the same for drugs as in the US, with two exceptions:
a) certain crucial drugs are subsidized by the government (suppliers get paid fully)
b) there’s a ceiling for how much I personally have to spend on such crucial drugs per year
As for the elderly, they receive the same care as everyone else. I grew up with two grandparents in the house, saw them grow old and die. At the end of their long lives, they did not receive insufficient treatment, far from it.
I can’t see that this is true. Quite the opposite, in the US health care is more expensive. And as I said above, people go to the doctor when they are feeling sick. And even if they should go more often (I don’t know if they do), most of the cost is in the treatment, not in the visit.
I’m not updated on the american system, but the way I see it the problem in the US is that the insurance system doesn’t make people shop for the best treatment in regards to cost/quality. People shop for the best/cheapest insurance, which is something completely different. I would like to hear more about to what extent prices are affected by consumers in the US, if you have time?
In Europe there are different systems. In some countries people pay a forced insurance and rely heavily on private suppliers. In my country it’s funded mainly by taxes, with a small co-payment per treatment. Hospitals are state-owned, the rest (doctors, specialists) are in private practice but part of the system (they get reimbursed per treatment). Some private companies are outside the system and they charge whatever they like. Inside the system, the co-payment is the same for everyone, people pay more taxes the more they earn. All kinds of treatments are covered by the system, with the exception of cosmetic surgery. Dental is covered for everyone under the age of 18.
Once again, I don’t know about France, but the co-payment for any kind of treatment is beteeen $10 and $40 - per treatment. Hardly unaffordable. The $10 is for the blood sample, the $40 is the bypass surgery. If I reach my yearly ceiling I’ll request to reimbursed. It usually takes a couple of weeks.
Every study or article I have seen lists increased demand for medical care as one of the leading factors in the rise of medical costs.
You’ll have to qualify your relative term for me. More expensive that what?
Partly this is true. It is something some fear to get worse in a more socialized setting.
I’m not exactly sure what you are asking. Consumers are the demand in the supply and demand equation which determines all sorts of things. Medical treatments are more complicated because the government and insurance companies hide the costs. Also, the demand for medical treatment is different than the demand for most things. Meanwhile, the ability of any system to increase its supply of medical treatment is often hampered by forces other than capital investment. Politics and regulations often play a larger role.
My understanding is that French consumers pay up front for their medical care. Not a copay, but payment upfront. Then the national system reimburses them up to (70 or 85) percent of the payment. If they have additional insurance, this reimburses them the rest. I eagerly await clairobscur’s further input into the matter.
Meanwhile, thank you for your input into the Scandanavian (I assume from your location) system. Can you find any cites which show the historical amounts spent per capita on medical care in your country? This might go a long way towards determining how much more expensive care is here than there.
With your enormous understanding of statistics, it seems odd that you keep saying this. Certainly it is true that if people who are going to get sick would go to the doctor early enough to prevent their illness, those people would save a lot of money. But most of the time catching an illness early means catching it before symptoms are felt by the patient. This means that we would have to test a lot more people a lot more often to realize the savings you are talking about for the whole medical system. Can you give me a cite which suggests that testing every adult for aids every 6 months, for instance, would really be cheaper than treating those who develop aids? For any particular illness?
My appologies, Alien. I meant to include this List of reasons why health care costs so much. It is not very scholarly, but it does include the argument that more demand for care can drive up costs.
HIV/Aids is not a good example, not least because it is incurable. The real savings to be made through preventative methods are for those problems which cause massive drains on medical costs through their prevalence; and preventative methods no not just involve screening. Public health campaigns, education about diet & exercise, and so on can decrease the incidences of heart disease and common cancers, which would be a huge saving. Likewise, education about how to spot an illness early would be helpful. A private healthcare system has no vested interest in such campaigns, as they would actively cost the private organisations money while lowering their income. A public system, however, has an obvious need to operate preventative systems as much as possible. And they can be imaginative - free fruit for schoolkids is one idea gaining favour in the UK, which costs very little, but helps both their long-term health, and also their short-term proneness to colds and other common illnesses.
That’s illegal in most of Canada, which is part of our problem.
You had me until this last sentence. This is simply a lie. I have seen more informative information about health services, when to use them, and how to use them from my health insurance carrier than I have ever seen from the government. I would venture to guess that insurance carriers spend quite a bit more on such campaigns than the government does.
Your math is also faulty. If a carrier convinces a customer to go to the doctor early and thereby keeps him healthy longer, that carrier earns much more money than if they did otherwise. They have a direct incentive to keep healthy clients. While I agree that sometimes this leads them to select healthy clients and drop sick ones, it also leads them to have a vested interest in the health of their clients.
This is incorrect as well. While there certainly are pressures on governments to provide cost effective health care, this is not always measured in the same way. The only costs which effect government action are political costs. How many voters do you think are sufficiently informed about the nature of medical costs to be motivated to political action by the presence or absence of public information campaigns. Unless there is a complete connection between the health of citizens and their political wishes, you cannot make the same claim I did above about private insurance carriers. Namely that governments have a direct interest in the health of their clients.
Besides which, this was not at all jshore’s point. His point was that if you provide medical services to those who cannot afford them then they will not need drastic care later. Medical services, not public service anouncements.
And while I’m at it, AIDS is a perfect example. I chose it off the top of my head. There may, in fact, be better examples. However, the point that preventative medical services may not result in a cost savings to the system can be illustrated in many ways. One anti privatization site I visited mentioned (as a hypothetical example) that insurance carriers will not spend $40 on a bycicle helmet but will spend $400,000 on cranial surgery. While certainly such spending would have saved money for the person who has an accident, would the system really be better off if we spend $40 on every single citizen? Would we really reduce the number of cranial surgeries sufficiently to justify that expense?
Can you come up with a single illness or medical condition for which this math works out? I’m not saying there are none. Honestly, I don’t know the answer to this question. I merely made the point that you cannot claim that individual savings via preventative care will translate into savings for the system as a whole.
pervert: What GorillaMan said. I was not advocating running unnecessary tests on people. I was advocating things that actually prevent disease. And, I was also talking about the fact that people without health insurance but with serious medical symptoms often will not go to the doctor until the symptoms become so severe that they end up in the emergency room. If, for example, it is an infection, it might be that if they had presented early enough a simple antibiotic prescription would have done the trick but if the infection gets so far along that it becomes an emergency, it could be very expensive. Here is an opinion piece by a physician in Washington State that I turned up on this subject by typing “preventative care for the uninsured” into google. Here is another article by the Illinois Hospital Association:
Information on how to use the service, not how to avoid needing it?
The insurance companies are only one part of a private system - the providers are also private. So they’re making money from your illness.
And don’t premiums reflect the likelihood that somebody will become ill, so healthy clients are not necessarily a better earner?
Public information => healthier population => less demand on healthcare => lower costs => lower taxes. Put that into action, and it’ll win votes.
Public information should be regarded as part of the medical services.
By definition, you can’t have preventative screening for a terminal condition. You can, on the other hand, have a massive emphasis on sexual safety among high-risk groups. And provisions for drug users to not need to reuse needles. Unfortunately, these both have other political complications.
I don’t understand the context of this example - can you provide a link?
Thank you for the response jshore. But I think it makes the same argument you did. Is the “50 percent more…” statistic adjusted for income level?
There are many reasons why people don’t get preventative care. One of them is certainly cost. This of course, translates to the fact that uninsured people seek such care less often than insured people. But do they do so at rates which are large enough to offset the costs of paying for such preventitive care for everyone without insurance? This is what I am asking.
No, that sort of information is included as well. I remember seeing all sorts of wellness programs at IBM when I worked there. They were part of the companies program to promote general fitness amongst their workers. I realize these are anacdotal. If you can provide me with a cite which suggests that governments spend more on such things than private insurance companies do, I’ll look at it. My only point was that it is not at all true to suggest that insurance companies have no incentive to keep people healthy.
No. Illnesses requrie treatment. An Insurance carrier has to pay for such treatment. Usually far more than the premiums paid by that individual. They make far more money if their clients are healthy than if they are sick.
No.
No it will not. At least not enough to turn elections. You and I would look at such schemes, perhaps, and see the long term gains. Most people will not. Let’s face facts, shall we, people vote based on how they are now, or how they expect to be soon. Very few people examine the complex issues which politicians play with to decide rationally if one policiy is really better than another. I’m not saying that governments do not have an interest in a healthy citezenry. I am merely suggesting that politicians interest in such is one step removed from the fact. That is it is filtered through the politics of the issue.
Maybe. But where
But you can have screening for care to begin earlier and have a greater chance to extend the life of a terminal patient. My point is that catching conditions early (which is what preventative care is all about) requires catching those conditions before they manifest themselves with obvious symptoms. This may amount to cost savings system wide, but I have not seen good numbers indicating such. Have you?
My appologies. I cannot find it in my history file. I am truly sorry about this. Please feel free to deride my use of the hypothetical. I unconditionally withdraw it from consideration in this debate.
Well, to be honest, you were advocating more medical procedures for people who do not now have medical insurance. But that is a nitpick.
What sorts of things, exactly, are you suggesting? More imunization shots? Wellness public information programs as GorillaMan suggested?
Don’t we now subsidize imunization shots? Isn’t public information campaigns already withing the power of the federal government to do? What will instituting a universal healtcare coverage scheme do to alter either of these things?
The article you quoted included these conditions:pneumonia, uncontrolled diabetes, coronary bypass, total hip replacement surgery, and mental health treatment. Once again, I totally agree that someone who had a coronary bypass is less likely to suffer from heart conditions requiring even more expensive procedures. However, in order to give such bypasses to everyone who needs them, would we not have to test an awfull lot more people? To be clear, I’m not actually claiming that such a program would be cost prohibitive. I’m simply suggesting that we have to look more deeply before we conclude that we would obviously save money. And I’m trying to suggest that you are more than capable of looking plenty deep enough. 
That’s different. It’s in IBM’s interest to keep you fit - because then you’re off sick less.
In a private or public healthcare system? In a private one, there’s much less reason for a government to be spending money on that at all, and in a public system there’s no private companies.
Conceded - that’s very true.
I think we’re getting off the point by focusing on terminal illness. Surely the biggest areas where cost savings could be made, however they are paid for, is by reducing the incidence and severity of common major problems such as cancer and heart disease. One part, but only one part, of this is interventionist methods such as screening. The best way to improve in this area is to help people never reach the stage where the screening shows up positive.
And I lack cites, too, but I very strongly doubt that the cost savings of not screening people for early signs of illnesses could outweigh the saving from treatment - not least because if the condition develops further before detection, more drastic (and probably expensive) treatments will often be needed.
Good question, this is a difficult subject to discuss in absolute terms.
First of all, currently the US spends more on health care than any other nation in the world, in terms of spending per capita and as a percentage of GDP. As far as I know, this is true even if we leave out the cost of drugs (which skews the data). The health care available to people in most of the rest of the world is mostly of the same quality and pretty much or almost as available as in the US.
Obviously this situation is strange because:
- a market driven system should result in lower pricers, not higher
- nothing suggests that americans are sick more often than people in other western countries
- not all Americans can afford health insurance, while in the rest of the modern world everyone is covered
The way I see it, there could be five important reasons for this:
a) the US system is not actually a market driven system
b) american companies use a lot of money on developing cutting edge technology
b) in countries with a national health care system governments can influence the whole chain: education, infrastructure, salary, cosumer cost; which = availability
c) in countries with a national health care system diseases are discovered earlier so they cost less
d) in countries with a national health care system nobody makes money on this, while in the US the owner shall have his usual 10%-15% profit, why else would he invest his money in a company ?
I don’t buy the argument that by introducing national health care in the US the cost of health care will rise even higher. However, if national health care was introduced overnight, the system undoubtly would collapse .
I’m not rejecting that people in Europe visit their doctor more often, in fact, I suspect they do. It’s fast and cheap. However, the cost of a vist is not very expensive, it’s the treatment that sucks the money out of the system. This leads to two suggestions:
a) if diseases are dicovered earlier, you can, as an example, get tens of thousands of doctor visits per avoided heart surgery
b) when people are treated earlier, they can get back to work earlier and pay taxes again
No cites for any of this, though I’m casually looking for some.
What I was looking for was to what extent health care is a market driven system in the US. If the person with a health insurance can get treatment “anywhere” regardless of cost because the insurance company picks up thre tab, it’s hardly a market driven system. If the hospital can charge the insurance company whatever they like, if covered, there is no incitement to keep prices down, on the contrary, the hospital could jack prices up because they want to make more money. This “hidden price” is then returned to the insurance holders who actually pay for this.
If this is true, it should be easy (as in let’s-solve-the-world’s-problems-at-SDMB) to reduce the cost: Turn the system into a market driven system. Let the consumer shop by price. However, somehow I suspect it’s not that easy.
There are some very nice data (a comparative analysis of 30 countries) in a 2003 OECD report:
- the report: http://www.oecd.org/dataoecd/10/20/2789777.pdf
- background: http://www.oecd.org/document/39/0,2340,en_2649_34629_2789735_1_1_1_1,00.html
In addition, The National Coalition on Health Care has some interesting information, but mostly about the US, including:
http://www.nchc.org/facts/cost.shtml
On preview, I see the link you added, I’ll check it out
It is the same. Your insurance carrier has the exact same incentive to keep you healthy and working (and paying premiums BTW).
I guess it wasn’t you who reminded everyone that most socialized medicine countries include private care as well. I would only say that there is no such thing as a private healthcare system in the world today.
I agree. I’ll drop it.
I agree totally with this. Prevention is always worth a pound of cure. The only thing I am quibling with now is that we may be focused on a particular form of prevention which may not be true prevention at all.
But that is the same argument we started with. I agree that for a specific person catching a disease early means much cheaper treatement. And since the later treatmenst as so much more expensive than earlier ones, I’m sure that screening could be paid for several people who don’t need it in order to catch the ones who do and still come out ahead. However, I’m not convinced that such a relationship would provide the huge cost savings suggested when we look at the simplified statistics such as those offered by proponents of universal health care. Also, as you mentioned, preventative actions are not, nor should they be, limited to medical screening. However, nothing in the proposals for universal healtcare coverage suggests that public information campaigns will increase under a national healthcare plan.
From your link with the 11 reasons why health care costs so much [more] in the US, I agree with:
- Technology: Developing and perfecting this technology is enormously expensive …
- Emphasis on Treatment: There’s an emphasis on treatment, rather than on prevention …
- Some of Us Aren’t Very Patient: A patient may demand a procedure be performed immediately even though the doctor prefers to wait …
- Some of Us are Too Patient: Too many people wait too long to see a doctor.
- We Sue A Lot.
I’m not saying these are actually true statements about the American system, that’s your cite saying that, I’m only saying that if they are true then these 5 I listed above are usually not a big problem in my part of the world. The rest are more or less present within national health care systema as well, though every country its own method, I suspect.
Let me understand this correctly. I cite a study that shows that Canadians are more dissatisfied with their health care system than Americans are with ours, and you offer me a bet about Europeans? Are you saying that Canadians are Europeans? That would certainly help put things into perspective.