I forget to add, pervert that I didn’t think the cite gave any good reason for why increased demand with a national health care system will drive prices up. As I said before, I suspect the problem with high prices for health care in the US has more to do with that it’s not a truly market driven system.
Thank you for a very thoughtful post. Let me just address a couple things.
I agree. The subject as a whole is very complex.
There is a lot of debate as to whether the care is “the same quality”. However, I agree that by most objective measures (life expectancy and such) there are little differences. I’m not sure we have a good objective measure which really shows care quality.
This is the answer to your question. The US prefers to use market forces for much of its medical care. But in real terms, the system as a whole is not market driven.
This is true as well. I’m not sure exactly how much it contributes, but it certainly does.
Well, to be sure, they can influence the whole chain. But I’m not sure they can do so positively without impunity. They can spend more on medical schools, for instance, but can they really ensure more good doctors will graduate and stay there?
[QUTOE]c) in countries with a national health care system diseases are discovered earlier so they cost less
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To some extent this is true. See my discussing with jshore and GorillaMan for more in depth information.
Well, I actually see this as a problem in other countries. This profit is generally made by keeping people alive. This is a great motivator to come up with new techniques, improve quality of care, and generally provide better service. I acknowledge that it does not always work this way, but I also said above that the current US healthcare system is not totally market driven.
Well, I think you are wrong on both counts. We could, probably introduce legislation which would cover the currently uninsured citizens without causing the economy or healthcare industry to collapse. At least in the short term. We would have to make lots of decisions in thelong term that our European cousins are making now about how much to charge and how much to provide. At the same time, we would need to increase revenue or increase our deficits considerably to pay for such a scheme.
Well, the Federal government is the biggest purchaser (or at least payer for) of healcare services. That should tell you right away that it is not on balance a market driven system.
Most policies do not work that way. Most have a specific set of doctors and require a much higher copay for using doctors outside said system. Also, most do not cover every concievable medical treatment. Additionally, the insurance companies have negotiated specific fees for specific services. Much the same way governments do in socialized medicine countries.
Well, I think a good argument can be made for such a proposal. However, politically, such a thing is impossible. Small steps can be made one way or the other, but grand overhaul schemes are not met with rousing success.
Remember, though, medical care is subject to some unusual forces. You cannot simply build another factory and produce more heart transplants. The startup costs can be very prohibitive. Additionally, the government still has a lot to say about the requirements to become a doctor, nurse, hospital, or clinic. It is not as simple as hiring more medical personel.
Thank you for the links. Very interesting information.
Yes, but under a nationalized system, it would be even less of a market driven system. That is the argument in a nut shell.
I’m sorry, pervert but you may have the wrong perception about how national health care systems work. Early treatment/preventative care is not about testing everyone regularly for certain diseases. It’s not about efforts initiated by the state at all, it’s about patient behaviour. As in when people begin to feel sick they’ll usually visit their doctor right away instead of postponing it, because it’s cheap and easy and with no paper work whatsoever.
Likewise, if the doctor feels further test is necessary, he’ll refer me to a specialist, and for me it’s still cheap and easy. I’ll I have to do is make the appointment and turn up. On the other hand, if the doctor says I’m fine I cannot demand that he perform tests on me, if I still want to do that I’ll have to visir someone outside the system.
I’ll read the rest of the replies later.
On waiting lists–the waiting list to get an outpatient echocardiogram in my community (Greensboro, NC, USA) right now is about four weeks. Appointments for routine GYN care are probably at least a six weeks away. The gastroenterologist I worked with last month is booking new patients in September. Hell, I’m a lowly internal medicine resident, and I don’t think I have an appointment until July.
A lot of the things for which there are long waiting lists in Canada are simply unavailable to a lot of people in the US. My clinic sees a lot of indigent patients who fall through the cracks (too sick to work, not sick enough for Medicaid). I have three patients who have back pain (with documented pathology–no fakers here) that is disabling and could be remedied, at least in part, by some fairly simple surgery, but they can’t get it because they have no way to pay for it. Instead, they have to get larger and larger doses of pain meds just to make the pain bearable, but only adding to their inability to function. The same is true for hip and knee replacements; people who could get on a waiting list in Canada are just SOL here.
I don’t want to make a ringing endorsement of socialized medicine, but I’ve never really seen the waiting lists as much of an argument.
But, as GIGOBuster pointed out, that Bloomberg site that you posted a link to cherry-picked the one most positive statistic for the U.S. out of that study. He provided a link from WEBMD that gave a more detailed view of the study. Here is another article that appeared in Toronto’s Globe and Mail newspaper:
So, the sum total seems to be that we are spending way more money and getting a bit higher satisfaction, but less meeting of our needs, much more inequality, and about equal overall quality of health outcomes by various measures.
You can read the press release and download the study itself here.
Yes, it is the argument. And yes, it would be even less market driven as a nationalized system. I guess my point was that the reason why health care in America is so much more expensive even though it’s a “capitalist system” is because it’s not market driven, ie. it would be easier to turn the system into a truly market driven system to get prices down, than it would be going the nationalized system route. Today, it’s basically about:
- United States: a majority group pay high prices for health care because they are not given the opportunity to shop by price = high prices for few
- rest of world: everyone gets health care equally, but government control supply and to some extent control of demand = low prices for many
In other words, both system could have ended up with the same total cost.
Very quickly, because I don’t have much time right now :
No, because I don’t understand what you’re refering to. I’d need more details.
I wouldn’t know what is the extent of the problem concerning the elderly. It came as a major shock when a very high number of them died during a heat wawe last year. The issue isn’t with medical care per se (like receiving substandart madical treatment, for instance) , but with underfunded and understaffed old people’s homes.
Saying that we’re forced to carry medical insurance would be misleading, since there’s only one general insurer, the social security. Public healthcare is funded by a mandatory deduction from wages, to simplify a little, but it doesn’t make much difference with a system funded by taxes (though the system isn’t directly managed by the government, as I already stated, but it still has a heavy hand in it).
Though I can’t remember which, I know there are some countries where people are covered by the public healthcare system under a given level of income, and have (mandatorily) to carry a freely chosen insurance if their income is higher. Which would be closer to “be forced to carry medical insurances”. Though by a broad definition of the term, you could say that indeed we are (except that we don’t have the choice of the insurer), but once again it’s rather similar to a tax-funded healthcare system in practice.
Maybe to some extent, but once again, medical services are a kind of service that people usually don’t enjoy that much to benefit from, so making it very cheap or even free won’t result in an incredible rise in demand. Besides, visiting more often the doctors, once again, can be a good thing, since it will result in medical conditions being discovered earlier, for instance.
It is roughly accurate. The social security indeed has currently a huge deficit (though it already hapened in the past), it is expected that it will become more and more costly in the coming years due to an older population, and the government is indeed promoting various controversial measures to reduce the costs.
I already adressed this point.
A given percentage (capped) is taken out of my salary. I would have to check my salary slip and do the math, but out of my head, perhaps 8% or so (I never pay attention since it’s money I never get, anyway). My employer add perhaps the equivalent of 10% or so (don’t quote me on these figures, though). But basically, both are the same thing (money paid by my employer and not received by me), except if for instance on percentage is raised and not the other. I don’t have time to search for the overall cost of the Social Security this night.
There’s a list, yes. But what is excluded from the list is essentially things which are considered not to be medicaly necessary, like say elective surgery or viagra. Heck! Even homeopathy is reimbursed!
Well…Very roughly :
-For medical acts (seeing your doctor, having some test done, a X-ray, etc…), there’s a fixed price. You’re essentially reimbursed for all of it, barring a very symbolic co-pay (perhaps, say, a couple € for a visit to the doctor). The doctors can charge you more, and you’ll have to pay the difference from your pocket, but they have incentives, in particular fiscal, not to do so. So, in most case, generalists will charge you the “official” cost. But for some specialities (say, psychiatrists), a lot of them will charge more. And it’s impossible to find a dentist who won’t charge you way more that the reimbursed amounts, which are notoriously ridiculously low. Now , if you want to see the famous doctor X, or are living in an upscale district, chance are that you’ll won’t be fully reimbursed.
-For hospital stays, there’s a fixed co-pay amount (perhaps 10-15 €/ day, or something similar, I didn’t go to the hospital since childhood, so I wouldn’t know exactly), the treatments you’re receiving being irrelevant (you pay the same for a intensive care and for an appendicitis). Private hospital, once again, can charge more, but as I already mentionned in this thread, the bulk of medical care is provided by public hospital, over here.
-For drugs, the part reimbursed vary depending on the usefulness/ efficiency of the drug, from 0% (say some skin treatment prescribed by your dermatologist), to 35% (generally treatments which are deemed to be marginally useful, for instance a lot of old drugs people are accustomed to take but aren’t currently considered as state of the art medications) to…I can’t remember…perhaps 85%-90% for other drugs. I wouldn’t know because I get a complementary insurance which pays for the difference and the system is so organized that in this situation, generally, you don’t pay anything when you buy the drugs and the pharmacist is reimbursed directly by the social security and your complemetary insurance.
Also, for people with certain serious conditions (say cancer, or AIDS…), all cost are 100% reimbursed (there no co-pay).
And finally, you receive a daily payment from social security when your on medical leave for more than 3 days.
Mine costs me 40 €/month, roughly. It covers the things I mentionned as not being reimbursed above (dental care, co-pay for drugs, amount charged by doctors above the “fixed price” up to a given amount, some of the amounts billed by private hospitals, etc…) plus some other things, like a compensation for my loss of salary in case of a serious medical condition making me unable to work for an extended period, or some amount for my potential funerals.
I would add that most of these complementary insurances, in France, are in fact non-profit organizations, not really regular insurances. They don’t make money, and the people insured, for instance, can vote to elect the administrators, etc… (though honestly I never bothered to actually vote or attend a general assembly). Real corporation exist too, and they have advantages and flaws when compared with these non-profit “mutual insurances”.
That indeed is an issue. Not for most people, though, since costs are generally low. For instance seeing a generalist costs 20 €. I already mentionned the low cost for hospital stays, and anyway, you’re only billed when you leave it. Most people will only pay upfront the non-reimbursed part of the price of their drugs to the pharmacist. However, there certainly are people who can’t afford to pay upfront the 20 € to their doctor, let alone two or three times as much, with a significant part non reimbursed, to a psychiatrist, and wait to be reimbursed. These people will have to rely on organizations/ charities providing medical care for free, or will have to go to the ER to see a doctor.
Well…As usual, I wrote much more than I intended to…
A problem already solved in many developing countries who have to send students abroad to medical schools - the costs are paid by the government, but are treated effectively as a loan, which is gradually repaid by the government as long as they are working back in their own country, or they can choose to ‘buy themselves out’ by repaying faster, and then going abroad to work.
I understand your suspicion but it has turned out fine. Over here, medical school is the second most popular choice of education, and after graduation they make a lot more money than Joe Average (but less than in the US). With the exception of hospitals, doctors are mostly in private sector, meaning they either have their own practice or work for someone in private practice.
My argument is that with the lack of schools or lack of infrastructure it doesn’t matter how much the government pays for treatments, it’s still going to be a shortage. Building hospital is almost like building a space shuttle, it costs a shitload of money and takes several years to complete. It’s not something private investors would do unless they are absolutely sure they are going to make money on it.
I agree with this, and to me this is the only argument against national health care, allthough just a small one. The fact is that there’s a lot of research being carried out outside the system even in countries with national health care, and it could be even more with a tax relief for this kind of research. Just the other day several american companies visited a small local company which had had a small breakthrough on HIV. Other things, like research into antibiotics, are very costly and are better taken care of in the US.
But I actually think we’re mixing profit from running a health care service with profit from what is mostly drug research. Drugs only account for about 10% of health care costs. A 10% increase in the price of drugs is only a 1% increase in the total cost. If the US lowered (use the magic wand) the price of all drugs by 10%, its cost of health care would drop from 13.9% of GDP to 13.75% of GDP. Not much for the consumer, but it could mean the end of the medical research industry in the US.
However I forgot something in my previous post. Not only must private health care providers return a profit of 10%-15%, the insurance industry must also run on a similar profit. So it may be that, in total, 20%-30% of what you use on health care is a profit for someone else, though I’ll have to admit I haven’t looked for cites about average ROI for the medical industry in the US. However, if true, the cost of health care in the US could drop from 13.9% of GDP to between 9.7% and 11.8% of GDP, bringing the cost of health care in the US more in line with the cost elsewhere in the world.
Yes, I should have been more clear. What I meant to say was that I don’t think that a national health care system in the US where everyone is covered would cost more because the current system is not very cost efficient. But that also requires fixed prices for treatments from service providers who chooses to be part of the system, and it requires a public health insurance. But simply providing coverage for those who are not currently covered, without any other changes, would lead to shortages and higher prices because suddenly more people are going to ask for treatment.
All in all, to me this is fairly easy. National health care has been a success in almost every modern country and these countries are using 8%-9% of their GDP on health care. In the US the cost is 13.9% of GDP, and even then not everyone is covered. If I woke up one morning as a business owner and found out that I was paying 70%-90% more in salaries with maybe, only maybe, a slight advantage in quality or availability I would go bananas, because I would be out of business in no time. A 20% difference could be explained, a 70% difference cannot be explained. Something just isn’t right, it appears to be the biggest inefficiency ever.
Even though the government is the biggest purchaser of health care services it should (or could) still be a market driven system, even if the government negotiates prices for the services she buys. It only becomes a command economy when availability of services and the level of prices in private sector are subjected to legislative control.
The key line here is “the insurance companies have negotiated specific fees for specific services”. How widespread is this? It’s not the easiest field to fix prices in. Obviously, insurance companies would like to keep prices down while keeping premiums as high as possible. Do they manage to keep prices down?
The short answer is, “not very”. The government already pays for roughly 45% of all health care spending in the US.
Another factor that mitigates against the idea that health care in the US is market-driven is that consumers are shielded largely from the actual cost. Either the government pays, or insurance pays. Taxes are withheld automatically, and so are premiums. Therefore (except for co-pays) consumers percieve no direct benefit in savings if they actively seek to remain healthy. This drives a lot of the idea that “everyone is entitled to free health care”, when no health care is ever free.
You can look at the drawbacks of socialized medicine as combining the worst of both worlds. The cost is indirect, and thus perceived as “free” or nearly so. The supply is perceived as infinite, or nearly so ("I don’t get my super-special secret treatment for my arthritis? What the dickens do I pay taxes for? ").
This is one of the ideas behind Medical Spending Accounts. Let consumers spend their own money, and (it is hoped) they will look for efficiencies.
The trouble is that consumers don’t like it when they are denied health care for any reason. Thus it is possible that even a system that was market-driven and therefore efficient would be unpopular. Because everyone would see how their Aunt Petunia was denied her hip replacement because her MSA was empty, but no one would see how the cost of health care had stopped rising.
My take is that we can never address the problem of rising health care costs until we decide how much we want to spend - and then not spend more. And be up front that this means people are going to die as a result.
Imagine a politician saying that during an election campaign. He is always going to be out-polled by someone with a plausible scheme under which everybody gets everything they want, and it is all free.
Regards,
Shodan
Can you name a single developing nation which uses the method you describe and has no shortage of doctors? If not, what exactly do you mean by “solved”?
I answered many of your points, but then lost them. I’ll let your comments stand on their own.
It is very widespread. I don’t know of a single insurance company that pays “full price” for medical treatment anymore. And just for the record, it is a very easy field to fix prices in. Medicaid does this in a way very similar to the way it is done in many socialized healthcare countries. Namely, they make it illegal to charge more (or less) than the fee charged to Medicare if you are going to accept Medicare. Since the federal government is the largest purchaser of medical treatment, this is a huge incentive to only charge whatever medicare says they can charge.
Insurance companies do manage to keep prices down somewhat. They have a great incentive to do so. Although as in most countries, medical costs are increasing faster than we can tolerate for long.
Jumping in late, but:
As long as we’re going to guarantee some level of treatment regardless of insurance or the ability to pay, we don’t have a capitalist system. I would much rather have a single payer system and distribute the load across the tax-base than have just those of us who pay for insurance cover everyone.
The major problem I see is that while a single-payer system by itself might be acceptable to many people, the necessary measures to make it work wouldn’t. If the government started enacting common sense policies like capping prices it would pay, requiring generic use, limiting procedures and the like (which insurers do already), you’d be hearing on NPR that Lenin himself was administering medical care. In the end a US single payer system would have the same failing as the new Medicare drug benefit: it would be designed to spend as much money as possible.
Yes, I read something similiar at the OECD site. The number was a lot higher than I imagined. However, you and I have a different perspective on what market driven means. If the government decides to stock up on something, thus buying a significant amount of what’s available on the market, the market is no longer “free” according to your analogy. In my opinion the market only becomes a command economy when the government legislates that the market has to sell them X amounts of item Y at price Z. With national health care you have the Y and the Z, but only partly the X, btw.
This is what I was aiming at in some of my previous posts. The way I see it this debate is not only about national health care versus market driven health care, but just as much about that without a truly market driven system (cost vs. quality) you end up with both high prices and people without coverage.
I believe national health care, managed efficiently, combines the best of both worlds, coverage for everybody, at a reasonable price (percent of GDP). Especially in a two-tier system. I would like to hear if you have an opinion on why the cost of health care is so much higher in the US than in a system of national health care. Even if the USG steps out of the health care business the cost would still be higher than in most of the rest of the modern world. I would also like your opinion on the following:
http://www.nchc.org/facts/coverage.shtml
Well, I think it’s more complicated than that. Under your scenario, I think the biggest question would be who should contribute what and who should receive. In a system of national health care supply is infinite, just not free. Everyone has an equal right to treatment, which then is paid for by taxes. The system would collapse only if too many needed treatment.
Or if too few doctors or hospitals were built. The whole discussion about waiting lists earlier in the thread was about this very topic. The supply (how many doctors, nurses, and technitians there are) is never infinite. The only question is how to ration them.
OK, not ‘solved’, but ‘tackled’.
And you are overlooking the fact that most countries that are losing doctors, they’re losing them to America. And it’s not just because the pay is better in the US - it’s also because people want to live there. That wouldn’t disappear overnight because of a change in the system of funding.
I’m still not sure how such a policy tackles the problem. I understand that it is the policy that many countries have implemented. I even understand some of the reasoning. But I’m still not sure how it does much good.
Well, yes I am ignoring the problem of “brain drain”. I really do not think it is significant in this discussion. The issue of the shortage of medical services has much much much more to do with the fact that more and more people need more and more services. The rate at which services are being demanded is far outstripping the rate at which new doctors are being trained (or even born I think).
The problem is one of supply. To make matters worse, it is one in which governments the world over are hiding the costs associated with a short supply. Eventually we will all have to do something radically different than we are doing now.
That’s a very important point. People do want to live here, although I’m not sure why. I do understand why Mexicans, et al, come looking for our shitty jobs, but doctors can live a pretty wealthy lifestyle in any “1st World” country. My doctor (from the US), and an anesthesiologist (from India) I talked to both don’t much like our medical system. Some actually get into medicine, partly at least, because they want to help people.
Supply is infinite in that regard that as longs as society can afford it - or as long as society accepts paying for it -, then everybody is supplied.
Think about the education system. In our world, every child is given free elementary education. It’s basically a birthright. Nobody is discussing whether some kids shouldn’t receive education (for instance if they don’t do their homework or if their parents are homeless), or if we as a society can afford such education, which is paid for by taxes. If there are many children born in a certain year, more money is put into the education system, more teachers, etc. So, in this regard supply is infinite.
It’s the same concept that applies to national health care. If society decides that everybody should have an equal opportunity for treatment, regardless of income, then supply is infinite, as long as society can afford it, or as long as the public accepts paying the necessary taxes.
Which yet again brings me back to my main point: That the rest of the modern world has adopted a system of national health care that has turned out much less costly than the current american somewhat market driven system. The american conservative argument (including Shodans) that society cannot afford health care for everybody and that someone has to be left on the outside, has in my opinion been proven wrong by a string of nations.
The problem with waiting lists in Canada and Britain could be easily solved by these two countries by putting more money into the system (or reforming the system), by raising wages, buying more equipment or something else. My home country was headed the same way as Britain and Canada in the early 90ties, with long and continuously growing waiting lists. The public complained and the politicians acted upon it by reforming the system and putting more money into it. I have already shared my own experience with this system earlier in this thread, about how I got non-critical x-rays within two days and didn’t have to wait for weeks or months.