# US Healthcare rant. **URL:** \ **Category:** The BBQ Pit\ **Created:** [January 8, 2017, 3:50pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630 "2017-01-08T15:50:42Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![cochrane](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cochrane/32/10441_2.png) [@cochrane](https://boards.straightdope.com/u/cochrane)\ **Post date:** [January 9, 2017, 6:18pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/81 "2017-01-09T18:18:11Z")
> [@running\_coach](#): > > Heaven knows, it’s actually quite simple for a rich man to shove a needle in the eye of a camel. No, a rich man would hire somebody to do it for him, in case the camel spits all over his fancy suit. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [January 9, 2017, 6:21pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/82 "2017-01-09T18:21:09Z")
> [@Superdude](#): > > At one point in my life, I worked in a call center for Anthem Blue Cross/Blue Shield. What it sounds like with your mother is that she was there for a 23 hour observation, rather than a full admittance. Yeah, sure - but while the insurance company is legally in the right is it really morally in the right? > [@Novelty\_Bobble](#): > > I find it hard to believe that only 50% of people ever pay tax during their lifetime. > Do you have a cite for that? No, he doesn’t. This has come up often in the past. > [@cochrane](#): > > Here’s one cite. 45.3% of U.S. households paid no individual Federal income tax for 2015. To which the best reply in this thread so far (insults not directec at cochrane): > [@Budget\_Player\_Cadet](#): > > I knew there would be stupid when I opened a thread to a post by D’Anconia. Can you maybe _try_ to turn on your brain next time, you semen-coated dunce cap? That 50% figure applies only to federal income taxes. Not state taxes. Not sales taxes. Not estate or property or luxury taxes. And not fucking FICA, you mental leper. > [@cochrane](#): > > To be fair, **D’Anconia** didn’t say. “in their lifetime.” He said that only 50% pay taxes. And 45% is close enough to 50% as to make the difference not worth quibbling about. Except even people who don’t pay Federal Income Tax STILL PAY TAXES. I speak as someone who has been through the poverty grind. I got a pass on the Fed INCOME tax, but not on anything else - state taxes, sales taxes, SS, self-employment tax when self-employed… EVERYONE who purchases anything besides just non-taxed food items - which is EVERYONE who isn’t shitting in the bushes and wiping their ass with leaves and dumpster-diving for clothes - pays taxes. Everyone. If they’re poor enough they get a pass on ONE tax - the Federal income tax. That’s it. They still pay all the other ones. > [@Chimera](#): > > **Someone being angry that poor people don’t make enough to pay taxes is the clearest and most obvious sign they’re a complete asshole, lacking basic human compassion and kindness.** ^ This. QFT. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [January 9, 2017, 6:44pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/83 "2017-01-09T18:44:06Z")
Maybe rich folks go to a more exclusive Heaven? And Heaven for poor folks is like a Greyhound Bus depot at 3 am? Keep in mind, the Old Testament Yahweh had a kind of warped sense of humor. “Go up the mountain, take your son, and kill him! Ha, just kidding! Wanted to see if you would do it! Psych!” Well, at least He isn’t cruel and evil, like that Muslim Allah is! So, there’s that! ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [January 9, 2017, 7:21pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/84 "2017-01-09T19:21:17Z")
> [@Northern\_Piper](#): > > **Grim Render** , could you provide a cite for that 1,6 million? Not that I’m doubting, but it would be interesting to have that in future discussions. Sure. But bear in mind that these are very rough figures. [Here is a Deloitte report](http://www.medretreat.com/templates/UserFiles/Documents/Deloitte%20Report%2020091023.pdf) from 2009 that estimated that numbers will hit 1,6 million in 2012, with further growth down the line. While, on the more conservative side, [Patients Beyond Borders estimated 1,4 million in 2016.](http://www.patientsbeyondborders.com/medical-tourism-statistics-facts) As far as I know, no-one checks why an American travels across the borders outbound or runs any kind of statistics on that. I believe the numbers have generally been obtained by surveying a number of foreign hospitals about their paying patients nationalities. Hence, people who filch healthcare in Canada doesn’t get registered, nor people who obtain it through being resident and legally entitled. On the other hand, people do check why foreigners come _into_ America, so the 80 000 number is on firmer ground. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [January 9, 2017, 7:56pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/85 "2017-01-09T19:56:55Z")
tbh, this thread reminded me of when I lost it for a few minutes during the London Olympic Opening Ceremony: celebrating your healthcare system at the Olympics ffc. I actually felt proud for a while … I hope the American people get a better deal soon. It’s not just the individual, it’s about peace of mind for all your loved ones, alive and not yet born. ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [January 9, 2017, 8:03pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/86 "2017-01-09T20:03:24Z")
> [@Chimera](#): > > … > **Someone being angry that poor people don’t make enough to pay taxes is the clearest and most obvious sign they’re a complete asshole, lacking basic human compassion and kindness.** > > If that same person ever tells you that they’re a Christian, laugh in their face. Then walk away, because they’re not someone you need in your life. You just described the incoming administration and both houses of Congress. I wish we could walk away. ☹ ---
**Author:** ![levdrakon](https://avatars.discourse-cdn.com/v4/letter/l/49beb7/32.png) [@levdrakon](https://boards.straightdope.com/u/levdrakon)\ **Post date:** [January 9, 2017, 8:08pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/87 "2017-01-09T20:08:32Z")
> [@Novelty\_Bobble](#): > > Actually I don’t think that is true for the US. > > Look at the third pie chart down at [this link](https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/). > The federal spending on healthcare is greater than for the military. > > And yet, on top of that, people still need top cough up for insurance and out of pocket expenses and millions remain inadequately covered. Yeah, the Dept. of Defense is the largest employer in the world, but we spend even more on Medicaid and health (whatever that is). It really is astounding how much we spend and we’re supposed to have our own insurance on top of that. ---
**Author:** ![Blalron](https://avatars.discourse-cdn.com/v4/letter/b/35a633/32.png) [@Blalron](https://boards.straightdope.com/u/Blalron)\ **Post date:** [January 10, 2017, 1:05am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/88 "2017-01-10T01:05:37Z")
Just got my Oregon Health Plan (Medicaid) card in the mail. For the first time in my life I have health insurance! Will it be yanked away later this month? :smack: ---
**Author:** ![levdrakon](https://avatars.discourse-cdn.com/v4/letter/l/49beb7/32.png) [@levdrakon](https://boards.straightdope.com/u/levdrakon)\ **Post date:** [January 10, 2017, 1:51am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/89 "2017-01-10T01:51:07Z")
> [@Blalron](#): > > Just got my Oregon Health Plan (Medicaid) card in the mail. For the first time in my life I have health insurance! > > Will it be yanked away later this month? :smack: Probably depends on your state, but I don’t think anything’s going to happen in a month. ---
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [January 10, 2017, 2:07am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/90 "2017-01-10T02:07:54Z")
This thread is why we can’t have nice things. 1. Increased income taxes is part of how we funded the ACA. We did not increase SS or FICA - it was a hit on Income Taxes. That makes the 47% number a relevant one, even if it is misquoted. Yes - half of the nation pays income taxes. Providing more health care under our current system will require that they pay more. 2. Focusing on insurance companies alone ignores other players. YOu can’t just get rid of insurance companies in one fell swoop. 3. You must also include the impact on pharmaceutical firms who make more money per pill in America. Bringing them down to non-Us pricing WILL have an impact. 4. Physicians themselves make a shit load of money, thanks to a rigged economy that prevents more supply of physicians due to AMA residency limitations and immigration requirements. Physicians at the university make a few hundred thousand a year, and they give up cash to work for the University of California. Those pay packages, plus that of the nurses and others who will also receive pensions, adds up to the cost as well. 5. We don’t even have a set price list that you can review when comparing providers except in certain cases (orthodontics, for example). People have no clue what something costs until afterwards. There also is not a single better model. Germany does it differently from the UK, Canada has a different flavor across the provinces, hell - Medicaid, Medicare, Tricare, the ACA and the plan that Federal Employees are on are all different. The government itself can’t even switch over to a single model - how the hell do you expect them to push one on the rest of the nation? I would love to see a single payer option available to all, with the ability to buy up to a higher level of premium care if I like. Reform in the US could happen if you can convince the rich they can keep their Cadillac coverage, while giving the poor just enough not to revolt. I realize how ugly that statement is - but that is how it works. The Obama administration gave out waivers to their Union supporters allowing them to keep their plans - nice deal if you can get it. Politics in America. ---
**Author:** ![AngelSoft](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/angelsoft/32/440_2.png) [@AngelSoft](https://boards.straightdope.com/u/AngelSoft)\ **Post date:** [January 10, 2017, 2:10am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/91 "2017-01-10T02:10:52Z")
I keep joking with a friend in Canada that we need to get married just so I can move there and take advantage of all the great things Canada has to offer 😃 But really, the healthcare system here is just awful. I’m on my state’s ‘medicare’ program right now and it’s the only reason I’m getting the blood pressure and depression medications I need to well, live. I was joking to my mother that I shouldn’t even bother trying to renew because Trump was going to take it away anyway. She just looked at me and was like, you don’t have Obamacare. I’m worried that a lot of people don’t realize that it’s not called Obamacare when you have it. That yes mom, your daughter is taking advantage of that evil, liberal, socialist monstrosity you voted for Trump for to get rid of. If it weren’t for that, I’d probably have died of a stroke by now or killed myself. She just doesn’t see the connection and I think that’s a lot of the problem with people rallying against the ACA. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [January 10, 2017, 3:15am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/92 "2017-01-10T03:15:03Z")
> [@elbows](#): > > I’ve never had to file forms to get care and cannot imagine trying to address mountains of paperwork at the worst possible moment of my life, as my loved ones lies perilously ill! > > It’s so easy to overlook this harsh and cruel aspect of the system. As your loved ones life hangs in the balance it’s almost a full time job, it sometimes seem, just to ensure they actually get the coverage they’re entitled to, etc. > > I cannot imagine the stress it must add, for people facing the most crushing circumstance to pile on a lot of forms, phone calls, run around and red tape! > > This seems like one of the cruelest aspects of your system to me. And I get angry whenever I hear about it. How can you subject people to this at such stressful times? This being the Pit, I was going to be snarky, but I gave up on it. Good OP, and thank you for this. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [January 10, 2017, 6:59am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/93 "2017-01-10T06:59:09Z")
Something often cited for higher U.S. drug prices is the high cost of R&D which is born by U.S. patients. In fact, drug companies’ profits exceed their R&D spending; and their marketing costs are larger than profits. And even the R&D figures they cite may be inflated. They pay doctors for “research” which may take the form of “prescribe this drug and research how well it works, wink-wink” or flying doctors on junkets. [The pie-chart slightly more than halfway down this page](https://priceonomics.com/the-rapidly-escalating-price-of-cancer-drugs/) shows R&D as only 15.6% of the “Rx Industry Dollar.” Other pie-charts on the web show similar figures. (The webpage I linked to may be interesting — it makes a case that drug companies are profiteering on cancer drugs, with detail and nuance — but I linked to it primarily for the pie-chart. Drug companies spend more on dividends and junkets than they spend on research.) ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [January 10, 2017, 8:15am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/94 "2017-01-10T08:15:35Z")
> [@Algher](#): > > I would love to see a single payer option available to all, with the ability to buy up to a higher level of premium care if I like. Reform in the US could happen if you can convince the rich they can keep their Cadillac coverage, while giving the poor just enough not to revolt. I realize how ugly that statement is - but that is how it works. To be fair, that is the NHS in a nutshell. The rich can still pay extra to get gold-plated services and jump the queue on many procedures but there is a very good standard of care to everyone else based on medical need alone. How do do it? One way is a huge expansion of medicaid and medicare that eventually covers everyone. Simply expand the acceptance criteria and once those become the main source of customers for doctors and hospitals you nudge out the existing insurance providers and can drive costs down. That could happen over a decade which gives times to build new facilities, recruit and train new doctors and allow the insurance companies to redefine their businesses. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [January 10, 2017, 10:29am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/95 "2017-01-10T10:29:15Z")
> [@Algher](#): > > 1. Increased income taxes is part of how we funded the ACA. We did not increase SS or FICA - it was a hit on Income Taxes. That makes the 47% number a relevant one, even if it is misquoted. Yes - half of the nation pays income taxes. Providing more health care under our current system will require that they pay more. Or, instead of funding it out of general income tax funds make it like other line items you don’t get refunded on a 1040. I don’t understand why this generates such brain cramps. As I noted, no matter how dirt poor you are you pay _some_ sort of taxes. > [@](#): > > 1. Focusing on insurance companies alone ignores other players. YOu can’t just get rid of insurance companies in one fell swoop. Why not? > [@](#): > > 1. You must also include the impact on pharmaceutical firms who make more money per pill in America. Bringing them down to non-Us pricing WILL have an impact. OMG! Pharma companies won’t be able to jack up the price of somethign 500%!!! It’s the end times! There is a middle ground between “anything goes” and “make them paupers”. > [@](#): > > 1. Physicians themselves make a shit load of money, thanks to a rigged economy that prevents more supply of physicians due to AMA residency limitations and immigration requirements. Physicians at the university make a few hundred thousand a year, and they give up cash to work for the University of California. Those pay packages, plus that of the nurses and others who will also receive pensions, adds up to the cost as well. Physicians also _pay_ a lot of money to things like student loans and malpractice insurance. Yes, there are some amazingly high paid specialists. There are also a lot of PCP’s who net a much smaller amount than you’d expect from just looking at their gross. Then again, if Americans were assured of health coverage no matter what maybe there’s be less incentive to sue after a bad outcome just to ensure someone will be able to get the care they need down the line. That could bring down malpractice insurance prices which would further help with costs. > [@](#): > > 1. We don’t even have a set price list that you can review when comparing providers except in certain cases (orthodontics, for example). People have no clue what something costs until afterwards. That is inexcusable and should be fixed. No one else does it that way, why do we insist on being stupid and cruel? > [@](#): > > There also is not a single better model. So? All of them seem to work better than the jacked-up mess we currently have. > [@](#): > > The government itself can’t even switch over to a single model - how the hell do you expect them to push one on the rest of the nation? This is irrelevant - everyone else has managed to do this. Are we back to maintaining that Americans are stupid and cruel? The government has multiple systems because they’ve been implemented piece-meal instead of as part of a single, integrated system, and that was largely due to ideological reasons. > [@](#): > > I would love to see a single payer option available to all, with the ability to buy up to a higher level of premium care if I like. Reform in the US could happen if you can convince the rich they can keep their Cadillac coverage, while giving the poor just enough not to revolt. I realize how ugly that statement is - but that is how it works. It certainly sounds better than what we currently have. ---
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [January 10, 2017, 11:55am UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/96 "2017-01-10T11:55:07Z")
I don’t care for this because it’s too easy to indulge in reflexive America bashing — when the state is such few Americans are responsible for such idiocy as non universal health care nor approve it. And least of all can do fuck all about it. However, those who _do_ bear another responsibility of free market corruption. The Tories in Britain have spent the last 40 years tearing down all the socialist achievements since 1945, with many many privatisations — ‘…_.having crucified Him, they divided His garments_’ ( inspired by the American Right to a large extent ) and some would dearly love to remodel the NHS on the chaotic American model — the Neoliberal Blair governments made some strides to this goal ---- so Britons shouldn’t feel _that_ smug. I saw in a New Statesman a profile of a senior UKIP person who wanted to destroy the NHS as socialist; and UKIP are basically Thatcherites without that dim malevolent cunning. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [January 10, 2017, 1:01pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/97 "2017-01-10T13:01:45Z")
> [@Evan\_Drake](#): > > some would dearly love to remodel the NHS on the chaotic American model — the Neoliberal Blair governments made some strides to this goal ---- so Britons shouldn’t feel _that_ smug. Whether some would like it is irrelevant. We are no closer to the American system than at any time in the last 40 years. The public will not wear it and the politicians won’t dare stand on that platform. The NHS care you receive still won’t result in a bill you can’t pay. But of course the NHS has changed, that’s true. As it has to when we live longer and greater elective choices are available. The NHS is very good but not perfect and should be open to making changes where needed. Heck even a change to other funding options should be on the table. That’s enough for some to scream blue murder and guarantees that if we follow their undirected outrage we will one day end up with a system that is no longer fit for purpose. There were noised about small out of pocket charges for doctor visits and all hell broke loose. of course if you look at those notoriously USA-leaning countries on the continent you’ll find they do exactly that. I agree we shouldn’t be smug but not for the reasons you suggest. Smugness means we may miss the opportunity to make changes that keep costs down whilst maintaining the “free at the point of delivery” concept that is at the core of our society. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [January 10, 2017, 1:28pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/98 "2017-01-10T13:28:55Z")
Well. People even in the UK -maybe especially in the UK- don’t seem to realize how good value for money the NHS actually is. A lot has been said about how much cheaper it is than the US system, but what people don’t fully apprehend is that its also significantly cheaper than other European systems. For example, the UK can spend more on its military than France and Germany because it spends much less on healthcare. So I don’t really think other financing models for the NHS is going to improve it. I don’t think there is room. The NHS is basically running on the backs of staff who treat it like a religious obligation. The problem is, politicians are not going to make much of an issue about how good value for money the NHS is. Because that would mean admitting how fucked the rest of the UK economy is. Its basically got a first world healthcare system at a massive discount and still can’t turn the savings into an economic non-shambles. Its much easier to imply that money is tight because of the NHS “and you DO want the NHS -don’t you?” because yes, people in the UK really, really do want the NHS and are willing to tighten their belts if they think that is what the NHS needs. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [January 10, 2017, 11:30pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/99 "2017-01-10T23:30:06Z")
From here, it looks like the NHS is an amazing socialised system that allows the people to tolerate the rest of the UK being a capitalist hellhole. ---
**Author:** ![Algher](https://avatars.discourse-cdn.com/v4/letter/a/3d9bf3/32.png) [@Algher](https://boards.straightdope.com/u/Algher)\ **Post date:** [January 10, 2017, 11:37pm UTC](https://boards.straightdope.com/t/us-healthcare-rant/776630/100 "2017-01-10T23:37:52Z")
What does it cost to get an MD or an RN in some of these European nations? I know that one issue in the US is the massive debt load required to become a physician or a nurse. [Previous page](https://boards.straightdope.com/t/us-healthcare-rant/776630.md?page=4) [Next page](https://boards.straightdope.com/t/us-healthcare-rant/776630.md?page=6)