# What Americans dont understand about Public Healthcare (YouTube Video) **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 13, 2019, 10:41pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389 "2019-11-13T22:41:51Z")\ **Posts on this page:** 16\ **Page:** 3
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [November 15, 2019, 1:54pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/41 "2019-11-15T13:54:54Z")
> [@Wesley\_Clark](#): > > They discuss how R&D investments would go down if medical profits decline. That is true, but there are ways around it. > > There is nothing stopping the public sector from increasing R&D spending via tax credits, investments in basic research, matching funds, etc. to make up for whatever shortfall there is in R&D. I think this is partially addressed by **Babale**. If all health care is funded by the taxpayer, then public subsidies that replace drug company profits don’t save anything. If M4A saves money, then we could re-allocate some of that money back to R&D, although that means we would save less money. If. Regards, Shodan ---
**Author:** ![Babale](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/babale/32/15666_2.png) [@Babale](https://boards.straightdope.com/u/Babale)\ **Post date:** [November 15, 2019, 2:11pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/42 "2019-11-15T14:11:34Z")
> [@Shodan](#): > > I think this is partially addressed by **Babale**. If all health care is funded by the taxpayer, then public subsidies that replace drug company profits don’t save anything. > > If M4A saves money, then we could re-allocate some of that money back to R&D, although that means we would save less money. > > If. > > Regards, > Shodan Yes. But the scales involved are ludicrously skewed. We are wasting tons of money, way more than the 156 billion spent on R&D (Not to mention that other countries bear the R&Dcost as well). Do you think Americans are just so stupid that our doctors waste 8% of all money and there’s nothing we can do about it? Clearly, one of three things is happening to the money: 1. our system is particularly inefficient and wastes far more than any other nation 2. Americans are just so obese and unhealthy that it costs twice as much to care for them as it does to care for people in other nations 3. our healthcare system isn’t trying to provide the best care possible for the lowest cost and failing; it’s trying to line the pockets of special interests and succeeding marvelously ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 15, 2019, 4:05pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/43 "2019-11-15T16:05:53Z")
> [@Babale](#): > > OK, but that’s not really a fair way to look at it, because you end up bearing that cost regardless. For example, I accept the wages that my company offers me because they offer full healthcare benefits. Those benefits have value – if I were self employed, or owned a business (like my parents do), I would be paying for it myself. It looks like that’s worth around $397 a month for an individual, before any government subsidies. This actually happens to just about fit what I know from people who do purchase their own insurance. That’s $4,800 a year. And the market rate for wages for my position are based on the fact that employers include this pay; frankly, I would happily pay some portion of that in taxes and negotiate higher wages from my company in exchange for these savings. Until Obamacare, I would PAY TAXES on the value of this insurance plan. That’s money that my company is spending on me, but that doesn’t come to me. I worked for that money, though. I bear that cost. > > I tried looking for that 3,414 amount and I wasn’t able to find anything like that. I saw that [the average American paid about that much on insurance alone in 2018,](https://www.cnbc.com/2019/10/09/americans-spend-twice-as-much-on-health-care-today-as-in-the-1980s.html) around 5,000 total when you include the 1,500 dollars the average american paid out of pocket during that year. That article says that the average American’s health insurance costs $7,188 a year, with much of that paid by their employer (but they’ve still worked for and earned that money – or, if you prefer to think of it a different way, the employer passes the cost of that health insurance on to the consumer, and since we all consume we are all hit with the cost). > > That’s another factor. Medical bankruptcy is a real issue. I won’t give a particular percentage because that’s notoriously hard to define, since medical debt could be only one factor that leads to bankruptcy. But there’s no denying that it is a very significant issue. The average cost doesn’t capture the fact that if you get a serious illness, your costs will skyrocket, you will become too sick to work and lose your job and therefore insurance, etc… > > [What To Do For Health Insurance When You Lose Your Job](https://www.forbes.com/sites/deborahljacobs/2014/01/21/what-to-do-for-health-insurance-when-you-lose-your-job/#4606ebff77b4) > > Regardless of cost, I don’t believe in a system that can lead to that outcome. The problem with equating the cost of health insurance with the cost of taxes for health care is that they are not the same thing. The more you spend in health insurance the better your health insurance is. However with taxes, everyone benefits equally regardless of how much they pay. This gives everyone an incentive to pay as little tax as possible. People arrange their affairs to minimize taxes as much as possible currently, when income taxes are doubled to pay for healthcare this incentive becomes much stronger. This deadweight loss to the economy is estimated at around 25% of the tax paid. That is much more than the hypothetical savings of unified administration. The way around that is to pay for it like much of europe does with regressive taxes such as a VAT. Politically regressive taxes are even more unpopular than regular taxes, so that would be very difficult to get through congress. Medical bankruptcy is an outcome that can happen in almost any system. In Canada which has a universal healthcare scheme, medical issues are the 3rd leading cause of bankruptcy. Most of the difference in bankruptcy rates between America in Europe are because the bankruptcy laws in America are much more lenient than those in Europe so more people take advantage of them. ---
**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:** [November 15, 2019, 4:22pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/44 "2019-11-15T16:22:33Z")
> [@XT](#): > > I’ll leave you guys too it, but I wanted to point out that it’s [17.8%](https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/) of GDP, not 27%. I’ll also just point out that, on average, Americans pay about 6-7% of their actual take home pay towards healthcare. This is going to more heavily impact the poor and obviously be a lot less, as a percentage of their take home pay to the wealthier citizens. > [@Babale](#): > > Yep, you’re right, I don’t know where I got 27% from in those two posts. I had 19% (though your source looks better). Either way, it’s far more than the 9% average. > > I’m interested in your 6-7% figure, though. Where is that from? At 4:30 in the Video XT posted, the video states that covering everyone in the US with a great system such as Frances would mean that the US government would have to allocate 12-15 % of its budget to healthcare. It seemed reasonable to point out that the US government is allocating 27 % to the government parts of its current healthcare setup. (I think the videos numbers are wrong, but its hardly the only issue its got.) What strikes me about this whole thing, is that if you were to make an actual video about the European perspective on UHC, it would be about how cheap and easy it is compared to the current setup. These discussions always degenerate into many Americans declaring that they simply cannot believe that healthcare can be cheaper and more effective than in the US system, and everyone who lives in a UHC nation trying to explain that yes, it obviously is, and everyone else is doing it. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [November 15, 2019, 4:51pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/45 "2019-11-15T16:51:30Z")
> [@puddleglum](#): > > Medical bankruptcy is an outcome that can happen in almost any system. In Canada which has a universal healthcare scheme, medical issues are the 3rd leading cause of bankruptcy. Most of the difference in bankruptcy rates between America in Europe are because the bankruptcy laws in America are much more lenient than those in Europe so more people take advantage of them. I’d like a cite for those statements. And preferably one that differentiates between “medical bankruptcies” caused by becoming seriously ill and losing one’s job (which happens everywhere) and “medical bankruptcies” specifically caused by high medical bills (which…doesn’t). ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [November 15, 2019, 5:08pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/46 "2019-11-15T17:08:02Z")
> [@Gyrate](#): > > … “medical bankruptcies” caused by becoming seriously ill and losing one’s job (which happens everywhere)… In which countries can you go bankrupt from medical bills by becoming seriously ill and losing your job? I thought one of the selling points of UHC was that this couldn’t happen, because health coverage was a birthright and not tied to employment. IOW we implement Warren’s version of M4A, everyone is covered whether employed or not, and [there are no premiums or co-pays or deductibles.](https://www.cnbc.com/2019/11/01/elizabeth-warren-releases-plan-to-pay-for-medicare-for-all.html) Then somebody loses his or her job and gets sick. Wouldn’t M4A pay for everything, just the same? Unless I don’t get your question. Regards, Shodan ---
**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:** [November 15, 2019, 5:21pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/47 "2019-11-15T17:21:32Z")
I believe he is separating “_bankruptcies cause by medical bills_” from "_bankruptcies cause by becoming too ill to work and losing the income needed to pay other bills. Such as mortgages etc"_ The first is mainly a US thing in the First world, the second can happen anywhere. Puddlegum tries to lump them both together which allows him to pretend the first happens frequently outside the US. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [November 15, 2019, 5:22pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/48 "2019-11-15T17:22:21Z")
> [@Shodan](#): > > In which countries can you go bankrupt from medical bills by becoming seriously ill and losing your job? I thought one of the selling points of UHC was that this couldn’t happen, because health coverage was a birthright and not tied to employment. IOW we implement Warren’s version of M4A, everyone is covered whether employed or not, and [there are no premiums or co-pays or deductibles.](https://www.cnbc.com/2019/11/01/elizabeth-warren-releases-plan-to-pay-for-medicare-for-all.html) Then somebody loses his or her job and gets sick. Wouldn’t M4A pay for everything, just the same? > > Unless I don’t get your question. > > Regards, > Shodan You don’t get my question. “Medical bankruptcies” as a category can include bankruptcies caused by the inability to work due to illness. Even where you don’t have medical bills, you’ve still got to eat, pay rent, etc,. Some stats lump both types of bankruptcies (those due to loss of income and those due to high medical bills) together. ETA: Or what **Grim Render** said. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 15, 2019, 5:23pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/49 "2019-11-15T17:23:16Z")
> [@Gyrate](#): > > I’d like a cite for those statements. And preferably one that differentiates between “medical bankruptcies” caused by becoming seriously ill and losing one’s job (which happens everywhere) and “medical bankruptcies” specifically caused by high medical bills (which…doesn’t). If this is your definition of medical bankruptcy, then it almost never happens in America. Only about[4-5% of bankruptcies](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/) are caused by medical bills and not lost work. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [November 15, 2019, 5:36pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/50 "2019-11-15T17:36:45Z")
> [@puddleglum](#): > > If this is your definition of medical bankruptcy, then it almost never happens in America. Only about[4-5% of bankruptcies](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/) are caused by medical bills and not lost work. 4-6%, actually, but close enough. How often does it happen in UHC systems? Of course, just because one doesn’t legally file for bankruptcy doesn’t mean everything is fine. From the same cite: > [@](#): > > **Our results also do not speak to the financial costs of hospital admissions outside of the bankruptcy filing decision. We have found that hospitalizations cause: increased out-of-pocket spending on medical care, increased medical debt** , and decreased employment and income. These costs may have considerable adverse consequences, and evidence from the Oregon Health Insurance Experiment indicates that they can be partially ameliorated by health insurance. But our findings suggest that medical factors play a much smaller role in causing U.S. bankruptcies than has previously been claimed. **Overemphasizing “medical bankruptcies” may distract from understanding the true nature of economic hardship arising from high-cost health problems**. Bolding mine. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 15, 2019, 6:07pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/51 "2019-11-15T18:07:18Z")
> [@Gyrate](#): > > 4-6%, actually, but close enough. How often does it happen in UHC systems? > > Of course, just because one doesn’t legally file for bankruptcy doesn’t mean everything is fine. From the same cite:Bolding mine. Exactly, if the problem is bankruptcies caused by medical issues, then disability insurance reform is much more important than medical insurance reform, and the emphasis on the bankruptcies in medical insurance reform is only clouding the real issues. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [November 15, 2019, 6:10pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/52 "2019-11-15T18:10:11Z")
That’s an _interesting_ conclusion to draw from that paragraph. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [November 16, 2019, 4:20pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/53 "2019-11-16T16:20:01Z")
> [@Shodan](#): > > I think this is partially addressed by **Babale**. If all health care is funded by the taxpayer, then public subsidies that replace drug company profits don’t save anything. > > If M4A saves money, then we could re-allocate some of that money back to R&D, although that means we would save less money. > > If. > > Regards, > Shodan I think US pharma R&D is closer to 80 billion. Assume M4A cuts that by 20 billion. We don’t even need 20 billion in public funds to make up for it. Due to the multiplier effect, something like 5-10 billion in subsidies, tax credits, basic research funding, etc. should be met with an additional 10-15 billion in private sector spending, making up the 20 billion loss. Which is far less money than the 400-500 billion a year we’d save with M4A to start with. Savings would grow with time. Medicare for all has lower administration, lower reimbursements and bulk negotiation power. All of which save money. ---
**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:** [November 18, 2019, 11:57am UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/54 "2019-11-18T11:57:56Z")
The entire worlds biomedical research budget is about 320 billion. US healthcare is about 3 200 billion, and the waste in that is about 1 600 billion. Most productive nation by head of population is the UK. Mind, its a small difference. ---
**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:** [November 18, 2019, 1:06pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/55 "2019-11-18T13:06:25Z")
> [@Wesley\_Clark](#): > > I think US pharma R&D is closer to 80 billion. Assume M4A cuts that by 20 billion. Apologists for present-day U.S. health financing like to weep for the poor pharma companies and their huge R&D costs. Know that Big Pharma spends more on marketing than it spends on R&D. (And IIRC takes in more profit than it spends on marketing!) Even their published figures are misleading: Payments to physicians for “drug studies” are accounted as R&D but are little more than marketing ploys. > [@](#): > > Ten companies, including nine pharmaceutical giants, accounted for half of the health care industry’s $50 billion in worldwide profits in the third quarter of 2018, according to an analysis by Axios’s Bob Herman. Drug companies generated 23 percent of the industry’s $636 billion in revenue — and 63 percent of the total profits. ---
**Author:** ![Mallard](https://avatars.discourse-cdn.com/v4/letter/m/b9bd4f/32.png) [@Mallard](https://boards.straightdope.com/u/Mallard)\ **Post date:** [November 18, 2019, 7:31pm UTC](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389/56 "2019-11-18T19:31:22Z")
It’s a simple principle. Overcharge the public on cigarette taxes and the lung transplants are free. Overcharge the public on liquor taxes and the liver transplants are free. :eek: [Previous page](https://boards.straightdope.com/t/what-americans-dont-understand-about-public-healthcare-youtube-video/843389.md?page=2)