No, that’s not the good part. THIS is the good part. Public health expenditure as a % of GDP. USA is near the top, higher than Sweden, UK and Canada, and only slightly lower than France and Germany. Our government spending, that covers a fraction of our population, is HIGHER than other countries that have universal coverage through their government.
OTOH, free market efficiency!
You must be easily amused, since I did say “with that limitation in mind …”. Although a direct comparison between the views of people in three different countries would seem more valid that the claim that “Americans are happy with what they have” without any reference point whatsoever.
But there’s a more important dimension to this. People in many countries with single-payer (or its functional equivalent) are old enough to have direct or generational memories of what things were like before health care was universal and government-paid. Most Americans have never known any other system than the one they have.
As for “empty rhetoric”, as I said before: you have much higher health care costs than the rest of the world, yet you still have some 40 million uninsured, you have health care costs as the leading cause of personal bankruptcies, even among those who thought they were protected by insurance, and, for many, you have a feudal dependence on the employer for health care, so that loss of job can become tantamount to loss of health care and maybe loss of life. And in exchange for all that you get insurance bureaucrats meddling in the doctor-patient relationship and trying to block access to health care to improve their “medical loss ratios”. Those facts are neither rhetorical nor “empty”.
The reality is that progressive administrations have been trying for the better part of a hundred years to improve the state of health care in the US, but except for a few successes like Medicare and the ACA, have mostly failed because of relentless pressure from the AMA and, in more recent years, the insurance lobby and the Republican ideologues that they control. Absent this self-interested lobbying, national health insurance might have come about back in the 30s concurrently with Social Security, and America might have been a leader in health care for its citizens instead of a shameful laggard caving to vested interests.
Why would you want to? That’s the private-insurance mindset – when things are unaffordably expensive and different private interests are competing to try to make things look better, all kinds of costs and benefits get juggled in a kind of shell game. This is the private-insurance mythology of “choice”, where what the patient really wants is not “choice” but medical care when he needs it, care that cannot be denied, paid for as efficiently and cost-effectively as possible.
What is a “government doctor”? Do you still not understand how single-payer works?
Your strawman hypothetical doesn’t arise because single-payer coverage is unconditional. But here’s a question about something that actually does arise, all the time: if all the doctors you consult direct a certain treatment, but the insurance company refuses to pay for it, do you get it?
That’s not an argument, it’s your opinion and a baseless statement of ideology. Much like your “refutation” of the success of single-payer in Canada and Canadians’ satisfaction with it, which was, and I quote: “I couldn’t give two shits about it myself but knock yourself out.”
Not splitting out the charges - charging for something that used to be included.
You aren’t getting it - they use to charge for X, which included Y and Z. Then the government wanted to cut costs so they said they would pay only so much. So now the hospital charges for things they used to do “for free”.
Bill Before -
Routine Office Visit - $100
Government: “We will now pay only $80 for a routine visit”.
Bill After -
Routine Office Visit - $80
Converting Medical Record from Paper to Electronic - $10
Colorectal Screening - $10
Smoking Cessation Counseling - $5
Regards,
Shodan
Again, they already do this to insurers.
The Supreme Court is perfectly capable of pulling emanations and penumbrae out of their bony old asses. I don’t see anything that will stop them from doing the same the instant Cousin Shirley finds out that she had to go home after giving birth in 24 hours, but in California she could stay for 48.
Regards,
Shodan
Other than the fact that they’ve had decades of opportunity to do the same thing with unemployment benefits, college tuition, state income taxes and any number of other government programs that differ between states?
This is the free rider argument, that the rest of the world benefits from the higher prices in the US used to fuel the actual research and development of treatments.
I’d be interested in seeing a calculation of the total r&d dollars spent by big pharma, then a projections of the potential savings if we engaged in the sorts of price controls so many other medical systems engage in (including Singapore btw).
My guess is that the savings from the price controls will far outstrip the actual the r&d budgets. So why not just take a portion of those savings and come up with a system that replaces that funding (hell add more from some of the savings) to fund research?
And you still aren’t answering the actual question I asked. You are showing me that we as a country pay more than Canada does. Knew that. What I’m asking is what the average cost out of pocket an American pays in total costs compared to the average Canadian in an apples to apples manner. So, I’m an IT engineering making, say, $80k per year. I pay X amount in taxes, and Y amount healthcare per month. My Canadian counter part who makes the same pays, what, in comparison? As I said, when I compared my check stub to my Canadian counter parts my take home was actually more. Now, this was over 10 years ago, and maybe I’m missing something in all of this, but THAT is what I’m asking. You are answering an entirely different question that I wasn’t disputing.
Well, I wouldn’t quite call it an argument, just a sarcastic comment that if the Americans are truly determined to hit themselves in the heads with clubs, at least the rest of us can derive some indirect benefit.
When I first moved from Canada to the US I spent a lot of time trying to answer that question, but with 10 provinces and 50 states a true apples to apples comparison is nearly impossible.
When comparing my US peers with my Canadian peers I found that Canadians were paying roughly $8k-10k more in taxes each year on the same salary. At the time my high deductible plan was about $1,000 per year, so compared to by brother I had an extra $7000 in take home pay each year. Keep in mind that I didn’t own a house so I was only getting the standard deduction, and before Ontario added that extra health tax.
This also neglects the 7% GST and 8% PST my brother was paying in sales taxes. I bet few Americans on this board are aware that Canadians will pay upwards of 15% sales tax on goods and services (the GST has since been lowered to 5% and not all provinces have the same PST).
What’s interesting to note is that my max out of pocket was $8,000. The conclusion was that if you are young and healthy you could instantly make an extra $8k per year by working in the US. If you got sick or had medical expenses it was a wash.
Because I’m healthy and want to pay less. Can I?
And controlling the system within. The Veterans Administration is an example of both.
And the British system is an example of the Veterans Administration on steroids. It does well on minor medical needs and poorly on serious medical events.
It’s not that it can’t be done it’s just the nature of most governments to fuck it up beyond recognition.
But I’ll turn the question back on the op, why not allow 100% deductions for all medical expenses from taxes. Best of both worlds. medicaid is what it is and the rest of us can have the medical care we’re used to.
You are going to have to define “average”. For one thing, does the Canadian make more because his employer does not have to pay some of his insurance? Or is the employer more profitable because of this, and the employee does better in indirect ways, such as better job security? How progressive is the Canadian tax system? How much do the rich pay in taxes to support healthcare above what they get?
How much of their taxes go to health care for the poor versus ours?
And how do you quantify the benefit to the person who in the US works several part time jobs and cannot afford healthcare (before ACA) but gets it in Canada. We’d have to add in the tax increases in the US to support this.
And those are the complexities I can think of off the top of my head. You’re not asking for a post, you’re asking for a dissertations (and I’ve written one already, thanks.) However, I’m hard pressed to understand that under any reasonable definition of average the average Canadian can pay more for something which costs significantly less. I’d guess that there are Canadians who do pay more, but not on the average.
And we here in America may pay less, if we do relative to an equivalent Canadian, on the backs of those who can’t participate fully in the system.
Short answer is that it seems complicated, are you taking advantage of the mortgage interest rate deduction? You have to calculate the taxes paid for social security and medicare and add on insurance costs you pay via your private insurance.
My guess is that you will probably do a bit worse if you don’t pay for health insurance at all and take full advantage of the mortgage interest rate deduction in the US. And we should not care because that system costs the nation so much more while doing so little that it’s not worth preserving.
I want the mortgage interest rate deduction phased out, we are basically subsidizing homeowners at the expense of renters. Maybe that is a calculation done to increase the number of people the state can collect property taxes from, but it’s still a handout to homeowners.
I agree with point (1), and the article I linked earlier makes a similar point, although they do make a pretty good analytical effort to try to highlight differences, which on balance as you can see from the link are not very great. Given point (1) and the findings of the article, I don’t see how you can suddenly proclaim the definitiveness of point (2) which is directly contradicted by the premise of point (1).
I’ve not tried to address XT’s challenge because direct comparisons on any individual level are so difficult, and XT does seem to be conveniently avoiding the obvious point that the aggregate numbers tell the story – after all, if total health care costs are about half of those in Canada, then surely that is, on average, reflected in less individual burden, regardless of whether the burden is taxes or direct premiums.
There’s another point to be made in aggregate numbers, too. Canadian government program spending on health care as a percentage of the GDP is almost the same as US government spending – 7% of the GDP in 2001, compared to 6.7% in the US. For this, we get full universal coverage for the whole population with no deductibles or co-pays. The real difference in government spending – and where many Canadian tax dollars go – is in significantly higher spending in the social-spending categories of “income security” and “housing and community services” – a staggering 12.4% of the GDP, or 4.8% of the GDP more than the US spends. Blame Canadian governments for spending too much on social services if you want, but don’t blame health care spending. It just goes to show how unbelievably, staggeringly wasteful the US health care funding system is. And it’s all intrinsic to the private insurance system.
In other words they used this as an excuse to raise prices. Let’s forget the smoking part. Assuming they set prices in some rational way, the two $10 charges were included in the old $100 charge. Unless they were giving it away for free.
Say the hospitals costs were $80 for the exam, $8 for the other two things and $4 for smoking. Under the old system it ends up with no margin. Not likely.
In any case the single payer will decide whether the other charges are acceptable. If they are the hospital was leaving money on the table before. If not they will be cut back. You see, I have no problem at all with hospitals being paid fairly for services. if they were really providing $105 worth of services they should be paid $105.
I’d hope the hospital finance people would have this under control.
Now that I buy. Staying in the US while young and buying minimal insurance, then moving to Canada to be covered under their system when older is more or less the equivalent of not buying insurance here until a certain age and then picking it up when the expected value turns positive. The very reason for the mandate. Not as big a deal here before since you ran the risk of getting sick uninsured and thus becoming uninsurable here.
Actually, not at all true. Both my immigration status and my health insurance was tied my employment. And the nature of my employer based health care was that I couldn’t be uninsurable [sic]. Hence, as long as I was employed I had insurance. If I lost my employment I was required to move back to Canada where I’d promptly get health care.
Crazy still is that we opted for the cheapest insurance plan which was the high deductible. That plan meant we had to spend $3k in a year before insurance kicked in and covered 90%, but they started you off with $1500 a year. That $1500 rolled over every year, and now we have enough to cover our entire out of pocket.
The downside to all this is that we’ll most likely have to pay for my mother-in-law to fly from Canada to the US to get the knee replacement surgery she’s still on the wait list for. Easy come easy go.
First, “Canadians pay $8000 more in income tax than Americans”! (See my previous post about that.) And now this. I don’t know where you get this stuff, and while I don’t doubt that the anecdote is true, my spidey-sense says “but what is he not telling us?”. Because a good friend of mine had elective knee surgery, and he got it sooner than he would have liked. Then needed to have the other knee done, same thing – no problem. Then his wife needed knee surgery, and that got done without any undue delays. I’ve never in my life heard of any personal experiences from anyone having to go to the US for anything, though in exceptional circumstances for unusual procedures it does happen, because of the research base down there. I have, however, heard of Americans coming up here for various procedures – cardiac surgery at Toronto General, or hernia repair at the Shouldice.
P.S.- Oh, and when my mother elected to get a pacemaker, the wait time was… three days. Mainly, the three days from Friday to Monday, because the surgeon we wanted was, well, not working on the weekend!
I can proclaim that with definitiveness [sic] because those were the numbers. Since then it seems taxes in Minnesota went up, while taxes in Canada/Ontario have come down, so currently it seems that a person making $100k will pay about $6-8k more in Canada. Note that doesn’t include the 13% sales tax they’re also paying. Also note I didn’t look into property taxes. But Americans get a massive tax break for having a mortgage, and local taxes are deductible.
Keep in mind that heath care costs in the US are independent of your income, so I paid the same insurance (and had the same out of pocket) as someone making half as much as me, or twice as much as me.
Wrong. Like so many others you’re confusing costs. In Canada the costs are spread out through taxation. In the US it’s some taxation (Medicare) plus premiums, plus out of pocket expense. I don’t get any say in the taxation part, but I can choose my premiums, and while young and healthy I choose how much I spend out of pocket. I was able to choose high deductible and didn’t pay anything out of pocket. My Canadian peers weren’t able to choose.
You’re making one simple yet brutally ignorant assumption about what the correct amount of spending should be. Do you think Canadians would rather the government spend more on health care or less? You act like the amount Canada spends is somehow the correct number but the amount spent in the US is somehow wrong.
I’m going to let you in on a little secret, more is spent in the US because Americans are allowed to. The amount the government can spend is pretty much fixed based on acceptable levels of taxation. But after that Americans are allowed to spend money on health care if they so desire, Canadians are not. You probably didn’t realize but the Canada Health Act specifically prohibits private for profit health care. That means that even if wanted to you, even if you had the means, you are not allowed to buy health care in Canada. This notion has been challenged over the past few years and now some places are allowed to offer MRIs.
A better example is ultrasounds. To cut back on costs, to keep that aggregate number low, the IWK in Nova Scotia won’t tell mother’s the sex of the baby. It’s not considered medically necessary, and the process takes too long. The budget only allows for so many machines and so many techs. In response private clinics are opening that allow people to choose if they want to spend more. Should they be allowed?