But I don’t just mean in terms of status. People often lower the mental value of something if it is totally free and not consider it valuable in their minds. You want students to feel like they’re obtaining something valuable that is worth studying hard for.
Charging even a very modest amount for tuition, textbooks, room and board, etc. tends to have a big psychological effect on minds. Even just $250 a semester feels drastically different to the consumer/economics/payer mind than $0.
This is why, for instance, in some nations that offer single-payer universal healthcare, by analogy, they’ll still charge a small fee that does almost nothing to defray the actual cost of the healthcare provided, such as $10 or $20. It’s not about the money, it’s the psychology. It’s a deterrence against frivolous use.
Well, most CA community colleges charge a modest Student body fee, and then there’s textbooks, which AFAIK, arent even free in the nations with “free” colleges.
Yes, many nations with UHC still have a modest co-pay.
The U.S. of course has perverse incentives: You are poor. You go to an urgent care center and they want $150 cash if you don’t have insurance coverage. But if you go to the hospital emergency department they are legally required to serve you. They may later send you a $2,000 bill which you ignore. Consequently hospital emergency departments have a huge number of patients which could be cared for as well, but much more cheaply, elsewhere.
Insurance doesn’t actually cover shit. It’s not the answer. You pay thousands every month for most of your life, and sure you can go to the doctor without paying their $250 fee every time, get a few shots or antibiotics at a lower cost. But if you get cancer, or major injuries from a car accident or something, it’s still going to cost you tens or hundreds of thousands of dollars, and you’re still going to go bankrupt.
That’s part of the problem. Lots of people think they’re well covered, until they have to actually test their insurance, and find out they’re really not. But until they figure that out through personal experience, they vote like healthcare isn’t a major issue.
I had double-bypass surgery in 2019. I was on Medicare and had a supplemental insurance policy. IIRC, my out-of-pocket was the $240.00 deductible on the supplemental. And my total bill, including hospital, surgery, and everything else, was just over $200k.
That was also my experience when I was handling the finances of my aging parents.
Medicare is exactly the sort of thing I’m not talking about. That’s government healthcare. Not universal, unfortunately, but it’s not private insurance either. It exists precisely because of the shortcomings of private insurance. And you still had to have a second insurance policy? You’re making my point for me.
Personally, I’m a mid-career professional making over six-figures, and spend thousands of dollars a year on basic medicine and doctor/urgent care visits for me and my family. That’s not counting the thousands I pay in premiums, nor the many thousands more my employer pays. Yes, I have a high deductible plan and HSA, but that’s because I’m not sure I could even afford a low-deductible plan, they’re that much more expensive. And I know from people with low deductible plans, they’re not that much better. They still pay out the nose for every little healthcare related expense, even if the insurance company covers a larger portion of it.
That’s not even addressing the poor and lower middle class, who might get Obamacare subsidies, but they’re still not getting anything close to affordable or accessible healthcare. Just the privilege of (hopefully) not dying in the street before a doctor can give them a once-over first.
If you want to talk about Medicare for all, that’s a very different story.
Well, no, I’m not, because my major surgery didn’t cost me squat. $240.00 is not tens or hundreds of thousands of dollars.
Before I retired, I guess I was one of the fortunate few who worked for a company that always negotiated a damn good health insurance plan. On the occasions that my family’s health care costs exceeded our deductible, the insurance covered it.
Don’t get me wrong. I agree that the health insurance industry in this country absolutely sucks and is a huge ripoff. But IMO, a blanket statement that insurance ‘doesn’t actually cover shit’ is not correct. YMMV, of course.
I 'm not saying that my experience is representative but the deductible for myself and my husband combined is $2500. Which I had to look up because I always use network providers* and therefore don’t worry about my deductible since all I have to pay is the copay. Which is $25 for a doctor visit,$25 for diagnostic tests, $90 for outpatient surgery, $100 for ER and $70 for an ambulance. I don’t spend $2000 a year on medical care, maybe not even $1000.
Whether the coverage is really worth the thousands it costs ( between my share and my employer’s)** might be another issue but I will not get stuck with tens of thousands of dollars in medical bills if I get cancer or need surgery again.
* That’s not possible for everyone, but I live in NYC and it’s possible for me.
** it’s self-funded , meaning the insurance company is paid to administer the program, but this program ( which is for state and local govt employees) manages the risk.
Things change though. When I was a kid, my dad’s health insurance was free to him (all premiums paid by his company) and there were essentially no copays or medical bills at all. That was 30 years ago though.
Nowadays even good jobs with good insurance require you to pay hundreds a month just for your portion of the premiums, and copays can be $100 or more, and insurance might cover 80% of the $100k hospital bill, if you’re lucky.
I don’t disagree that there are still good insurance plans out there. Tricare for the military, whatever Congress gets, some companies who want to attract valuable employees might cover all the premiums for even good coverage.
But my main point is that’s not the insurance “all but 10% of Americans” have, according to DrDeth. The vast majority of Americans have crappy insurance that only covers them on paper, with a free preventative office visit once a year because Obamacare mandates it. In a real life health catastrophe, though, they’ll find they’re little better off than the uninsured.
Just as a reminder from north of the border, our equivalents are $0, $0, $0, $0, and $50 (ambulance shows up) / $80 (ambulance transports patient). (Cdn$80 is US $57.36). We save a lot of money by not requiring the exchange of money for every point interaction with the medical system.
Co-pays are not a necessary feature of the system. I’ve heard the argument that they prevent abuse, but who is going to abuse the system by seeking excessive medical treatment? People with mental health issues, who could then be referred to that part of the medical system.
I pay about $200/mo for me and the wife. And when I had prostate cancer, the bill for the procedure was something like $30. Mind you I had a couple test visits before, each one with a modest fee. I have Kaiser.
So, given the parameters of the questions i replied to- a cut that needed sutures, that is just a Urgent care visit, which is $30 for me- and the average copay is $35- $75. If you have no insurance at all, the URgent care fee averages $100-$200.
About right, plus maybe an office visit or two.
Looks solid to me.
Again, I have cites that say the cost to go to Urgent care for a few stitches is not that much, even if you have crappy or no insurance.
Yes, if you dont have decent insurance, getting hospitalized for something major can cost a bunch. But that is not what we were talking about- the example was needing a few sutures.
I think a lot of people are underestimating the cost of health insurance and underestimating the deductibles involved. A lot of people have to pay both deductible and copay. And we haven’t even gotten into coinsurance yet.
Health care in the US is a mess. Possibly 5% of GDP is devoted to the paperwork necessary to make someone else pay the bill. Very inefficient. There are countries with private insurance that have nowhere near the waste that the US does.
I was curious about the market shares of US insurance companies. Table 5 of the following link suggests that about half is Blue Cross or Kaiser and half is everyone else. Not all Blue Cross plans are great. Not all “Everyone else” plans are bad. But as a first pass, I’d WAG that about half the country not-on-medicare-or-with-the-Veterans-administration, has crappy health insurance whether they know it or not. Better data-driven estimates are welcome.
(Blue Cross and Kaiser combined had 48% private market share in 2023. “About half” means 40-60%. And the estimate is a WAG. Medicare Advantage provides inferior insurance at higher costs for the government, but I’m setting that problem aside in this post.)
The claim that 5% of GDP is devoted to paperwork related to paying bills for someone else is not a widely accepted statistic. While there is bureaucratic overhead associated with government spending, including transfer payments like Social Security, these are not included in GDP as they don’t represent production. GDP is calculated by summing consumption, investment, government spending, and net exports. Therefore, the “paperwork” associated with government spending is part of the government spending component of GDP.
Here’s a breakdown of why the claim is likely an oversimplification: