What realistically happens as health care becomes unaffordable for all but the rich (in the US)

Great Debates
1

emphasis on realistically. I guess I don’t consider single payer realistic right now for a couple reasons.

  1. Neither political party wants to offend the rich and powerful, and single payer would offend them because it cuts medical costs. This is a major issue, true reform requires cutting medical costs and neither party wants to do that because the medical industry is 3 trillion a year, and that funds a lot of political attack ads.

  2. Because our health care system is so bloated and overpriced, the taxes needed to fund it may be so high that nobody wants to try.

Single payer, right now, seems like a pipe dream. It was defeated in Oregon by 80% of the vote. Vermont passed it, then balked when they saw how much taxes would have to go up to fund it. California talks about it, but that is all they ever do. Talk.

Even in the deep blue states (California & Vermont), single payer is just a talking point.

But anyway, per capita health expenses are now $10,000 a year in the US. Within about 15-20 years they’ll be $20,000. Then $40,000 in ~30-40 years. Meanwhile wages aren’t really budging. Virtually all economic growth goes to the rich and has since the early 70s.

What happens in ~30 years when it is $40,000 a year in per capita health expenses, but median household income is maybe $90,000 (neither figure adjusted for inflation). We are already at the point where even dual income college educated couples are having trouble affording health care.

What happens in 5 year intervals going forward? What are the likely scenarios for 2020, 2025, 2030, 2035, etc?

Will market forces drive prices down somehow (maybe more international travel for care)? Will market forces result in massive investment in robotics? Will some state actually pass single payer? Will massive relocation out of the US become an issue?

how will retirement planning be affected if one day in the hospital can wipe out 30 years of savings and investment? Or when 70% of your retirement savings are eaten up by medical costs not covered by medicare, and the other 30% goes to all other expenses combined (housing, food, luxury items, transportation, etc).

Or will Americans just continue to do what it seems they are doing, avoiding care and looking for alternatives (or just hoping it goes away)?

Or will health care become so overpriced, that it stops growing in price because people stop getting it? Personally if I were elderly and had an expensive illness, I think i’d rather just die so I can leave a nest egg for my children’s generation rather than spend it all in 1 month on health care.

2

It is a problem needing a solution

The free market is the solution and Trump implemented it by executive order just yesterday.

Trump Care MAGA

Obama care still needs to be repealed completely and those with preconditions need to be added to the medicare/medicaid roles.

3

So we take the sickest and make it the job of the government to take care of them? How much are you willing to increase your taxes to do that?

4

So the solution is to eliminate consumer protections? That isn’t going to work, it will just give people cheaper insurance that covers less medical costs.

Medical costs themselves will still be unsustainable.

Also moving sick people to medicare/medicaid is just a slower way to do single payer. It will also require higher taxes to fund them. If the sickest and most expensive Americans are on public health care but the most health are on private health care, that is just socialism for the rich because the government is eliminating all risky investments by private companies.

5

Yes
The US is not Nazi Germany where the sick and mentally ill were euthanized.

The amount of medicare fraud (on the order of $50B annually) when policed, would be more than enough to cover the costs of medical care.

The government already takes care of folks that are costing us more than those folks ever paid into medicare from the payroll deduction.

6

I doubt that anybody over 50 is free of a pre-existing condition, for example high blood pressure, high blood sugar, high cholesterol, allergies, the list goes on. It’s true that most of that can be controlled by medication, but for insurance companies, that stuff can be the kiss of death, depending on how strict they want to be. So then, everybody over 50 and many under 50 would be on Medicaid/Medicare?

7

There will be a thing similar to Prop 13 in CA.

There will always be more voters willing to vote than rich people who can stop them.

8

Huh? $50 billion in medicare fraud savings --assuming every last case could be found and eliminated, and the low-end figure of 50 billion non-elderly with pre-existing conditions and no employer coverage, that only comes to $1.00 per person. And that 50 billion people does not include those already on Medicare or Medicaid.

9

By this do you mean, that the public will vote for medicare for all via proposition?

That’d be nice, but again in Colorado single payer lost the vote 79-21.

10

Where do you get “50 billion non-elderly with pre-existing conditions and no employer coverage”? There is only a little over 300 million people in the US to begin with. What am I missing?

11

Good idea. Because nothing supports the public interest like the profit motive of a slimeball corporation. Maybe you can get Martin Shkreli to organize this free-market solution when he gets out of jail.

If you think about it for around a nanosecond, the free market is what created this fiasco in the first place, because the central goal of a universal guarantee of medically necessary health care is directly at odds with the central purpose of business.

12

I think the OP is flawed in similar ways to people predicting that the overpopulation issue will basically destroy civilization in the 1800’s, but I’ll not fight the hypothetical. My thought is that if, indeed healthcare would only be affordable to the rich, then the healthcare industry would collapse, since there aren’t enough rich people to keep it afloat. Of course, if we define ‘rich’ in some arbitrary way to include everyone making $100k today then this goes out the window, but if, truly, only rich people can afford it then the industry will collapse or become a shadow of what it is today wrt annual revenue, so you will see doctors and nurses graying out as new students don’t enter the pipeline in those industries…after all, how many nurses and doctors do you need for a handful of billionaires (or whatever arbitrary figure you are using for ‘rich’)? Not nearly as many as are needed today, for the hundreds of millions of users of the healthcare system.

Perhaps automation will come into play. I understand that some aspects of medicine are susceptible to the new generation of learning AI, so in the next 10-20 years you are probably going to see a lot more automated personal systems that will monitor basically everyone all the time and connected AI that can evaluate and prescribe remedies, even do surgery. It’s possible that emergent strong AI could even be so pervasive and trusted that we basically ask it to solve the issue and…well, it does. With some sort of single payer system that is optimized to the US and the US tax payer as well as US needs, and it can demonstrate that such a system will work in the US, instead of pointing out how it works in a lot of other countries that aren’t the US. This would get around the main political hurdles which are basically the voters, who aren’t convinced by someone pointing at Europe and saying that it would work exactly the same here, and also aren’t convinced that they would get comparable care at a similar price point, even cutting out what most pay monthly for insurance and what corporations pay for insurance and saying that instead it would come out of general taxes.

Or, I suppose, the country falls apart in some sort of mad max scenario, or dogs and cats start living together. Basically, to be realistic, this would actually be optimal (not the dogs and cats nor mad max thingy, but the only the rich angle of the OP)…if healthcare cost rose to the point where the average American couldn’t in fact afford it then real change WOULD happen, whether from the private sector with emergent AI or just companies looking to undercut the pricing to gain market share or dictated by the government, it would happen. But it won’t, because the OP is unlikely in the extreme for the same reason civilization didn’t collapse in the 1800’s due to population explosions couple with too few agricultural resources. My WAG is that in the US we will continue with our broken ass system pretty much for my lifetime because, sadly, the average American CAN afford it, and is used to it as it is. The glimmer of hope I have is for that emergent AI stuff and some serious medical breakthroughs that will allow me to live long enough to see my prediction be wrong. :stuck_out_tongue:

13

I think the “50 billion” refers to a sum of money not the size of a population.

14

I will grant you that yes the system cannot be sustained, but that is my point. The system cannot be sustained. So what happens in 2020, then 2025, then 2030, etc as it becomes more and more obvious that the system is not sustainable?

What happens when household income is 90k (not adjusted for inflation) in 2050 but per capita health spending is 40k per person, which would be 160k for a family of 4? Does it ever get that bad or does the system change before it gets to that point? Obviously we can’t reach the point where health care makes up 100% of GDP, that isn’t realistic. Something has to change before that.

My point is that the system is not sustainable. So what happens when it stops being sustainable? Do Americans look more towards outsourcing health care? Do they just go without? Do people start committing suicide more? Do people leave the country in large numbers? Does automation undergo massive investment? Do state government start radically reforming health care? Is a parallel low cost health system created (one that only costs 1/2 the mainstream health system but only covers 90% of the services)?

As I mentioned in my OP, it is now hard for double income college educated couples to afford health care now. The system will keep getting worse. And yes if people can’t afford it, the system will change. But thats my point, how will it change?

15

I suspect you’ll start seeing doctors opening shops that don’t take insurance, instead requiring you to pay in cash on the spot or as some kind of payment plan. There’s at least one place here in town that let’s you pay a certain amount each month and giving you X number of visits a year with at least basic visits and treatment covered - my boss had a representative of theirs come to my workplace and try to interest us in it. At the moment such an office wouldn’t be able to do major surgery or anything, but as costs push more and more people out of the traditional health care marketplace the doctors who are now surplus will be looking for other places to go.

16

That is one (of many I’m sure) reforms we will see.

Personally I have done outpatient work that was far far cheaper than it would be in a hospital. When I needed bloodwork, I went to a standalone lab and the prices were at least five times cheaper than they would’ve been at a hospital.

I once needed to see a physical therapist, so I found one who charged $40/hr. Far less than the $1200 I had to pay to see a PT who was connected to a hospital (despite being an outpatient facility). I’ve looked into MRIs and they are far cheaper at a standalone facility than a hospital.

So I’m sure there will be movement away from hospitals into medical practitioners going more into business for themselves, because fewer people will be going to hospitals.

But I’m wondering is that the future of medicine?

For minor care you either self treat using google, or find medical professionals who have their own shop and charge reasonable rates?

But if you need something more major like a major surgery or long term care, you travel overseas (maybe to Canada, Mexico or Cuba).

17

There’s another place they can go: concierge-style health care. As health care costs squeeze regular doctors with regular patients into spending less and less time with them, effectively rationing their services, the wealthy are moving to concierge services where, for a fee that may be as much as $40,000 annually, they have access to services that direct them to upscale health care facilities that they pay for separately that have no such restrictions. These are doctors that, for the appropriate fees, will spend quality time with them, and hospitals that have no waits, luxurious facilities, and even gourmet meals – all for a fee, of course. Meanwhile regular health care gets more unaffordable and more rationed. Such are the wonders of the free market in health care.

18

Part of Obamacare was to move people who are too poor to even qualify for a subsidy onto Medicaid. However, many states (mostly Republican ones) fought that tooth and nail and prevented it from happening. In many states, such as mine, you can’t be on Medicaid as an adult over 18 unless you have kids under a certain age OR are severely disabled. That’s what Republicans seem to want. So why would part of Trump’s plan be to move people with preexisting conditions onto Medicare or Medicaid? You must be joking!

19

Let me just answer the titular question, before digressing into the wider array of topics that come up in the rest of the OP:

We already have universal health care. Emergency services are mandated to help everyone, of any financial class, and those people are not prosecuted for failure to pay the hospital for their service.

So, as access to health insurance drops, use of emergency services rise, meaning that either the government raises more taxes to help pay the hospitals or the government borrows from China and others to do so.

People receive health care service, but only in a reactive framework, rather than a proactive framework.

Moving on from that topic, I will say that fundamentally the US needs to deal with the issue of our health care spending before we work on coverage. When it costs 2.5x (or whatever we’re up to) more to see to the medical needs of a person than it does in other countries, then obviously you’re going to be spending a lot more unless you’re only covering a third as many people, let alone trying to expand past that.

But, at the same time, single-payer health care is not necessary to achieve that aim. While it would, likely, lead to a price reduction over time (depending on the specifics), it’s not a viable option for our country because it basically puts a million people* out of a job in one fell swoop. And, given that it’s not necessary to do, that’s a million people put out of a job for no reason.

It is likely that our health care costs are high simply because we have been willing to pay more.

In other countries, the government or various entities that are approved by the government, score available equipment, drugs, techniques, etc. against the number of years of life that they allow a person to live, on average. And if the cost-value analysis doesn’t bear out, then they don’t buy. The maker has to reduce the cost or skip that marketplace.

In the US, health insurance is offered as a perk of employment. The government underwrites a tax writeoff for it, regardless of what the plan offers or doesn’t offer, and the company chooses the largest plan they can afford that will hopefully lure you over from a competitor. There is no cost-value analysis. Rather, the market forces push the total payment upwards, as a side effect of trying to recruit employees.

Simply making health insurance something that people pay for themselves, rather than having it granted to them, is likely to start putting sane market forces back on, and put pressure on the costs to go down again.

  • Number pulled from my butt. I can do some investigation to figure out the real number if anyone cares what it is specifically.
20

Trump isn’t a Republican. He’s a populist. He does lots of things Republicans have traditionally been against and they grit their teeth and pretend to like it because his mouth-breathing base has them held hostage. Not that I feel sorry for them. They dug their own hole, but simply saying Republicans are against it so Trump wouldn’t propose it is at odds with what we’re seeing.