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

Based on the linked article, it should be 50 Million, not billion.

That’s because state and local governments don’t have sufficient leverage in making those who have the money pay for a socialized health scheme - they can just move across the border. Reform has to be a nationwide effort, which could be inspired by states but implementation has to come from a larger power. Perhaps we could have some states forming regional health pools at some point, but that’s still highly unlikely. Why would voters in population sparse Oregon, Nevada, and Arizona want to support the health of Californians, and vice versa?

I’m honestly terrified of hospitals, fearing I might catch MRSA. Haven’t been to one in forever, and would only want to be in one if I needed trauma care or cold storage after a fatal accident taking my life.

They already support each other all kinds of ways. This is a red herring.

Well, he’s sure as hell not a democrat or any kind of liberal. I don’t see him as a populist, really, except that he says things he thinks his base wants to hear, most of which seems to align itself with Republican goals for the most part, such as making sure nobody except the rich have health care, making sure ALL the money possible goes to the 1%, etc.

Yeah, maybe more traditional Republicans don’t like the trade war or the destabilization of the health care markets because it’s bad for business (not because it hurts the common man, of course), but Trump will probably pull back and do what’s best for business and worse for the people in the end.

This is getting off topic I suppose, but he is very unlikely to do anything to help this country’s health care problems, so in that sense he is very Republican.

For starters, I think you touch on part of the solution. We really do not need full-fledged doctors for a substantial fraction of health care: PAs and/or RNPs could handle the basic stuff and refer the more serious problems to MDs/surgeons. If getting the initial treatment/advice is cheap/free and easy, a great many health problems would probably be just annoying things that go away before an actual doctor is needed. That would greatly enhance the affordability of stuff.

If, for example, increased restrictions on tobacco sales cause major producers to fail, putting tens of thousands of people out of work, I think most of us would feel sorry for the cigarette factory employees, but oh well, and the top level executives who distributed lies and misinformation for decades, no sympathy for them.

If millions of people get put out of work because of UHC, that is unfortunate for them, but the job they are doing is not a net positive for society. It may be unnecessary to surplus them, but it is much more unnecessary to keep supporting their efforts in the decline of the country.

I think that’s what “populist” has come to mean, if not what it’s always meant: calculated to appeal, rather than calculated to be beneficial.

Some of the millions you described are certain doctors who are either not good, or who are good but not worth what they’re paid. That will be tricky politically.

If only we could look to other countries that have solved this problem.

US Healthcare is already too expensive for the all but the rich.

Health insurance is becoming unaffordable for individuals in the US. After that, for employers.

What happens when US employers decide they can compete better in the global economy if they didn’t have to pay for employee health insurance?

Yes, but there are several issues with that.

[li]Because we are a plutocracy, neither political party has any interest in genuine reform. Democrats just want to expand insurance into a broken system, republicans want to make insurance crappier in a broken system. Neither party has any interest in offending the rich by fixing the broken system. [/li][li]Because our health care system is so broken, we can’t just implement a working system like they have everywhere else. We spend 18% of GDP on health care, compared to 8-12% in every other developed nation. Even if we implement single payer, we will still be spending about 16-17% of GDP on health care because our system is so screwed up. The time to implement UHC was before the 80s, back when we spent a reasonable amount on health care (9% in 1980). Health spending in the US has gone up by 9% of GDP (from 9% to 18% since 1980) while most other nations have only seen health spending go up 2-4% during the same time frame. [/li][/ul]

I just don’t know if I see America doing the right thing anytime soon. We will push for minor tweaks on a broken system because nobody wants to anger the rich. Meanwhile peopel will fall further and further behind and trust Dr. Google, or find medical practitioners who aren’t tied to US hospitals to get treatment.

I dont’ know if it would honestly.

For one thing they have physicians as the first point of contact in every other health system, and they spend half what we do.

Plus medical spending is not distributed evenly. The most expensive 1% of patients make up about 22% of medical spending. The most expensive 5% of patients make up 50-60% of medical spending. The most expensive 20% make up 80% of medical spending, etc.

So its probably not primary care visits that are behind our overpriced system. A tiny % of people who need constant care in the form of endless medical devices, interventions, etc. are the ones using a big chunk of medical spending.

Making the point of primary care a NP or PA may save some money, but probably not a ton overall.

Your math is wrong by a factor of 1,000. There are at least 50 MILLION people on Medicare/Medicaid, and many are on both, and that would be $1,000 in fraudulent claims per person.

That alone would foot the bills for a huge percentage of the un(der)insured in this country, because many of them are relatively healthy young people who think they don’t need insurance. :rolleyes:

Mehmet Oz. We can start with him.

They have been touched on, but there are a few misconceptions to the pricing assumptions I see here.

First, it’s crazy to think that the cost of children’s healthcare/insurance will increase exponentially into the 40k per year range. Children in general are cheap and easy to care for 99% of the time. There will only be slow growth in the cost of their care over the ling term.

Secondly the ideas of fraud (cheating the system for straight cash) and waste (seeing a genitourinary specialist for a UTI when you could have seen an NP) are obviously factors but not likely to lead to much cost savings over the long term. It’s my belief that 0% fraud is a pipe dream, as people will always be outsmarting the system in one way or another. You can combat waste with lower level providers for less serious problems, but that is something that is already happening (witness the rise of GoHealths and other walk-in urgent cares) and honestly doctor’s aren’t making huge sums from their office visit fees. This is part of why you only get 12 minutes with doctor when you have an office visit, they have to do assembly line medicine to turn a profit.

So where are all the increased costs and bankruptcies coming from? I think there are 3 main culprits: advanced defensive medicine, an aggressive surgical approach and the long term critically ill.

  1. As we have developed better and better tools and theory for screening for serious illness and injury there has been an ethical (help the patient as much as possible) and financial (protect yourself from oversight or negligence lawsuits) imperative to do everything possible to find and treat any problems or complications. If something (drug, CT scanner, microdialysis, implanted defibrillator) works only 5% better than the old version, but costs 200% more, you can almost guarantee that cost will be seen as the price of doing care properly and passed right on to the patient/insurance. This is somewhat just the fact of technological progress, but I guess could be partially alleviated by some tort reform, allowing doctors to “trust their gut” more and not have to worry about being sued for it. Good luck convincing people that we’ll have a few more missed diagnoses but save a few bucks on labs and x-rays though.

  2. Following that, there are more incidental findings and serious problems require a surgical approach and we are doing much more complicated surgeries as we advance our knowledge. This leads to higher costs all around for anesthesia, the OR time, staying in the hospital, etc. In America surgeries are a major money-maker for the physicians and they are more inclined to advocate for a surgical approach or a more invasive approach when a different technique would be almost or equally as good. See shoulder surgeries vs PT, colonoscopy vs sigmoidoscopy, etc. Changing the MD’s pay structure could perhaps help here, good luck getting the AMA onboard.

  3. This is where a lot of the costs come from, as this builds on 1 & 2 above. We have an aging, sedentary and overall unhealthy populace that believes everything should be done to keep any person alive as long as medically possible.

Most people aren’t using 40k in healthcare yearly when they are 32, 38, 40, 47 years old. They have a major heart attack at 57 costing 350k in one week of care; goodbye savings. They have a second at 60; now they’ve hit their lifetime limit (historically) in a couple episodes of care. Cancer at 63, (“of course we want to treat it, Papaw survived 2 heart attacks already”); there goes the house and retirement fund. His wife falls and breaks her hip and gets an intracranial hemmorhage helping him into the car on the way to chemo, 3 surgeries and 2 months in rehab; hello bankruptcy. Historically, any one of these would likely have led to the death of these people but modern medical science will bring them back up to nearly full function. Even with insurance there are associated costs and lost wages that aren’t covered and god help you if you are trying to save for all of this out of pocket. The last time we talked about trying to address this I had nightmares for months about being pecked to death by shrill harpies screaching “Death Panels” so let’s not go there again.

All of this adds up to rising costs, plus we had to ‘capitalize’ the whole shebang with an added layer of profit motive so we got that going for us too. There is no chance of changing emergency care to a pay-to-play system, people aren’t just going to shuffle off and die because it will cost their family some dough, no one is going to Mexico/Canada/India for a stroke. These are all dead end ideas. What we will see is what has already been happening: rural hospitals with mostly poor, uninsured patients will close; larger hospitals will get more swamped with patients they can’t turn away and can’t earn any money from and the rich won’t see what the big deal is from their luxury beachside rehab retreats. If you think AI is going to come save the day (in 1 to 2 decades no less) with innovation and automation then you have obviously never set foot in a hospital. Some places are just now getting away from paper charts and into computerized medical records. Watson MD has been a dud so far. If AI comes and actually works it will cost a literal fuckton of money to use the AI hospital and it will probably only make things that much more expensive.

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This is sophistry because you define the rich as those who stand in the way of reform. While physician is one of the most common jobs of the rich the vast majority of rich people are not physicians and have no interest in paying more for health care than anyone else.

By the rich I mean the people who profit off our health care system. The people who own the pharma companies, medical supply companies, hospitals, etc. do not want meaningful reform because true reform will cut trillions of dollars out of health care. Those rich people won’t accept a multi trillion dollar pay cut.

WOOHOO! That means I’m rich…RICH! That’s wonderful news. I have a doctors appointment this afternoon, proving that as I can afford health care, and as I’m an American, I have to be RICH!!

Such a relief. I knew eventually I’d be considered rich, but it’s good to have this sort of confirmation. It’s interesting to see the other RICH people in the lobby when I go for my appointment. Hm…they don’t look particularly rich, but you know rich people…they blend in. But I bet there are not that many people with health insurance in the US…can’t be that many rich folks, right? How many is it again that have health insurance? I bet it’s like a few thousand folks like me. Right?

We were spending $400 per capita in 1970. We were spending $2854 in 1990. Its not that crazy. If prices can quadruple (not adjusted for inflation) from 1990-2018, then why can’t the quadruple from 2018-2050?

They have long term critically ill in every other wealthy nation on earth, and they spend half what we do on health care. We had long term critically ill in 1980 when we were spending 9% of GDP on health care (as opposed to the 18% we are spending now).

To my knowledge, states which passed tort reform like Texas do not have lower health care costs than other states.

Also defensive medicine may cost $46 billion a year. Not a small amount, but barely 1% of our total health care spending. The system in places like Australia are 50% cheaper than ours. Eliminating all medicare fraud and all defensive medicine may lower costs by 2%.

I believe this is true. I think Americans are more likely to get surgery than people in other nations. Even if the surgery has been shown to not work.

They have aging, sedentary and overall unhealthy people in every nation. Obesity rates in Australia, New Zealand & the UK are about as bad as the US and they spend half what we do on health care.

Also the US has one of the lowest smoking rates of wealthy nations. Yet nations where more people smoke, like Japan, still have lower medical costs.

Also healthy living doesn’t save money, it just redistributes when in your life you spend it. Healthy people live longer and the extra years of life cost more than the savings from lower rates of diabetes and heart disease in middle age and the early senior year.s

Every other nation on earth tries to keep people alive and has advances in health care technology. They still spend half what we do.

My understanding for why our system costs so much more comes down to 3 factors.

  1. Administration - We spend far more on administration due to redundancy and multiple payer systems

  2. Lack of market forces - we do not have either public or private market forces in the US. public market forces are things like public negotiation of prices, private forces are things like competition and transparent pricing, or the ability to buy goods/services overseas.

  3. A fee for service system - In the US, medical practitioners are incentivized to provide the most expensive care possible. Hospitals want to give the most expensive care they can. Medical device companies want to push the most expensive devices possible. Pharma wants people to buy the most expensive drugs.

Well, my own point is that the system can be sustained, and every indication is that it will be. That’s because, contrary to the assertions of some in this thread, health care ISN’T just for the ‘rich’…it’s for basically everyone with a full time job, by and large. Simply put, it won’t ever be $40k per year if the medium income is $90k. That would be $21+ TRILLION dollars. A year. That’s more than the current US GDP. It would also mean that even before taxes the average American would be spending nearly half of their gross annual salary on just health insurance. This is unrealistic in the extreme. As I said, it’s similar logic to those predicting global collapse due to the population explosion in the late 1800’s. Perhaps I wasn’t clear…this never happened. It was based on assuming things would remain exactly the same and we’d all just collapse.