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

[Lemur866]

Things that can’t go on forever, won’t.

It’s silly to imagine health care costs rising and rising and rising, until the rise so high nobody can afford them, so nobody gets health care anymore.

That’s not how it works. When prices rise, demand falls. Yes, demand for health care services are somewhat inelastic. If the alternative to an expensive treatment is death, you pay for the expensive treatment. Except if you can’t afford the treatment. Then you die.

Today all throughout the third world, people are dying of diseases that could be treated fairly cheaply. How can this be, if people will pay anything for effective treatment? It happens because they don’t have the money to pay for even the inexpensive treatments, let alone the expensive ones.

So as prices for fancy lifesaving treatments rise, people just won’t be able to pay for those treatments. It doesn’t matter if you could cure your pancreatic cancer with a 10 million dollar nanomolecular pancreas, if you don’t have 10 million dollars you’ll just die. Maybe a few super-rich people get the robot pancreas, but pancreatic cancer isn’t actually that common and super-rich people aren’t that common, and so the number of super-rich people who need a robot pancreas is tiny.

The truth is that the super-rich don’t usually need multi-million dollar medical treatments, even though they could afford them. They’re generally just as healthy as everyone else. And super-expensive experimental procedures generally aren’t as effective as tried and true treatments. There’s no cure for cancer known only to the super-rich that costs ONE MILLION DOLLARS, because to develop that cure for cancer you need a lot of clinical work, which means trying out the treatments on lots of regular folks.

So the point is, per-capita expenditures on health care will rise, until further increases are economically impossible, then the rise will stop. Sure, today health care costs are rising faster than GDP. But current trends are guaranteed to not continue forever, because eventually that means we’ll spend more on health care than our GDP, which is mathematically impossible.

Today it seems impossible that we’ll rationalize the health care industry. But eventually the system will get so intolerable that the plutocrats will demand reform. Every corporation has to pay huge amounts for employee health care plans, when that amount increases and increases eventually the megacorporations are going to get tired of just writing higher and higher checks, and they’re going to demand a government takeover.

[bump]

@XT

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.

I agree… something like 89% of Americans have health insurance, and the system in large part, works for them.

What we will see is different treatment models- either telemedicine or more of a tiered system where you initially see a NP or PA, and then get kicked up to a MD if their exam warrants it.

[Wesley_Clark]

@Lemur866

Things that can’t go on forever, won’t.

It’s silly to imagine health care costs rising and rising and rising, until the rise so high nobody can afford them, so nobody gets health care anymore.

That’s not how it works. When prices rise, demand falls. Yes, demand for health care services are somewhat inelastic. If the alternative to an expensive treatment is death, you pay for the expensive treatment. Except if you can’t afford the treatment. Then you die.

Today all throughout the third world, people are dying of diseases that could be treated fairly cheaply. How can this be, if people will pay anything for effective treatment? It happens because they don’t have the money to pay for even the inexpensive treatments, let alone the expensive ones.

So as prices for fancy lifesaving treatments rise, people just won’t be able to pay for those treatments. It doesn’t matter if you could cure your pancreatic cancer with a 10 million dollar nanomolecular pancreas, if you don’t have 10 million dollars you’ll just die. Maybe a few super-rich people get the robot pancreas, but pancreatic cancer isn’t actually that common and super-rich people aren’t that common, and so the number of super-rich people who need a robot pancreas is tiny.

The truth is that the super-rich don’t usually need multi-million dollar medical treatments, even though they could afford them. They’re generally just as healthy as everyone else. And super-expensive experimental procedures generally aren’t as effective as tried and true treatments. There’s no cure for cancer known only to the super-rich that costs ONE MILLION DOLLARS, because to develop that cure for cancer you need a lot of clinical work, which means trying out the treatments on lots of regular folks.

So the point is, per-capita expenditures on health care will rise, until further increases are economically impossible, then the rise will stop. Sure, today health care costs are rising faster than GDP. But current trends are guaranteed to not continue forever, because eventually that means we’ll spend more on health care than our GDP, which is mathematically impossible.

Today it seems impossible that we’ll rationalize the health care industry. But eventually the system will get so intolerable that the plutocrats will demand reform. Every corporation has to pay huge amounts for employee health care plans, when that amount increases and increases eventually the megacorporations are going to get tired of just writing higher and higher checks, and they’re going to demand a government takeover.

I agree with you that “Things that can’t go on forever, won’t.” But that is what I’m asking. If the system isn’t sustainable, what happens? If medical costs go up 5% a year but wages go up 1-2% a year, what happens eventually? Something has to give, but what?

I’m wondering if we are looking at a multi-tiered medical system.

For people with large amounts of assets, they have access to all medical care.

For the middle class, they have access to a health system that covers 95% of medical care (and doesn’t include the most expensive 5%)

For the lower class and poor, they have a system with wait times and covers 90% of all medical care (maybe no branded drugs, they can’t see an MD unless a PA or NP oks it first, they have to go overseas for expensive surgery or long term care, long waitlists, etc).

I’m not sure what a metaphor is, but it’d be a tiered health system that maybe follows the UK’s NICE program and only covers health care that provides 1 year of quality adjusted life years for every $X spent. And among the tiers, that dollar figure declines (maybe $10,000 for the poor, maybe $40,000 for the middle class, and no dollar limitation for the wealthy who can afford anything).

Right now we have one health system for everyone, and it doesn’t seem to be working.

Also I don’t know if the issue is robotic pancreas, the issue is more that just routine care keeps getting more and more expensive. A hospital visit for a routine surgery is far more expensive now than it was 25 years ago.

[XT]

@Wesley_Clark

I agree with you that “Things that can’t go on forever, won’t.” But that is what I’m asking. If the system isn’t sustainable, what happens? If medical costs go up 5% a year but wages go up 1-2% a year, what happens eventually? Something has to give, but what?

I’m wondering if we are looking at a multi-tiered medical system.

For people with large amounts of assets, they have access to all medical care.

For the middle class, they have access to a health system that covers 95% of medical care (and doesn’t include the most expensive 5%)

For the lower class and poor, they have a system with wait times and covers 90% of all medical care (maybe no branded drugs, they can’t see an MD unless a PA or NP oks it first, they have to go overseas for expensive surgery or long term care, long waitlists, etc).

I’m not sure what a metaphor is, but it’d be a tiered health system that maybe follows the UK’s NICE program and only covers health care that provides 1 year of quality adjusted life years for every $X spent. And among the tiers, that dollar figure declines (maybe $10,000 for the poor, maybe $40,000 for the middle class, and no dollar limitation for the wealthy who can afford anything).

Right now we have one health system for everyone, and it doesn’t seem to be working.

Also I don’t know if the issue is robotic pancreas, the issue is more that just routine care keeps getting more and more expensive. A hospital visit for a routine surgery is far more expensive now than it was 25 years ago.

Not fighting the hypothetical, the system would basically collapse. You’d have people and companies essentially opting out of medical insurance, or you’d have something similar to what happened to Bell when it was broken up and when smaller companies were allowed to use their infrastructure to sell service that undercuts the big companies. As noted, automation might play a big role. For all we know, we are on the cusp of a paradigm shift in medicine and treatment, where we no longer really need all of the current medical infrastructure because treatments can be done at the DNA level, or biological or robotic nano-tech can be put in our bodies that does a large percentage of what doctors and prescription drugs are doing today. 20 or 30 years from now people might look back and wonder what all the fuss was about.

I’ll tell you that the best thing that could happen to the US wrt medical insurance and treatment/costs is if, indeed, only the ‘rich’ could afford it, at least wrt the current paradigm, because then we would get change. But change is coming, regardless, and as with the peak oil folks, it won’t be because only the rich will be able to buy medical treatment or oil.

[Wesley_Clark]

@XT

Not fighting the hypothetical, the system would basically collapse. You’d have people and companies essentially opting out of medical insurance, or you’d have something similar to what happened to Bell when it was broken up and when smaller companies were allowed to use their infrastructure to sell service that undercuts the big companies. As noted, automation might play a big role. For all we know, we are on the cusp of a paradigm shift in medicine and treatment, where we no longer really need all of the current medical infrastructure because treatments can be done at the DNA level, or biological or robotic nano-tech can be put in our bodies that does a large percentage of what doctors and prescription drugs are doing today. 20 or 30 years from now people might look back and wonder what all the fuss was about.

I’ll tell you that the best thing that could happen to the US wrt medical insurance and treatment/costs is if, indeed, only the ‘rich’ could afford it, at least wrt the current paradigm, because then we would get change. But change is coming, regardless, and as with the peak oil folks, it won’t be because only the rich will be able to buy medical treatment or oil.

My thread isn’t meant to be an attack on the rich, my point is that health care is something that the masses consume. What happens when it becomes unaffordable to the masses. It’d be like if cars kept incrementally getting more and more expensive, and we were headed to a point where only the rich and the upper middle class could afford them. Something would have to give, but what? Also because health care is a need, not a want, I would assume some public or private mechanisms will step in to fill the need. Also even if the middle class can’t afford health care, they still have a huge amount of money they are willing to spend to be healthy. So there are massive market forces as well as massive moral forces to solve the problem. The American middle class is willing to spend trillions a year on health care, so I assume some solution will come to take their money because that is a massive investment opportunity for any group that can provide affordable health care for them if the middle class have to start avoiding mainstream health care like hospitals or long term care facilities.

But again, the real solution (fixing our health care system on a political level to make it more cost efficient) is not politically feasible because politicians do not want to anger the owners of health care. So I assume some third solution will come.

I agree we could see a paradigm shift in medicine soon. Implantable sensors are going to help with managing chronic diseases (which make up a huge % of medical spending) so people can be managed before they slip into expensive health states. But who knows. Long term care, major surgery and management of serious disease seem to be some of the biggest expenses in medicine. I’m wondering if Americans just start going overseas for these things.

But again, routine stuff keeps getting more and more expensive. Is childbirth really much better now than 30 years ago, despite being many times more expensive?

[XT]

@Wesley_Clark

My thread isn’t meant to be an attack on the rich, my point is that health care is something that the masses consume. What happens when it becomes unaffordable to the masses. It’d be like if cars kept incrementally getting more and more expensive, and we were headed to a point where only the rich and the upper middle class could afford them. Something would have to give, but what? Also because health care is a need, not a want, I would assume some public or private mechanisms will step in to fill the need. Also even if the middle class can’t afford health care, they still have a huge amount of money they are willing to spend to be healthy. So there are massive market forces as well as massive moral forces to solve the problem. The American middle class is willing to spend trillions a year on health care, so I assume some solution will come to take their money because that is a massive investment opportunity for any group that can provide affordable health care for them if the middle class have to start avoiding mainstream health care like hospitals or long term care facilities.

But again, the real solution (fixing our health care system on a political level to make it more cost efficient) is not politically feasible because politicians do not want to anger the owners of health care. So I assume some third solution will come.

I agree we could see a paradigm shift in medicine soon. Implantable sensors are going to help with managing chronic diseases (which make up a huge % of medical spending) so people can be managed before they slip into expensive health states. But who knows. Long term care, major surgery and management of serious disease seem to be some of the biggest expenses in medicine. I’m wondering if Americans just start going overseas for these things.

But again, routine stuff keeps getting more and more expensive. Is childbirth really much better now than 30 years ago, despite being many times more expensive?

I seriously doubt a large percentage of Americans would go overseas for medical care. Basically, if that started to happen (i.e. more than a few rich folks doing so) I would think someone would try and build a new private health system here to take advantage of that market. That’s the thing…if we posit the sorts of increases you are talking about without some radical new care being given, then someone WILL find a way to tap that market. Hell, if we were talking about half of what you posit wrt health care spending per working American, that’s still over $10 trillion dollars. I don’t care what you think of US corporations being evil or whatever, that would be the single larges market to tap into today…that’s more than the GDP of freaking China! Someone is going to what a piece of that, and will undercut the competition to gain market share.

If we assume the care in your theoretical world is similar to the care today, you’d have to ask yourself WHY the costs would be going up so much. Is it because the treatments are REALLY that much more expensive? Perhaps the things used to cure cancer or halt or even reverse old age are exotic materials that are really that much more expensive. Perhaps the tools used have that much more of a capital cost. But in both of those cases, the ability to undercut the pricing will be there, if for nothing else than you could offer people treatments that aren’t that exotic.

[Jackmannii]

@Wesley_Clark

1. Neither political party wants to offend the rich and powerful, and single payer would offend them because it cuts medical costs.

This one ranks right up there with Bill Gates promoting vaccination as a means of drastically reducing world population.

If the Evil Rich prevent the vast cost savings from single payer health care from coming to fruition while no one but the 1% can afford health care (as the Lower Classes die premature deaths by the millions), who’s going to work for the wealthy as nannies, gardeners and limo drivers?

[Lemur866]

Here’s the thing. There are other countries in the world that spend a lot on health care, but not nearly as much as the United States does. And they don’t see dramatically worse outcomes, in fact the United States sees some pretty mediocre outcomes despite spending literally twice as much per capita compared to other developed countries.

Everyone knows this. This means that literally half of all the money spent on health care in the United States might as well be flushed down the fucking toilet. And it’s not like other countries don’t have waste, fraud, and abuse, they have tons. So it’s actually even more than half.

If the question is “How long are the American people going to endure the gouging we get from the Health Care industry?”, well, who knows. But the gouging can’t get very much worse without seeing a political re-alignment that suddenly makes universal health care inevitable. Right now we have one party, the Republicans, who are intent on making health care cost more and deliver less. This is a horrible strategy. You can shear a sheep every year, but you can only skin him once. When our current private insurance model becomes intolerable for most people, then they’ll embrace public insurance even knowing the potential problems. Remember “death panels”? Why are government death panels a nightmare, but private insurers refusing to cover treatment just the free market working it’s magic?

Again, the current obstacles to tearing down our current system only exist because our current system isn’t intolerable quite yet. All sorts of things become politically possible when the correlation of forces change.

[nearwildheaven]

There’s always Gofundme if all else fails, I guess.

[Wesley_Clark]

@Jackmannii

This one ranks right up there with Bill Gates promoting vaccination as a means of drastically reducing world population.

If the Evil Rich prevent the vast cost savings from single payer health care from coming to fruition while no one but the 1% can afford health care (as the Lower Classes die premature deaths by the millions), who’s going to work for the wealthy as nannies, gardeners and limo drivers?

If you think I’m wrong for saying that politicians have no interest in enraging the insurance industry, pharma, medical device industry, AMA & AHA, feel free.

But it is a 3+ trillion dollar a year industry. True genuine reform will cut medical spending drastically, which means that business for these groups will drop quite a bit. They aren’t going to take that lying down.

[Leonard]

@wolfpup

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.

When has there been a free market in health care? Most transactions have the healthcare insurance market separating the customers from the providers which screws up the cost/benefit analysis. The medical industry does everything it can (usually with the help of the government) to stop the flow of market information and maintain a mountainous cost of entry to the industry.

[survinga]

@Wesley_Clark

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.

Health care is affordable for the vast majority of America right now. Three out of four Americans are pleased with their own healthcare. Of course, more than 1/4 of the nation complains about costs. Also, 90% of America has some form of private or public health insurance. The real problem is that about 10% of the country is not insured. That’s what we have to fix first. It would technically be easy to do via the rest of the states accepting the Medicaid expansion provided in the ACA. And then, the premium subsidies provided in the ACA need to be stronger for people between about 150% of the poverty line and 400% of the poverty line. This could get almost everyone insured.

Then, the IPAC which was provided for in the ACA needs to be fully implemented, to help control costs. And then, I would consider giving medicare more power to set guidelines for drug prices for Part D. How much power, I’m not sure, but something would be helpful. Then, I would try and beef up allowances for people to carry HSA’s with a catastrophic plan. I think all of these things would make a difference to lower costs.

Finally, I think what America needs more than anything else is a dietary shift away from red meat toward vegetables & fruit. I have been overseas to other countries, and their populations are well-nourished without being nearly as obese. I think this is mostly diet-driven.

[survinga]

@Leonard

When has there been a free market in health care?

Health care is highly regulated. People who think we have a free market in health care have no idea what they’re talking about. There are some states with “markets” in a sense…but with massive regulation, and in many cases monopolies.

[Kobal2]

@nearwildheaven

There’s always Gofundme if all else fails, I guess.

Also guillotines and lamp posts. C’mon people, this is why we’ve been working on The List for so long.

[jasg]

@XT

@jasg

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?

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?

You do understand that Healthcare <> Health insurance, right?

If you have health insurance, why don’t you drop it - including Medicare if you are that lucky. Then in a few years, check back to tell us how rich you are. Ok?

[Voyager]

@survinga

Health care is highly regulated. People who think we have a free market in health care have no idea what they’re talking about. There are some states with “markets” in a sense…but with massive regulation, and in many cases monopolies.

The food industry is also highly regulated. Are you saying it is not a free market?
There is plenty of competition for doctors and hospitals, much less in insurance. Is it a classical market in the sense that information is available to make decisions? No, but that is not due to the government.
I think the real problem is that the health industry is more of a free market than makes sense.

[chappachula]

@survinga

Health care is affordable for the vast majority of America right now. Three out of four Americans are pleased with their own healthcare.

If the OP’s scenario of unaffordability comes true,–what will happen is: most Americans will become DISpleased with their own healthcare.
Then, maybe, they will start a mass revolt and demand that Congress change the system.

But as of now, most Americans just don’t care enough. They are willing to live with the system as it is.
They know that they are living in danger of catastrophic financial costs and personal bankruptcy, but are willing to accept the risk.

If the situation changes so that the risk becomes unacceptably dangerous (and I agree with the OP that it will happen), then people will wake up and vote in new congresscritters.
But first, you need to assemble a critical mass (tens of millions of people suffering ), and then you need a mass-advertising drive to raise awareness(something like the milk-carton children in the 1990’s) and then you need a tipping point to actually start the changes happening (something like a Harvey Weinstein “MeToo” moment) .

My guess is that it might happen in 30 - 40 years .

[survinga]

@Voyager

The food industry is also highly regulated. Are you saying it is not a free market?
There is plenty of competition for doctors and hospitals, much less in insurance. Is it a classical market in the sense that information is available to make decisions? No, but that is not due to the government.
I think the real problem is that the health industry is more of a free market than makes sense.

No, I’m saying that the Health Insurance industry is not a free market. People don’t generally go out and choose among a slew of options. There are many states where one Blues plan might be a monopoly. And of course, most people get their insurance through their company and don’t actually have choice. Calling what we have a “free market” is a joke.

I’m not discussing this from the standpoint of someone who is advocating a totally free market, btw. But just acknowledging what we actually have, or in this case what we don’t have.

[Wesley_Clark]

@chappachula

If the OP’s scenario of unaffordability comes true,–what will happen is: most Americans will become DISpleased with their own healthcare.
Then, maybe, they will start a mass revolt and demand that Congress change the system.

But as of now, most Americans just don’t care enough. They are willing to live with the system as it is.
They know that they are living in danger of catastrophic financial costs and personal bankruptcy, but are willing to accept the risk.

If the situation changes so that the risk becomes unacceptably dangerous (and I agree with the OP that it will happen), then people will wake up and vote in new congresscritters.
But first, you need to assemble a critical mass (tens of millions of people suffering ), and then you need a mass-advertising drive to raise awareness(something like the milk-carton children in the 1990’s) and then you need a tipping point to actually start the changes happening (something like a Harvey Weinstein “MeToo” moment) .

My guess is that it might happen in 30 - 40 years .

Pretty much. If you use the rule of 72, if health insurance costs go up 10% a year they double every 7 years. That isn’t sustainable forever.

[Steve_MB]

@burrunderthe_saddle

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

TrumpCare Has Just Replaced ObamaCare - Lunch Alert! - DickMorris.com at DickMorris.com

https://trumpcare.com/

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

You are not addressing the actual issue. The problem is not providing everyone with medical insurance; the problem is providing everyone with health care. TrumpCare (legalizing the sale of policies that pay for medical treatment if and only if you are injured by a left-handed gibbon on a February 29th that falls on a Wednesday) solves the former problem but not the latter.