What's the Math on Universal Healthcare?

I’m going to do my best to keep this in GQ territory, I hope you’ll all do the same.

There’s been a lot of talk about Healthcare in the campaigns and debates and neither candidate is really talking about true universal healthcare. Any time it’s mentioned anywhere everyone screams about the cost, and there’s no doubt that it would be expensive, but what is the actual math on the real price to the average worker?

Here’s what I mean:

  1. I’m sure there’d be a new line item on everyone’s paystub with a “Healthcare Tax”, what are the projections on what that number would be?

  2. What is the current average charge to employees right now?

  3. How much does the average employer pay on the employees behalf?

  4. Would Universal HealthCare essentially solve the issue of Medicare and Medicaid’s entitlement shortfalls? If so, what is the projection of the cost of this without universal healthcare?

  5. Where does perscription cost fall in the most common UHC proposals?

I know that all of this has a lot of nuance that I’m not considering, feel free to add any details from a monetary standpoint that I’m overlooking. For example, what would the difference in coverage be? Currently pre-existing conditions are not covered nor are most prescriptions. What’s the cost of those issues to the average customer that falls outside of current coverages that would be covered by UHC?

Do Not offer your opinion on whether the US Government can effectively manage a UHC service. I’m not interested in turning this into a free market vs. socialization debate nor am I interested in supposition about the fate of R&D in a UHC system.

A lot, and quite a lot:

FWIW, my employer picks up the entire tab for my health insurance, but I’d pay approximately $173/mo. per kid/spouse if I had kids/spouse.

Really Not All That Bright, do your figures include co-pays and deductible? If you truly pay nothing for health insurance that is quite the deal…

My part ($250) + my employers part ($950) at my last job = US$1200/ month for my family of four with decent, not great, insurance.

<pro-single payer rant deleted>

Thanks for the data so far. Just bumping it for the weekend crowd so see if we can get the rest of the numbers filled in.

$50/$20/$10 copay, no deductible at all. Want great health insurance? Go work for a law firm.

Per capita, universal coverage in Canada costs about 2/3 of what Americans pay. Taking into account that nearly 1/6 of Americans aren’t covered that means that Canadian coverage costs 5/9 of what US coverage does. In part, this is because doctor’s pay is lower. For the rest, it is because there is no bureaucracy whose job it is to decide who can be covered, whose job it is to deny coverage, etc. I have read that administrative costs for health insurance companies approaches 30%. Here it is less than 5%.

My daughter-in-law is a family physician in NYC. It is only an exaggeration, but not much to say she spends as much time fighting with insurance companies as treating patients. She is one of the 5000 signers of an ad in the current issue of the New Yorker by Physicians for Universal Health Insurance. Her sister is quite seriously ill with metastatic cancer that was discovered only last June. Treatment has been quite expensive but she is supposedly covered by insurance. The claim was denied with the claim that it was a pre-existing condition. This is nonesense since it was discovered only four months ago. But as my son explained to me, they will eventually pay it, but by giving a senseless reason they can hang on to their money longer. There is no penalty to them.

By contrast, three and a half years ago, I slipped on ice and fractured an ankle (actually one of the leg bones). I presented my medicare card when I went in to the hospital, signed a couple of permission forms (to operate, to give anasthetic) and six days later walked (well limped) out of the hospital never having seen another piece of paperwork. It is easy to see that the administrative cost was negligible.

A few doctors opt out of the system. If they do they are on their own. They cannot practice partly in and partly out of the system. So they had better have something special to offer. There are a few that make house calls. I had one once–it costs $125, which in the event was worth it. Another one is my opthalmologist–I have a special problem and his charges are actually modest. I think he left the system to lose patients as he prepares to retire. They are the only two I ever met. Our system is not perfect–there is a serious shortage of family physicians. But that is because the med schools have been restricted over the years to produce fewer doctors. A little more money would go far. Canadians are not as tax-averse as Americans, but the disease has caught on here too.

As an employer, I cover one family with a regular every day plan and then me, a single person with an HSA (I pay a small monthly premium and dump some tax-free money into an account. All of my medical bills are at a discounted price that I pay fully from that account.)

So for two of us, one family, we pay about $15k a year (a little over $1000/mo plus whatever we can manage to put into my HSA). I do know that my partner, on the family plan, pays co-pays and does have out-of pocket. We have crappy dental but no vision.

I’d be more than willing to pay $15k/year in taxes to cover me, my partner and his family if I knew neither of us would ever have to pay a dime out-of-pocket and we’d never be personally bankrupt by medical expenses.

The $15k/year we pay now is pretty much a gamble as to how much we’d really end up paying if anyone covered under our plans ever got seriously sick. I wouldn’t begrudge the cost at all if I knew it meant something more.

I don’t think any of us would mind that, but you’re forgetting about subsidizing people that don’t want to pay. If I could trade what my employer pays for my insurance for a single-payer plan that had the benefits, flexibility, on-demand service, accountability, and options that my plan has, I’d have no reason to turn it down. But for the same money to cover my family plus others, something’s gotta give. Either more money, or less of the good stuff.

But remember, Balthisar, you are already paying for uninsured people. You pay extra to cover their delinquency when they receive care in the Emergency Room. Emergency room care is a very expensive way to provide care that is often not emergent, but is often the (uninsured) patient’s only option.

People who don’t want to pay, eh? You really think will is why people are uninsured?

You end up paying for them anyway, but you end up paying more because they show up in emergency rooms when problems become critical, instead of practicing cheaper preventative medicine.

Also remember you would reap the savings by not feeding the insurance beast. The number given below was the 30% of health care costs go to insurance company administration fees. And this doesn’t even figure in how much health care costs have been inflated by the insurance system. I always marvel about how a CBC (complete blood count) costs me $6.00 overseas, and $150.00 in America. It’s the same machine doing the test. It only takes about ten minutes to run the blood through it. So where does the additional $144.00 go?

Finally, your figuring doesn’t count that you may one day find out your insurance isn’t as great as you thought it would be. It only takes one rejected claim to fuck things up pretty bad. With universal healthcare you wouldn’t have that risk.

That’s true, but only for the people that do abuse the emergency rooms. I have hope that there are a lot more honest, uninsured people that pay out of pocket (or try to), or don’t use the service unless it’s an emergency, then there are people that abuse the system. So I guess my choice now is to be happy subsidizing abusive creeps, or subsidizing honest people. Financially, one makes more sense than the other, and I like to be pragmatic, but pragmatism makes one look heartless.

Also, everyone currently pays in various indirect ways for the people who have to declare bankruptcy due to needing care while uninsured.

I meant “I” as an employer, paying $15k/year in taxes rather than purchasing a health plan for my employees (however few I may have).

The government compels me and all other business owners to pay into medicare and social security for my employees…so I don’t see why there would be any case of “don’t want to pay” other than “don’t want to be in business.”

This thread over at the somethingawful forums has a good collection of stats. It seems that on the whole, Americans pay more for less of the good stuff. Even the well off Americans that presumably have health insurance are at best no better off and usually worse off than those in countries with UHC. This all above and beyond the moral reprehensibility of allowing fellow human beings in a rich country to die in the ditch like dogs because you don’t want to subsidize his health care.

There may very well be a private solution that is superior to UHC, indeed lots of countries like Germany and Singapore have largely private medical industries, but rest assured no one is seriously looking to the United States for it.