Assuming that this is an established fact (I think it is), why is this the case?
Thanks,
Rob
Because it’s a not-for-profit industry. Physicians have standard costs set by the government.
Multi-faceted, complex answer to which I don’t think anyone has the 100% correct answer. (Because if there was a simple answer, it wouldn’t be an issue.)
One major factor, which most Americans refuse to recognize, is that Americans are horrible consumers of health care. In other words, it’s a cultural economics problem with the patients themselves. But that’s only part…
I think this is true. My mother for example goes to the doctor for every ache and pain and sincerely expects him to do something about it. She complains to me and it’s all I can do to keep my mouth shut and not say “What do you expect? You’re fucking OLD! Did you really think you’d be dancing the the God-damn Charleston at 85?!”"
Exactly, except my mother is 97. I keep telling her off-warranty, but she doesn’t want to listen.
One factor is that the U.S. health insurance industry employs half a million people. With UHC, these people could be given useful employment instead (or laid off). That doesn’t even count HMO, hospital, and doctor’s employees who spend their time doing insurance-related paperwork.
The answers aren’t all that complex, the reason its an issue is because there is a portion of the population that takes issue with everything from evolution to global warming why should a partisan issue like UHC be any less susceptible to partisan opposition.
Our medicare system cares for the large majority of the elderly in our society. A population whose previous insurance company knew they only had to keep healthy until about 65. So the insurance companies don’t promote healthy lifestyles the way they do in other countries. A lot of the crap you do when you are young doesn’t catch up to you until you are retired and medicare is paying the bills. That plus medicare itself os overly generous. Medicare should have higher decutibles on a mean tested sliding scale.
Insurance companies have a lot of overhead (sales, underwriting, claims adjsutment, executive compensation, shareholder dividends, asset management, etc.) that a UHC system does not (this accounts for at least 15% of the difference).
I have about a dozen doctors in the family and several pharmacists. The private practive doctors frequently pay a billing company 10% of their revenue to handle all the insurance processing. You don’t have this overhead with UHC. Its probably as big a pocketbook issue as malpractice tort reform but for some reason, doctors don’t seem as up in arms about it.
Finally, another reason our health care system costs more than UHC systems is because our largest health insurer (medicare) cannot negotiate drug prices).
Most nations have UHC and they have a large variety of costs for example South Korea has per person costs of 1,879 while the Netherlands has 4,914 per person.
The US is the outlier both in that we don’t have UHC and we spend much more than average. Part of this is just the richer the country the more it spends on healthcare and as the richest country the US spends most. Also in the US doctors and nurses make more money than average, people go to the doctor more, and more technology is used. Part of it is so much defensive medicine, but most of it is our culture is to want the best medical care possible at all times no matter what the cost.
Here is a great series about why healthcare in America is so expensive .
So, the fact that the U.S. has private insurance accounts for 25% of the difference, adding together the 15% overhead for the insurance companies plus the 10% that doctors presumably pass along to their patients?
All of the above, plus the fact that uninsured people do not EVER get preventative care. Because they can’t afford to treat an issue unless they’re at death’s door. So something that would have cost $100 to fix 2 weeks ago now requires emergency treatment costing many thousands of dollars. They can’t afford that bill, they declare bankruptcy, and the hospital passes those costs on to other patients.
This is a HUGE problem. Adequate preventive care for everyone would save this country big bucks.
What are the numbers like here?
There is no one study that has a definitive set of numbers that everyone will agree on. It is (as thatguyjeff says) multifaceted and complex.
And it is also true (as Damuri Ajashi says) that the issue, like most things in the US, has become politicised along party lines, and therefore even basic facts will be argued.
Pretty much all the points have been covered:
-Higher administrative costs with the multitude of private insurance compared with UHC
-Costs that UHC does not have, such as advertising, perks to attract customers
-Duplication of services between insurers - every clinic must have the latest MRI
-Lack of preventative care among the un-insured which then costs more down the road
-More testing in the US due to increased amount of litigation
-Cost of billing that doctors must pass along to patients
-drug costs are kept low in UHC countries due to large volume price negotiation
Doctors and other medical professionals make less in those countries (and related to that, medical school is covered in a different fashion as well - often times it is free).
Costs are heavily controlled by the government (e.g. The US pays for the development of drugs through high prices).
Legal costs are much higher - the great malpractice insurance racket
The US numbers also include our higher rate of “elective” work as well - from cosmetic surgery to hip replacements for 90 year-olds.
The Veterans Administration and other military hospitals is an example of how we can run medicine when the docs make less, the patients can’t sue, and everyone is covered.
If the entire country is part of one big group the risk, is spread so thin, it creates the lowest possible insurance rates. Just as large companies pay less than small ones.
Healthcare and hospitals are run like firehouses and police stations, at cost, not for profit.
Conditions are much cheaper to treat, at onset, than when allowed to worsen for years to avoid copays. Big savings.
For those unable to purchase insurance through their employer, the premiums are subsidized. Much cheaper than paying for the actual medical costs of those not insured.
Everyone is covered for everything. At lower costs. What’s not to love?
Cite?
I remember reading an article about the American healthcare system that said that actually preventative care increases costs - loads of tiny ailments are found and treated, relatively few illnesses reach a catastrophic level, and the uninsured are given the cheapest treatment.
The USA “system” adds two additional cost centers that are pretty much pure waste:
-
The insurance company takes money from clients to pay doctors and hospitals.
a. They try to keep as much of their client’s money as possible, use it as capital, and pay doctors and hospitals out of the interest.
b. They also refuse to pay even 50% of the doctors’ and hospitals’ asking price. They try to control as many accounts as possible to force the hand of the doctors, so they can pay as low a proportion as possible. -
Because of this, providers have to do things:
a. They hire additional staff to haggle with insurance companies, to try to get some of the asking price.
b. They raise their asking price even higher to try to have a better haggling position with insurers.
So (using made-up hypothetical numbers) if a doctor in the USA makes, say, 2x what a doctor in Britain makes, he may be charging 3x to 10x what he actually makes, thus 6x to 20x the cost in Britain, and the patient without insurance gets an outrageously high bill. The insured patient pays less than that full markup but still considerably more than what the doctor makes, because that patient is paying for middle-class salaries for the doctor, billing staff, and insurers–even if the patient is not middle class.
(And that’s just the first of** Euphonious Polemic**'s seven points in post #13.)
Also, professionals–physicians, nurses, attorneys, bankers, and the administrators of their companies–expect to have middle-class incomes that keep pace with inflation, even as most Americans do not.
The poor aren’t paid enough to pay for health care to begin with, let alone at a 900% mark-up. But that’s an opportunity to (if mostly indirectly) increase the general level of indebtedness in the economy, and thus looks like more money for moneylenders. It’s all scam.
Middle Class? Try Upper Class for many on your list (physicians, attorneys, bankers).
For others, an RNs average salary is $66k nationally per Salary.com.
I don’t follow the logic here. How does the second part of your post support your first part?