If you die before they find out it costs nothing.
A relevant personal experience: I work in health care in Norway. Our administrative procedure, billing, insurance work, and other sundry tasks when we get a patient in is this:
We ask the patients name.
That is pretty much it. We get reimbursed twice a year. Its a straigth “send a list” procedure.
A fact that might be relevant as well:
Governement health care in the US - medicare, medicaid, VHA etc- in itself costs more per person than UHC does in most UHC countries. In dollars per per person or as a percentage of GDP, Americans pay more taxes towards government healthcare than the citizens of nations where the entire population *gets *government health care.
[ul]
[li]Unhealthy transit - Europeans walk and bicycle more than twice as much as Americans. pdf cite[/li][li]Poverty - Poverty correlates with worse health: free overview article … the US has a much higher poverty rate than most other OECD nations: OECD cite[/li][li]Immigration - 6.3% of European residents were born outside the EU; as opposed to 13.5% of the US (with fewer than 15% of migrants to the US being from Europe today). Cites are Wikipedia: EU; USA[/li][/ul]
These are all factors to be considered if you’re going to try to compare the US and European healthcare systems (or rather, the largest effective private insured system, and the majority of effective UHC systems). There are a lot of nuances about the US being hybrid (private + Medicare + Medicaid + VA + etc…) and the EU (or rest of the OECD) being varying degrees of UHC, but I just wanted to remind everyone that we’re already starting from behind: these three things are negative health factors that are baked into our demographics and are going to gum up any casual comparisons.
Full disclosure; I’m an American and support single-payer universal health care. But I think the answer to the OP may be “because it happens to have been implemented first in the places where people are already healthier for other reasons.”
All I know, is that you can lead the stupid to free health care, but you can’t make them take advantage.
My company actually gives free mini-physicals complete with bloodwork, as well as free flu shots every year, but a surprisingly small number of people avail themselves of these things. (I’m in IT, so I can actually see the counts).
This is classic preventative medicine, that’s free, on the company clock, and yet, some of them can’t be bothered to do it, even when there are financial incentives for doing so. Most of these people at my location are professionals, with college degrees too.
I think it should be available at no cost, but I’m pessimistic about the actual participation rates of any preventative care programs.
Another thing to consider is the perception that Physicians in this country are the best & brightest, and that UHC and the expected lower salaries would remove it as a career for the best & brightest.
That’s a little below the mean individual adult income in the USA, which is, I believe, between $70K and $80K. Of course, it’s almost exactly 250% of the median $27K.
When I say “middle class” I don’t mean median. Most people are below the middle class. Upper class is not doctors, it’s large landholders and billionaires. If you think physicians are the rich, you’re missing most of the nation’s wealth, which is not held by households making under $200K /yr.
And this attitude drives sector-specific inflation.
Pretty much everyone is; that’s part of the reason why a free market based medical system works so poorly. Most people are not medical experts and therefore aren’t qualified to make an assessment of what is medically best for them (just look at the anti-vaxers). At least not until an actual expert lays down their personal options in a simplified, layman-graspable form, which free market medical providers won’t do since honesty and clarity will cut into their profits.
Are talking income or wealth? I was focusing on the income for the middle class.
http://quickfacts.census.gov/qfd/states/00000.html
Median Household income: $51,914, so our RN alone is above that.
Malpractice costs are a tiny fraction of overall health care costs.
Your cycling cite says automobile dependence and obesity rates are similar in the US and Australia.
25% of the Australian population was born overseas.
We spend $3341 per capita on health, 8% of our GDP.
The US spends $8362 per capita on health, 17.9% of GDP.
In 2008, Australia ranked 2nd in the world for life expectancy. In 2007, the US ranked 37th.
http://www.m.webmd.com/a-to-z-guides/news/20110614/us-life-expectancy-lags-behind?page=2
A lot of the excuses for the poor American system vs Europe fall away when you compare to Australia. It’s much more of an apples/apples comparison. We’re a similar physical size, have a similarly varied climate, we’re heavily influenced by US culture and import a lot of your bad eating habits. There are big differences too - two quick ones: our population is a fraction of the size, and we don’t have such a high homicide rate.
(Sorry for the messy links; I’m posting from my phone and have children climbing on me.)
It looks like about 2/5 of these immigrants are from other countries with UHC, which was sort of my point - the proportion of the US which are immigrants from poor countries is about 10% against the EU’s 6%. Either way 3/5 x 25% is 15%, so it does look like Australia has us beat here. And you are correct about the automobile dependence.
Here’s as good a place as any to point out that the OECD “poverty” figure (people making <40% of median income) is, on the other hand, higher for the US than Australia; 11.3% versus 7.4%. I wouldn’t be surprised if the putative immigration – health outcomes thing is just a proxy for a real relationship between poverty and outcomes.
You’re welcome for the bad eating habits. Thanks for reminding me about Australia! I would still argue we have it worse but you’re right that it’s a much more valid comparison than between the US and anywhere in Europe.
And that is a load of BS. Here in Germany (with UHC,) people go to the doctor for EVERYTHING.
Got a cold? Go to the doctor so he’ll prescribe you something so you don’t pay for it out of pocket. Maybe he’ll prescribe you some antibiotics while he’s at it. You won’t actually need the antibiotic (they don’t work on viral infections,) but he’s don something for you.
Bored with nobody to talk to? Make a doctor’s appointment. It is no joke here that old folks with no close friends or family will visit the doctor just to have someone to talk to.
The situation is so bad that they made it a requirement for you to pay 10Euros for the first doctor’s visit in each quarter just to discourage frivolous visits. And that worked out real well, too. It just made more work for the doctors without really reducing the frivolous visits.
If Americans are bad “consumers” of health care then I’d expect pretty much everybody is.
Not heplful. Check out #6 on this list - lies, damn lies and statistics, etc:
And the NHS cost comes in at almost 10% less GDP that the US model.
Fwiw, I’d put this question slightly differently; why is the US model so expensive when it is so selective?
at least you hear so much about people who thought they had cover but then found out the small print excluded them …
this guy might have a few ideas: Highest paid exec is in healthcare, earns $145M
http://www.fiercehealthfinance.com/story/highest-paid-exec-healthcare-earns-145m/2011-12-16
Germany has UHC. I’ll respnd to your points below.
Germany also has multiple insurance companies. They all have different prices and offer services and coverage above the legal minimum in an effort to get more customers.
Given the competition I mentioned above, there is a lot of advertising. I also get glossy flyers from my insurance company several times a year - expensive crap that amounts to advertising in the guise of health advice.
Right, and instead you end up with the situation here where you have to wait months for an MRI. Does you a shitload of good to confirm that you had a slipped disk six months after you’ve already been treated for it.
Not all preventative measures are covered, and some require you to pay up front.
And less testing here due to overworked and underpaid doctors not giving a fuck.
And cost of handling the insurance paperwork that the doctors here have to eat.
Ehhm. BS. No one here is really conscious of what medicines cost. If you ask the pharmacist what the full price is, then he’ll tell you. If you then compare to other countries you will find that the prices here are higher.
I had three slipped disks several years ago. At the time, all the doctors were interested in was telling me I had a stiff neck or pulled muscles. No one considered the possibility of a slipped disk, and just how the F. would I know that it could be a slipped disk. It just hurt like hell. Just recently, I had to have an MRI of the upper part of my spine for other reasons. The first comment from doctor who looked the scans over was “Oh, that must have hurt like a son of a bitch.” then he explained: There were three slipped disks in my back and neck. Those were the cause of the pain I had had serveral years back that kept me in bed and on pain killers for a week. Thank you, efficient UHC.
While preventive care may be cost-effective in terms of the benefit gained, it rarely saves money. See this report.
And this article.
Not sure what your point is with that cite. The NHS employs medical providers directly, so of course they are a huge employer. That is not comparable in any way to the US or to most other countries with UHC.
But that doesn’t really explain anything.
Canadians have universal health insurance but there’s nothing preventing them from being equally stupid health consumers. There’s anti-vax idiots here, too. I know people, lots of people, who won’t take their doctors’ advice, who do stupid shit, who go to the hospital too quickly or too late, who believe imbeclic pseudoscientific woo, who go from doctor to doctor looking for the one who will believe their idiocy. The existence of universal health insurance doesn’t make you smarter.
I think you missed the point - it’s the insurance industry in the US which employs 500,000 people. If we went to UHC most of these positions could be straight-up eliminated. That’s a cost savings for the US healthcare system. Surely you didn’t think the entire country had only 0.5 million healthcare employees.
I did some napkin calculations in a past thread which showed (despite making some generous assumptions) the US spends five times as much on administration per capita as the UK NHS and UK supplemental private carriers combined.
Because you don’t have private insurance CEOs like Mark T. Bertolini of Aetna making 10 million plus a year. That buys a lot of bypasses and MRIs.