Direct costs are tiny, but indirect costs can be huge. How many MRI’s are performed for a simple headache because the physician is afraid of having to sit in the witness box and explain it was really unlikely that it was a tumor and it was a one in a million chance that it turned out to be one? Juries end up punishing bad outcomes rather than bad medicine.
Frankly I would be happy to throw in malpractice tort reform in a comprehensive health reform package if thats what it takes. But generally I agree, anyone that thinks that tort reform (in the form that is most frequently proposed) is a significant factor in any of this, is either lying or stupid.
The US is a lot more generous with certain types of care too. My friends from the UK keep whining about how there’s a 6 month waiting list for psychotherapy and then they get sent to the curb after a year. When I decided I wanted therapy in the US I had an appointment the next week and have been seeing therapists for several years.
Also, note that all the health insurance jobs wouldn’t all disappear. Granted you wouldn’t need a dozen different CEOs, etc, but someone has to answer the phones and process claims. Since the actual Medicare processing of claims is done largely by private companies you’d just have more people working there under a “single government plan”.
I have the references at work, but I’ve seen studies showing tort to be 2 % of the US extra costs, and resulting defensive medicine a further 9 %. The data was from 1996, but I think the proprtions remain the same.
There are a number of systems that operate entirely without “claims”.
Lawyers and insurance companies aren’t involved.
Tests and procedures aren’t engaged in simply in order to heighten profits.
eg when I was a teenager living in the US my father was stopping off at the local optometrist and suggested that I get my eyes checked even though my eyesight was fine. Three hours of tests later I was told that if I didn’t get hard contact lenses ASAP I would need a cornea transplant within five years.
When I got back to Australia the next year I got a second opinion from another optometrist, which can be summed as “you have a slightly misshapen cornea, but basically those US doctors were just trying to drum up some business”.
That was 25 years ago. I’ve never visited an eye doctor since, and my eyesight is just fine. The American optometrists were just trying to fleece as much money out of my parents as they could get away with.
Sure there is; they don’t need to be. They can still be stupid if they try, but they aren’t forced by the health care system to makes choices they aren’t qualified to make. They aren’t stuck in a “free market” where they essentially have to blindly guess who if anyone is telling them the truth, and who is lying to them for profit.
So what this says is that one out of ten health care dollars is spent on unnecessary treatments and diagnostic procedures, procedures that are not only not required but in some cases may be harmful. From my point of view that’s not a small number.
I don’t doubt this happened because the US is a big place, but I wouldn’t say it’s endemic. The profit motive isn’t unique for American doctors either - surely other nations’ doctors can be paid hourly, or have to make quota, or like the prestige of having many cases, no?
Also if you haven’t been to the eye doctor in 25 years you should probably go for a checkup. Some eye problems don’t necessarily make themselves known with a defect in eyesight.
The Japanese visit the doctor far more than Americans and still pay a lot less.
Health care costs here weren’t too bad compared to other countries, but they exploded starting in the 80s. I don’t know why.
It is quite possible that I’m missremembering, but I think it was 2 and 9 % of the extra costs. That is, above what health care costs elsewhere. So since the US costs are roughly double the average, it’d be one dollar in twenty.
Its not large compared to things like administrative waste. However, it may be the one most amendable to legislating away.
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.
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I think you misread my post. I wrote about insurance employees. NHS employees are mainly doctors,nurses, medical technicians, no?
I’m surprised no other UK member has picked you up on this. I don’t think you are comparing like with like here.
Can the person in the USA simply walk into a psychotherapists office and be seen for free?
Does the USA citizen need an insurance policy in order to be treated? then please tell us how much that costs per month and whether there is any co-pay.
And how much would it cost to just walk in off the street? In the UK anyone can access the services with zero waiting for about £60-80 per hour session and this can often be covered in an additional health insurance policy through company schemes that cost around£80-£100 per month.
How does that compare the USA?
If a UK resident has no private policy and no money they may need to wait to be treated for free, how long would that wait be for a similarly disposed USA citizen?
From what I know of the USA health care scheme, “generous” is not a description I’d ever use. I may be wrong though and perhaps psychotherapy is indeed free at the point of delivery and available to all, enlighten me.
This times a thousand. Our litigious society is a huge issue.
Yes, the NHS tends to be stingy about certain sorts of things. Not all UHC systems are though. On the other hand, I doubt whether most insured Americans would get the level of psycho-therapeutic care that you apparently have. Yo umust have a first class plan.
It is not just the CEO’s you would get rid of. Yes, there would still be some bureaucratic work to be done, but a large proportion of what is done now in the US simply would not be needed: no checking of whether or not someone is insured, no figuring out exactly what their plan is and precisely what they are covered for (because it is the same rules for everyone), virtually no more need to resolve disputes or errors over what happened in the previous two stages.
In my experience, disputes about details of coverage, usually caused by insurance company or doctors’ office errors, occur quite frequently in the US system, and it can be a lot of hassle not only for patients, but also for doctors’ office staff and insurance company staff, to resolve them. This sort of thing almost never happens in the UK; for my US family of four, such a dispute was pretty much an annual occurrence. The sums involved were mostly fairly trivial too - $50 or $100 or so. It probably cost the company (and the doctor’s office) more to resolve them than the amounts involved (which, more often than not, they eventually recognized they were responsible for).
I’ve got a related question for those who are in countries with UHC. Is there a triage system set up so that the people with the most serious problems are seen first, or is everyone sent to the same queue to wait their turn?
For the NHS UK, of course. That is sort of the whole point. everyone is assessed on medical need and the most needy seen first regardless of money.
The last few posts are dancing around one of the major reasons health care costs are lower in countries with UHC, but no one wants to come right out and say it. So I will:
Health care costs are lower in some of these countries because health care is rationed. It’s very easy to control health care costs if you simply cap fees to doctors, set up health boards to determine who will or will not get treatments, declare some expensive treatments to be off limits, etc. Many of these countries have a doctor shortage because they don’t pay enough, and the doctor shortage then becomes a very politically expedient way of rationing care. If there just aren’t enough doctors to treat everyone, then a politician didn’t have to deny treatment.
You won’t see this reflected that much in statistics regarding cancer survivability, or even in lifespan statistics, because life-saving treatments aren’t the ones that are rationed in most cases. It’s the ‘quality of life’ treatments that get the axe. For example, there are huge, multi-year waiting lists in Canada for things like knee and hip replacements. I was just in a meeting the other day where the discussion came around to sex-change surgery: Our government allows for TWENTY FIVE such operations per year. Some people have been on a waiting list for it for over a decade. And it’s not available here at any price other than going through the queue, because private surgeries of that sort are illegal. So if you’re a transgendered person who needs sex reassignment surgery, and you want it done while you are still young, you have exactly one option: Leave the country and get the surgery done elsewhere.
In that same meeting, there was a person who was roughly 55 years old and who walked with a cane because he blew his knee out in an accident. He’s been on a waiting list for knee surgery for over a year already, and still does not have the surgery scheduled.
In Canada, our emergency rooms are so over-crowded that people have been known to die after sitting for hours waiting to be seen. In my city a couple of years ago, there was a scandal because a boy with a broken arm waited all night in an emergency ward, then was sent away without treatment because they couldn’t find a slot for him. He went to another hospital and waited another long period of time. By the time he was seen, his arm had knit together and had to be re-broken to be set properly.
Waiting lists are starting to affect life-saving treatment as well. Heart surgeries are getting harder to schedule. Radiation therapy is taking longer to get set up. MRI and CT scans are backlogged.
Wait Times for Patients Worsening
At the bottom of the article you will see a wait time ‘scorecard’, with the government benchmark for ‘acceptable’ wait times on the left, and a letter grade for each province on the right. You’ll notice that it’s considered ‘acceptable’ to wait 26 weeks for a coronary bypass, as well as 26 weeks for joint replacements. But you’ll also notice the provinces all met the 26 week deadline for bypasses, but all of them except Ontario failed to provide knee replacements in that time, and many of the provinces scored from a ‘C’ to an ‘F’ in that category, meaning wait times were MUCH longer.
Bear in mind that the clock on the wait times doesn’t start ticking until you’ve actually seen a specialist, been diagnosed, and put on the wait list. That process in itself can take months. Members of my own family has had to wait more than six months just to get an appointment with a specialist after being referred by our family doctor. And we’re lucky - there’s also a shortage of family doctors these days, and I know people who can’t find one.
Will Americans accept a half-year wait for heart surgery? Will they accept a multi-year wait for joint replacements? As the population ages, these surgeries will become more in demand, and therefore the lists will grow longer.
Oh, there’s another big reason why we control health costs - because of the waiting lists, we offload a lot of patients to the United States. People mortgage their homes and cash in their retirement savings to get painful, debilitating conditions treated in the U.S. when they can’t get it done here. That offloads a lot of our costs off the system, and it doesn’t show up in our health care cost stats because the money isn’t spent in Canada.
One other way we help the system work: We privatize it. Canada actually spends less government money per person on health care than does the U.S. Canadians pay for their own prescription drugs, dental care, and an increasing number of other health care services that are slowly being delisted and private treatments allowed. So for instance, Cataract surgery, which is provided by the government, has a waiting list of at least 16 weeks. But LASIK surgery, which is privatized, can be scheduled almost same day. And while other health care costs have been increasing, LASIK costs have been declining rapidly due to competition.
Dentistry is private in Canada, and as a result I can schedule just about any dental work I need within a couple of days, and for reasonable prices.
Another way other countries contain costs is because they refuse to do extremely expensive medical treatments. The U.S. innovates in health care in large part because it has a private system that can offload the costs of new treatments on ‘early adopters’ - wealthy people who are willing to pay for cutting-edge medicine. Eventually the costs come down and those treatments benefit all of us, but take away the ability of wealthy people to pay for their own health care, and you’ll cut off a major source of funding for innovation.
Canada’s health care system overall is pretty good. One reason is that unlike Obamacare, our federal government didn’t try to micro-manage the industry. Our Canada Health Act is six pages long. Obamacare is two thousand pages.
The reason ours is six pages is that it simply calls out the broad-stroke requirements that each province must adhere to, and then lets each province administer its own health care system with wide latitude. That allows wealthier provinces to spend more than poorer provinces, and it allows for innovation and competition between provinces. It also allows us to benchmark performance between provinces, so no province can get away with abysmal treatment and claim that it’s doing the best possible. Other provinces provide examples to the contrary.
You may notice that this is far more similar to what Mitt Romney is proposing than what Obamacare is. Romney says the key difference between Romneycare and Obamacare is that Romneycare is administered at the state level where it’s appropriate, and not managed by the feds. That’s what we do in Canada.
Yeah, you’d think that’s how it would work. But it really doesn’t. Tell me - if a sports star blows out a knee, do you really think he’s going to go on an NHS waiting list behind grandma? Here in Canada, granny can be on a waiting list for a knee for five years, but if an NHL player needs reconstructive knee surgery, he’ll be in the hospital within a few days getting the work done.
And when doctors are put in charge of deciding the order of people on a waiting list, do you honestly think they are going to put a construction worker ahead of a major politician? Or a homeless man on the street ahead of a captain of industry? I’ve seen first hand how Doctor’s discretion works. If you go into a doctor’s office looking like a biker with a long beard and leathers, you’re going to get a completely different assignment to a waiting list than you will if you go in wearing a business suit. It’s just human nature. The doctor knows both of you can’t be treated in a timely fashion, so he’s going to make a judgment call. Low-lifes and people living on the edge of society won’t fare well in that judgment call.
No - he will get it done privately. He may well have private insurance (many professional people do, not just superstars), or may just pay for the treatment out of (his club’s) pocket.
Private orthopedic surgery is allowed in the UK? In Canada it isn’t. So normal people who want it done quickly go to the States. Somehow, sports stars get instant access.