You’re either dyslexic or republican.
Quotes from two different posts, the latter in reference to European countries, but you continue to say the same thing: despite the mass of evidence presented, you continue to insist that other countries had not developed an entrenched system of private insurance, but the fact is that they did. Blue Cross first appeared in Canada in 1939. When Ontario finally adopted single-payer, for the first few years they actually contracted private health insurers to act as payment processors, because they were already there and had well established payment systems. (Which, incidentally, marked the first and only time in history that a health insurance company actually did something useful. ;))
I do agree with you, though, that Americans have a different attitude towards government than Canadians, Europeans, or indeed just about any other nation on earth. Namely, most Americans consider government to be comprised of self-serving miscreants that are at best just short of criminal, and at worst well into thieving criminality. And part of the reason this came about is precisely the point that up_the_junction keeps making and that you keep rebuffing: that the idea of a collective social solidarity is subsumed by an independent frontier spirit that prefers to worship at the altar of Personal Responsibility. Republicans tend to be the main cheerleaders, but it transcends political boundaries. Sadly, this attitude prevails even for issues like health care where it doesn’t freaking work! It’s also an attitude towards government that tends to become a self-fulfilling prophesy, because the more you advocate the primacy of individual freedom over the constraints of law in such issues as, for instance, unlimited spending on issues advocacy and electioneering, the more self-interested crooks and cronies you’re going to get in government.
(Emphasis mine.) So, IOW, in round numbers, you would need to cut US health care costs in half to bring it in line with that of other nations. Do you suppose it’s coincidence that if you compare per-capita health care spending in Canada to per-capita spending in the US, it’s about half?
The question is why the PNHP report estimates savings of “only” $572 B when other countries seem to be saving so much more. And the answer is: because this amount is only the savings from eliminating administrative overhead (plus a small amount in pharmaceutical cost savings). That’s just part of the picture, and only a relatively small part, too, though it’s compelling because it’s just pure counterproductive waste – essentially, everyone with private health insurance is paying through the nose for the “privilege” of allowing the insurance company to meddle between them and their doctor, looking for excuses to reduce or deny the claim.
But here’s the other part of why US health care costs are so high and out of control. What would you find if you did a national survey of provider fees? The first thing you’d find is that numbers are hard to come by, because there’s virtually no such thing as a set fee. There is a fee for cash customers, a fee for insurer “A”, maybe a different fee for insurer “B”. There may be different fees for different providers, and radically different fees in different regions. And above all, all of these fees are much, much higher – often by many multiples – than what they are elsewhere. Why?
Two reasons why providers charge exorbitant fees. One, because they can, and two, because to some degree they have to. They can because there’s no one to say they can’t, and to some degree they have to because they’re constantly getting stiffed by insurance companies and patients alike. The difference between a US doctor who has to maintain a pack of carnivorous Accounts Receivable personnel to chase down insurance companies and a doctor in Canada who simply submits a standard electronic claim and automatically gets a payment by EFT is the difference between night and day.
But the larger point here is that a single-payer system negotiates a single uniform fee schedule with the providers up front, and thereafter doesn’t meddle in the clinical process. Providers are willing to settle for lower fees because full payment is always assured, and they’re dealing with a simple streamlined system. The ability to control costs in this way is over and above the administrative savings, and is actually a much bigger factor in cost reduction.
I don’t like to link to random things but I did find this PBS article really interesting as it sorts out a few issues. Like a lot of people have said in the past that the cost of medication is killing the US system - the chart here says that’s absolutely not the case.
Somewhat surprisingly a huge cost to the US system is … ambulances (see the third chart down).
No idea why but admin in the US is seven times Japan.
Anyway, take a look at the charts - fascinating comparisons with other healthcare systems:
It is odd that Canada and the USA spend about the same amount of public money, but the US spends much, much more private money on health care.
And you are out of line. If you have nothing to contribute but snide comments, just don’t post.
[ /Moderating ]
Moo
The coming of the NHS in Britain was also fiercely and angrily fought against by many doctors — and whatever association was then the BMA — [ although some doctors would have been influenced by the then passion for communist example to welcome such socialistic practice ]; the labour Health Minister Aneurin Bevan * out-maneuvered them, perhaps by pointing out they would benefit financially from the new arrangements. The conservatives led by the welfare-minded Churchill seen rather muted in opposing.
It would have been amusing if those Saskatchewan doctors had also been the same sort of people who fulminated against workers’ unions…
- Never to be confused with Ernie Bevin, the labour Foreign Secretary. They hated each other.
No, or at least only as an addendum to the public system, but for example Spain’s system evolved from a mixture of public coverage, coverage by employers and cooperative coverage (unions/professional associations called mutuas). Coverage by employers went extinct pretty soon: the main advantage of belonging to, say, the Salesmen Mutual, vs. having your employer pay for your healthcare is that the coverage goes with you when you change employers or if you lose your job (my grandfather was in the Salesmen Mutual).
Pension coverage by the public system only became universal in the 80s and we have options for additional, private coverage (with many companies offering this within their benefits); medical care for non-job-related issues is separated from job-related ones. The first person you see if it’s not an emergency is a different doctor - one is in your primary healthcare center, the other in a work-healthcare center born from the aforementioned cooperativist structures; if they send you to the hospital, it will be the same hospital.
[InigoMontoya]I do not think ‘ambulatory’ means what you think it means.[/InigoMontoya]
And to be less cryptic: ambulatory care is outpatient care. Ambulances must be part if “Hospitals”. Apparently, Emergency medical is maybe 2% of spending from my quick googling.
I think a partial response to that was in the post before yours. In other threads, dopers who work in medical or insurance jobs have mentioned the nightmare that medical admin can be.
Japan: fixed rates.
US: multi-variant rates.
Spain: public system - what’s a rate? Private healthcare, rates vary by center but each center has fixed rates.
Japan: two billable parties. Each bill gets split 70(single-payer government agency):30(patient).
US: multiple billable parties which vary by patient. The ratio that goes to different payers (if there are multiple ones) varies by patient and coverage policy.
Spain: while there are a lot of billable parties when you look at the total situation, public-owned healthcare providers don’t create any bills. Private ones bill the patient. Concertados (privately owned but working within the public system) generally bill the regional healthcare agency, occasionally an insurer; many don’t even have a procedure to bill a patient.
The Japanese system and the Spanish one are different, but a medical center in either would have either no billing or billing that could almost be managed with an abacus. The American one needs a lot more work, and a lot of that work is manual.
I can’t find information on whether healthcare centers in Japan share information on patients. In most Spanish regions, medical personnel within all public or concertado centers have access to the same medical history (and that’s a very high amount of total medical personnel); administrative and medical personnel have access to contact information. In the US, how much time does any of you spend filling up contact info and history?
Ha! Okay, thanks guys.
Interesting, but one thing that may not be clear from the bare numbers is the impact of the costs on the individual.
i.e. you can state that it costs $10,000 for procedure A in the USA and $3,000 for the same procedure in the UK but that doesn’t clarify that the $3,000 for the UK is purely a cost to the system. The UK citizen will not have to pay any of that amount whereas the USA citizen will probably have a (possibly crippling) co-pay or a limit on yearly cover.
The affects of the WW1 and WW2 were very relevant to the development of a Universal Heath Care in the UK. In WW1 the country had a population of 45million, mobilised 5 million men and it lost about a million men and several million suffered war injuries.
In WW2 about half a million men were lost and a million or more injured. There were also many thousands of civilian casualties from nightly bombing raids.
I think it was fairly obvious to everyone that in the face of such national emergency it takes the concerted effort of a centralised government to organise healthcare on that scale. During wartime many sectors of the economy were effectively nationalised and people grew accustomed to the collective provision of services. It was quite clear who the common enemy was, there is nothing quite like high explosive bombing campaigns against urban populations to crystalise an existential threat. Healthcare, food rationing, housing - all these fundamentals were brought under centralised control as part of the war effort.
The Beveridge report published during WW2 set out the terms of reference and objectives of a Welfare state that would be provided by the government financed out of general taxation. Nonetheless, there was significant opposition from the British Medical Association, the doctors professional body, and significant compromises had to be made to get the NHS started in 1948.
Aneurin Bevan, the minister who forced through the laws creating the NHS, was famously quoted as saying of the doctors, he had to ‘stuff their mouths full of gold’ to overcome their opposition. This was all the more remarkable because at that time, the UK economy was pretty much bankrupt.
Red blooded socialism or simply ‘pay back’ time for the working classes who bore the brunt of fighting the war? Either way, the sanctity of ‘health care free at the point of provision’ became a principle embedded in the political culture. As far health care is concerned, it is a ‘natural right’ and the government picks up the tab.
There are very few that disagree with that principle and even our most right wing politicians tread carefully around the NHS (yes, even Thatcher.) It is a revered institution and its workings are highly politicised. This works very much to its detriment because it stifles rational debate. It rousing passions akin to the debates over gun ownership in the US.
After WW2, across Europe, there were many countries that were basically starting again amidst the devastation of war. Many with fresh constitutions and the opportunity to decide what the government should do and what should be left to private interests. They were dealing with fundamental issues like the starvation and homelessness. Most opted for Universal Health Care systems of one sort or another.
The political conditions in the US seem to have been completely different after these world wars. Certainly after WW2, the US was on the crest of an economic wave.
How did the insurance business in the US get such a hold on healthcare? I am also guessing that Big Pharma had something to do with it.
I would have thought that employers would have been pleased pass on the responsibility for financing healthcare to the state, it must be a significant overhead.
Was there a deal between the Medical profession and the Insurance industry to campaign to undermine any state financed healthcare initiatives or were they just occupying a vacuum?
Given the federalist structure of the US, did any individual states try to introduce UHC system like Canada? Surely there were similar pressures on the other side of the border?
Maybe it’s the cost of ‘going private’ in the UK. It has to relatively cheap or people will just go on the NHS.
Is it your sense that Canadians prefer their system?
I have nothing but anecdotal experience, but it’s common in my practice for Canadians to find various ways to consume US Healthcare instead–for example, to purchase vacation health insurance and then get something taken care of here in the US such as an MRI.
My own sense is that Canadians genuinely prefer their system as a whole, however.
There are some obviously unfair comparisons as well. If a drug developed in the US has its development costs recouped here, and then is cheaper in Canada b/c the incremental cost of making the next dose is trivial, that’s not a fair comparison unless you figure out who is developing the majority of drugs.
I personally think the Canadian system–from what I know of it–is better, and is better positioned to control costs. The maldistribution of money spent on healthcare in the US, and the inefficiencies–are quite remarkable. But I don’t see us able to control costs, ever. We aren’t going to ever ration care; we aren’t going to ever create a single-payer system that replaces our multipayer system; we aren’t going to ever hold a patient responsible for their crappy health; we aren’t…well; on and on.
My point is that our system is not set up well and prices are out of control. You can ideally create a system with more transparent prices and market forces without single payer. As I said, nations have different systems. The UK is a single public payer and public provider. The Netherlands is multi private payer and private provider. Both provide health care at a fraction of the cost of the US.
Changing our system to make it more cost effective should be doable under the aca assuming the will to do so exists. It doesn’t exist on the national level but on the state level it could. States could, I assume, pass laws that gave public, private and consumer market forces much more power to drive medical costs down via various methods. We need efficiency and cost control and that can come with either a single payer or a multi payer system.
The History of Health Care Reform in the U.S. may be instructive … or saddening … (or amusing?) There was a big push for government-supported or government-mandated health insurance in the early 1970’s. The outstanding Republican Senator Jacob Javits introduced a bill to offer Medicare to all Americans. Finally, President Richard Nixon pushed for a plan – let’s call it Nixocare – to counter the plans offered by liberals. It was popular among Republicans but Nixocare failed to attract Democratic support.
In 2010 Congress finally passed Nixocare (the main change being just the name of the program), but in an irony befitting of America’s Exceptionalness, this time Nixocare garnered zero Republican support!
Whatever.
Well, yes, but I think you may be underestimating the magnitude of the challenge – the point being that it would require the kind of political will and significant changes in the role of government in health care that would be almost tantamount to implementing single-payer.
I’m certainly not an expert on the many different systems of many different nations, but to take the case of Germany as an example, it’s often touted as a good model for the evolution of the American system because it combines a public system with a private tier, and even the public system itself is multi-payer. But in point of fact it functions under such tight government regulation that it may as well be single-payer, and the fact that it isn’t is more of an accident of history.
All the different statutory sickness funds all offer essentially the same coverage at the same rates, the costs are all community-rated rather than being risk-based, and coverages and provider fees are regulated by a combination of an annually convened multidisciplinary commission and the Federal Joint Committee – the kind of regulation that would have Republican lunatics turning bug-eyed with hysteria and clamoring about a communist-style “government takeover of health care” and the arrival of the End of Days and the zombie apocalypse! So of course this system works tremendously well, and covers everyone except those who qualify for private insurance and opt to take it. This private tier is a risk-rated system that resembles traditional US private insurance, but only about 10% elect to take it and it really just offers extra amenities.
Not only is this hugely and fundamentally different than the present US system either before or after the ACA, but I also strongly suspect that even if a two-tier public-private system could be implemented, socioeconomic factors here would push all the best doctors and hospitals into the private tier and relegate the public system to distinctly second-class status with far poorer basic health outcomes.
Here’s a simple question that sums up the challenge: what are the chances that any meaningful reform can happen that the health insurance industry doesn’t support?
Kudos for even considering it a question.
I’d suggest - with zero evidence to hand - other democracies want the US healthcare system like they want the US system of government.