# Would universal healthcare be more expensive or less than the current US system? **URL:** \ **Category:** Great Debates\ **Created:** [February 24, 2009, 8:01am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175 "2009-02-24T08:01:17Z")\ **Posts on this page:** 20\ **Page:** 15
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 9, 2009, 9:34pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/281 "2009-03-09T21:34:48Z")
> [@tumbleddown](#): > > I’m not sure why I’m attempting to debate with someone who attempted to claim that they don’t “use” the police, Since I didn’t say that, I don’t know why I’m answering either, except I suppose because I have 45 minutes to kill. And all of that you posted about the number of companies that don’t offer group insurance? For one thing, you didn’t carve out those jobs that one should not expect to be making a living at, such as cashier at McDonalds or manning a gas station. You do that, your numbers of actual make a living jobs without group insurance drops quite a bit. Then, for another, like healthcare, insurance isn’t a right. If your employer doesn’t offer it, then you get a private plan. If you cannot afford a private plan, you get Medicaid. If you are making too much to qualify for Medicaid, what are you spending your money on? > [@](#): > > **Curlcoat** , you talk about people being who “cannot be bothered” to pay this amount of money as if it’s insignificant (1/5th or more of median income levels) as if the cost of all consumer goods and services are not increasing – things that are more pressing on a day to day basis than health insurance, like housing, food, fuel, childcare and utilities – and eating up larger and larger portions of take home pay. So, why is it that you think I should be paying for insurance for people who would rather spend their money on other things? If all your example family is paying for is rent, food, fuel to get to work and back and utilities, then they would qualify for Medicaid. But that isn’t the typical family is it? The typical uninsured family has multiple children, multiple cars, usually owns a home, multiple TVs, high tech toys and on and on. You want **me** to pay so these folks can live the life they want without having to pay for medical insurance - why? Isn’t it enough that I am already paying more in income tax than they are, paying to bail out their stupid choice of mortgage, paying to support all the people that are living on the fed and state as it is? At what point to I get to say “enough!” - will it be before or after I’ve been taxed into the poorhouse? My husband makes six figures ferchissakes, we have a low mortgage and property taxes for our area and almost zero other debt, yet we have to be careful with our money due to the amount of taxes we are forced to pay to support other people. More and more, we are being punished for being responsible all our lives and I am heartily sick of this attitude that because we have a little bit of leftover funds, we must give it to somebody else. Not only is it not my job to support you, your kids, your parents, random people on the street or whoever it is you want, I simply can’t do it. Neither can the rest of the dwindling middle class and there simply aren’t enough rich people out there to cover it. Why don’t you get that? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 9, 2009, 9:38pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/282 "2009-03-09T21:38:18Z")
> [@Ca3799](#): > > Curlcoat seems to think that ‘bad things’ like lack of insurance or poor health only happen to ‘bad people’. Not planning ahead and being able to deal with it on your own is an prime example of lack of maturity. Expecting someone else to bail you out is a prime example of lack of personal responsiblity. How many real life examples do you think you could give me where those things wouldn’t apply? Then tell me, why is it my responsibility to fix it for all those folks? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 9, 2009, 9:51pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/283 "2009-03-09T21:51:11Z")
> [@Jayn\_Newell](#): > > I’m sorry, but this seems self-contradictory to me. If people can’t afford it, then by definition we are not getting it to those who need it. You’re right, healthcare is expensive, but unlike you I don’t take this as a given. Ones of the points to going to a UHC system (and something you and some others seems to keep forgetting is that UHC and government-run healthcare aren’t necessarily synonymous–private companies don’t have to be taken out of the market) is to be able to install measures to help control costs. There are already measures in place to help control costs, it’s one of the major things that the big insurance companies do as they don’t want to have to pay for high medical costs any more than you do. This is why coding is standardized, so they can track costs, it’s why you pay a higher copay on a brand drug than a generic, it’s why there are limits on how long you can stay in a hospital based on procedure/diagnosis. And people fight those controls constantly - any time it affects _them_ then those controls are BAD, but the rest of the time they bitch and moan about how expensive it is to get healthcare. > [@](#): > > It sucks, I know. It isn’t a problem unique to what’s going on at this time, unfortunately–the real estate bust just caused a much more intense problem than is normal, and we’re all going to have to deal with the fallout, whether we like it or not. But the difference between a house and healthcare is that you can save up to buy a house, and wait until the time is right. You can’t save up for medical treatment and tell yourself ‘I’ll get better five years from now’. No, you save up ahead of time, before you get sick. You know - plan ahead? Or even better, you make sure you are insured before you get sick instead of just blithering along and not worrying about it until OMG I’m sick and someone needs to pay these bills! > [@](#): > > Which is actually the point some of us are making–insurance benefits from a larger pool of clients. Insurance benefits from a larger pool of clients _who are paying their way_. A UHC in the US would mean that I would be paying into a policy that was covering all of these people who for whatever reason cannot afford to pay a premium right now. How high do you think that would jack mine up? > [@](#): > > Normally, I don’t have a problem with this mindset. Health is one area where I don’t, because frankly, shit happens. You get diagnosed with diabetes, or get hit by a car, or that cold _doesn’t_ get better on its own. And when these things happen, you can’t wait until you can better afford treatment–they have to be dealt with immediately. That sort of “shit happens” has been going on for decades - why suddenly is it that we are supposed to pay for it? > [@](#): > > But the current system is making it difficult to impossible for a growing number of people to take care of their own health. Why? Can you come up with one good responsible reason why it is that there is anyone out there who cannot afford insurance? And if you can, be sure to note how common you think that problem is. ---
**Author:** ![GorillaMan](https://avatars.discourse-cdn.com/v4/letter/g/50afbb/32.png) [@GorillaMan](https://boards.straightdope.com/u/GorillaMan)\ **Post date:** [March 9, 2009, 10:17pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/284 "2009-03-09T22:17:57Z")
> [@welby](#): > > That is why the UK has [NICE (pdf)](http://www.itup.org/Reports/Fresh%20Thinking/UK.pdf), which doesn’t negotiate price, but rather makes a cost/benefit analysis to determine whether a drug will be prescribed. And as I showed in the link in post 255, if the UK system decides that the cost/benefit ratio is inadequate the patients _don’t have the option of paying for tratment themselves._ If they choose to do so, they lose thier care. As bad as the US system is, I can still pursure a treatment that is outside my plan at my own expense while retaining my current coverage. That’s a complete and very ignorant misrepresentation of what happens in the NHS. The choice to pay for treatment applies only to that particular incident (typically a single hospitalisation or a single course of treatment) for a single condition. It in no way does it affect “the rest of your care for the rest of your life”, as you stated in post 255. ---
**Author:** ![Jayn\_Newell](https://avatars.discourse-cdn.com/v4/letter/j/f9ae1b/32.png) [@Jayn\_Newell](https://boards.straightdope.com/u/Jayn_Newell)\ **Post date:** [March 9, 2009, 10:22pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/285 "2009-03-09T22:22:43Z")
> [@curlcoat](#): > > No, you save up ahead of time, before you get sick. You know - plan ahead? Or even better, you make sure you are insured before you get sick instead of just blithering along and not worrying about it until OMG I’m sick and someone needs to pay these bills! And if you get sick before you have that much saved up? Or you don’t have the money to put away? Hell, Owls and I are in a relatively good financial position for our peer group, but if something major happened it could still wipe us out–we just don’t have that much saved up yet. Why? Because we’re _young_. We haven’t had time to put that much money aside yet. Or do 20-somethings not get sick in your world? Not everyone is in the position to put that much aside, even if they’ve made the ‘right’ choices. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 9, 2009, 11:01pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/286 "2009-03-09T23:01:14Z")
> [@curlcoat](#): > > What does that have to do with anything? You made an intelligent decision to not pass on whateveritis that you have, as well as to not bring even more people into our over crowded world. Are you saying you did this _only_ because you can’t get insurance? I am. There is no way I could properly afford to have a child that ended up with my condition so no kids for us… and the fact that I would not want to run the risk of having a kid with my condition in general even outside the insurance issue. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 9, 2009, 11:02pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/287 "2009-03-09T23:02:17Z")
> [@curlcoat](#): > > I didn’t say UHC did I? I was suggesting that since the casinos employ so many people in Nevada, maybe they should be offering group health. Most casino employees are part time and very low wage. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 9, 2009, 11:11pm UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/288 "2009-03-09T23:11:44Z")
> [@curlcoat](#): > > Why? Can you come up with one good responsible reason why it is that there is anyone out there who cannot afford insurance? And if you can, be sure to note how common you think that problem is. I have already given you a case. I have been responsible. I have never made a late payment, have a credit score of over 800 and earn a 6 figure income. I almost always have a fully changeable ticket out of the USA in the event I need medical treatment right away. It is just a hassle to have to fly for 24 hours to get affordable care… and in the worst case I could be unable to fly. Lack of health insurance happens to lots of people who are not irresponsible and poor. As I said, I know several people in my situation (good friends of ours are losing their home on Saturday due to medical expenses). The both have university degrees, but had a child born with an uninsurable condition right after a job loss with no COBRA extension because the company is gone. Now they are homeless and uninsurable. ---
**Author:** ![Raygun99](https://avatars.discourse-cdn.com/v4/letter/r/6f9a4e/32.png) [@Raygun99](https://boards.straightdope.com/u/Raygun99)\ **Post date:** [March 10, 2009, 12:39am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/289 "2009-03-10T00:39:25Z")
Don’t worry, I’m sure she’ll still find some way that it’s your fault. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 10, 2009, 12:52am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/290 "2009-03-10T00:52:49Z")
> [@Raygun99](#): > > Don’t worry, I’m sure she’ll still find some way that it’s your fault. Of course it is my fault. if I get hit by a meteor it is my fault too since I should always wear a helmet outside. :rolleyes: It’s ok… I won’t personally ask her to pay a penny towards anything, but I will hope our government does. 😃 ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 10, 2009, 1:51am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/291 "2009-03-10T01:51:10Z")
> [@Jayn\_Newell](#): > > And if you get sick before you have that much saved up? Or you don’t have the money to put away? Hell, Owls and I are in a relatively good financial position for our peer group, but if something major happened it could still wipe us out–we just don’t have that much saved up yet. Why? Because we’re _young_. We haven’t had time to put that much money aside yet. You are without insurance? > [@](#): > > Or do 20-somethings not get sick in your world? > > Not everyone is in the position to put that much aside, even if they’ve made the ‘right’ choices. How often do you think that happens? Often enough that we should spend billions of dollars in taxes on it? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 10, 2009, 1:52am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/292 "2009-03-10T01:52:19Z")
> [@Desert\_Nomad](#): > > Most casino employees are part time and very low wage. And? ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 10, 2009, 2:00am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/293 "2009-03-10T02:00:53Z")
Most casino employees are part time and very low wage. > [@curlcoat](#): > > And? And thus, they do not often offer benefits such as health insurance. In your world I am sure everyone gets insurance no matter who they work for, but that is not the case nation wide. I know if I hired a local employee, I could offer well above the national average wage, but I could not offer insurance. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 10, 2009, 2:07am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/294 "2009-03-10T02:07:04Z")
Not everyone is in the position to put that much aside, even if they’ve made the ‘right’ choices. > [@curlcoat](#): > > You are without insurance? > How often do you think that happens? Often enough that we should spend billions of dollars in taxes on it? I think it happens quite often. Do you have $100K in cash available for a week in hospital if you need it (I realize you have insurance), but how many people with or without insurance can really afford even a minimal amount of time in hospital? I mentioned a friend that was billed $9,000 for less than 5 minutes with a doctor and 2 pills. How many people have that? How many people have enough for 3 days in hospital? My doctor brother has about 25% of the ER patients come in uninsured. These are not all poor people but only 10% pay… since almost nobody can afford tens of thousands. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 10, 2009, 2:20am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/295 "2009-03-10T02:20:59Z")
> [@Desert\_Nomad](#): > > I have already given you a case. I said “afford” insurance. > [@](#): > > I have been responsible. I have never made a late payment, have a credit score of over 800 and earn a 6 figure income. I almost always have a fully changeable ticket out of the USA in the event I need medical treatment right away. It is just a hassle to have to fly for 24 hours to get affordable care… and in the worst case I could be unable to fly. I’m sorry getting treatment is such a hassle for you. > [@](#): > > Lack of health insurance happens to lots of people who are not irresponsible and poor. And yet, you still cannot give me an example of this. You have insurance despite your unusual circumstances but all you can do is whine about the fact that you want to live in Nevada, but you can’t go get yourself a job with group coverage because it would put your employees out of work and besides there really aren’t many of those sorts of jobs in Nevada anyway and and and. Your only solution to _your_ problems apparently is that _I_ pay for it. And then you wonder why I don’t like the idea? > [@](#): > > As I said, I know several people in my situation (good friends of ours are losing their home on Saturday due to medical expenses). The both have university degrees, but had a child born with an uninsurable condition right after a job loss with no COBRA extension because the company is gone. Now they are homeless and uninsurable. Which isn’t an example since you do not provide any details of their situation other than job loss and child born with an “uninsurable condition”, whatever that is. On the surface this doesn’t sound like these folks did much planning ahead - had they paid off their college expenses? Was their mortgage more than 50% of their income? Did they have any savings? Any equity in their home? My husband and I have gone thru this sort of thing twice now and haven’t even come close to losing the house. The first time COBRA didn’t come into it as I was still working then, but the second time we did pay for COBRA. Had there not been any, it was still early in my decision to give up and quit working, so I would have had to choose differently at that time and gone back to work to get insurance. Or maybe not, maybe I wouldn’t have been able to get a job and we would have had to go thru a waiting period when my husband got his new job. (Tho as it turned out, there wasn’t a waiting period). The point is, I don’t expect the rest of the world to pay to keep us going when shit happens. Why do you? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 10, 2009, 2:23am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/296 "2009-03-10T02:23:35Z")
> [@Desert\_Nomad](#): > > Most casino employees are part time and very low wage. > > And thus, they do not often offer benefits such as health insurance. In your world I am sure everyone gets insurance no matter who they work for, but that is not the case nation wide. I know if I hired a local employee, I could offer well above the national average wage, but I could not offer insurance. In “my world”, there are part time employers who do offer group insurance. Also, in “my world” there are small companies that offer group insurance as well. Apparently, in “your world” in Nevada you don’t look past your own situation to see what else is out there. ---
**Author:** ![Desert\_Nomad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/desert_nomad/32/177_2.png) [@Desert\_Nomad](https://boards.straightdope.com/u/Desert_Nomad)\ **Post date:** [March 10, 2009, 2:31am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/297 "2009-03-10T02:31:58Z")
> [@curlcoat](#): > > And yet, you still cannot give me an example of this. You have insurance despite your unusual circumstances but all you can do is whine about the fact that you want to live in Nevada, but you can’t go get yourself a job with group coverage because it would put your employees out of work and besides there really aren’t many of those sorts of jobs in Nevada anyway and and and. Your only solution to _your_ problems apparently is that _I_ pay for it. And then you wonder why I don’t like the idea? I was born and raised in Nevada and lived in the state for 30 years. It is home. After my job went away and there was no option for COBRA, and I was turned down by every insurer licensed in the state, I left the USA. I’d like to move back home full time. I am not asking you to pay for it, I am asking that _I_ be allowed to pay for it, and baring that, I would hope that the state require insurers to cover everyone as they do in other states. baring that, yes, I’d like the federal government to do something. > [@curlcoat](#): > > My husband and I have gone thru this sort of thing twice now and haven’t even come close to losing the house. The first time COBRA didn’t come into it as I was still working then, but the second time we did pay for COBRA. Had there not been any, it was still early in my decision to give up and quit working, so I would have had to choose differently at that time and gone back to work to get insurance. Or maybe not, maybe I wouldn’t have been able to get a job and we would have had to go thru a waiting period when my husband got his new job. (Tho as it turned out, there wasn’t a waiting period). The point is, I don’t expect the rest of the world to pay to keep us going when shit happens. Why do you? I think that if your husband’s company decided to close it doors tomorrow morning when he showed up for work (meaning immediate loss of insurance and no COBRA option), and a week later because of complications with a newborn, you had medical bills of $200,000, you’d find it difficult to keep your home. I am done discussing this. Obviously we will never see eye to eye. Congratulations on having a good situation with insurance. I hope it lasts for you. Perhaps someday I will be as lucky as you are. ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 10, 2009, 2:38am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/298 "2009-03-10T02:38:11Z")
> [@Desert\_Nomad](#): > > I think it happens quite often. See, what you think, what you want to believe, isn’t worth much in a discussion like this. You want so much to believe that there are all these thousands of people out there that need healthcare and can’t afford it thru no fault of their own, so you just decide it must be true. Then enough people buy into it to sway the politicians and the responsible folks - the few left with any money - get stuck paying for another wasteful government program aimed at relieving people of the chore of being responsible for themselves. > [@](#): > > Do you have $100K in cash available for a week in hospital if you need it (I realize you have insurance), but how many people with or without insurance can really afford even a minimal amount of time in hospital? I have no idea. How many of those people do you think _ **I** _ can afford? > [@](#): > > I mentioned a friend that was billed $9,000 for less than 5 minutes with a doctor and 2 pills. How many people have that? How many people have enough for 3 days in hospital? I have quite a lot of trouble believing that your friend was billed $9000 for an office visit and two pills. However, I also don’t know how many people could come up with $9000 but anyone who is out of school and on their own should be able to come up with that in credit at least. Provided of course they didn’t jump right into putting a bunch of stuff on credit, bought a house and started having kids that is. > [@](#): > > My doctor brother has about 25% of the ER patients come in uninsured. These are not all poor people but only 10% pay… since almost nobody can afford tens of thousands. Tens of thousands of dollars for an ER visit? ---
**Author:** ![curlcoat](https://avatars.discourse-cdn.com/v4/letter/c/ea5d25/32.png) [@curlcoat](https://boards.straightdope.com/u/curlcoat)\ **Post date:** [March 10, 2009, 2:48am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/299 "2009-03-10T02:48:45Z")
> [@Desert\_Nomad](#): > > I am not asking you to pay for it, I am asking that _I_ be allowed to pay for it, Then work on getting the pre-exist laws changed. As long as you support a UHC, you are asking me to pay for all the people out there who right now can’t afford to pay premiums. > [@](#): > > I think that if your husband’s company decided to close it doors tomorrow morning when he showed up for work (meaning immediate loss of insurance and no COBRA option), and a week later because of complications with a newborn, you had medical bills of $200,000, you’d find it difficult to keep your home. Actually, no, since our house is worth more than we owe, even now, so our equity line of credit would cover that. And why is that? Because we didn’t take on much in the way of other expenses until that was true. Apparently the mother of the child left her job before it was born? And they just assumed that everything was going to go just fine with the pregnancy and birth? > [@](#): > > Congratulations on having a good situation with insurance. I hope it lasts for you. Perhaps someday I will be as lucky as you are. If it doesn’t last, just like every other time in my life something went into the toilet, I will not demand that others take care of it for me. ---
**Author:** ![Ocean\_Annie](https://avatars.discourse-cdn.com/v4/letter/o/8797f3/32.png) [@Ocean\_Annie](https://boards.straightdope.com/u/Ocean_Annie)\ **Post date:** [March 10, 2009, 2:52am UTC](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175/300 "2009-03-10T02:52:13Z")
> [@welby](#): > > First, government run doesn’t mean less administration. That’s the point I’ve been trying to make over and over again. We would NEED a program that had less administrative costs, but I think it’s unlikely we’ll get one. According to Harvard Medical Economists David Himmelstein and Steffie Woolhandler, private medical insurance wastes 350 billion a year or 2 percent of GDP on a bureaucracy that has nothing to do with medical care. > [@](#): > > The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. **Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay.** Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars. [Cite](http://tinkerready.wordpress.com/) > [@](#): > > Health reform built on private insurance isn’t working and can’t work; it costs too much and delivers too little. At present, bureaucracy consumes 31 percent of each healthcare dollar. The Connector - the new state agency created to broker coverage under the reform law - is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare’s and 11 times those in Canada’s single payer system. [Cite](http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/09/17/health_reform_failure/) > [@welby](#): > > And negotiations with the pharmacuetical companies have to work. But as has been found with the UK system, it doesn’t work. > That is why the UK has [NICE (pdf)](http://www.itup.org/Reports/Fresh%20Thinking/UK.pdf), which doesn’t negotiate price, but rather makes a cost/benefit analysis to determine whether a drug will be prescribed. And as I showed in the link in post 255, if the UK system decides that the cost/benefit ratio is inadequate the patients _don’t have the option of paying for tratment themselves._ The U.S. health care system does the same type of analysis to determine what drugs it will and will not cover. The private insurance firms use cost-benefit ratios and ration care just like other health care systems in developed countries. > [@](#): > > The United States is evolving a number of health technology assessment initiatives for the purpose of informing coverage decisions. One such example is the Drug Effectiveness Review Project (DERP), a “centralized” process for conducting regular systematic reviews of evidence concerning the comparative performance of drugs within leading therapeutic classes of medicine.6 DERP is funded by a collaboration of private and public organizations that choose which drug classes are to be studied. It conducts the “assessment” stage of the drug review process by reporting what is likely to be the effectiveness of alternative products based on systematic review; it does not conduct an appraisal of the evidence in the sense that DERP does not recommend what drugs ought to be covered in light of the systematically reviewed evidence. [Cite](http://content.healthaffairs.org/cgi/content/full/25/2/337?ijkey=7IUMPx80EhxII&keytype=ref&siteid=healthaff) The cancer drug, Avastin, you referenced in post 255 is astronomically expensive with limited benefits. After heavy lobbying, U.S. insurance has only recently offered limited payment for the drug. Most patients have to a pay out of pocket for a significant percentage of the cost. [Avastin studies show the drug prolongs life by only a few months.](http://www.nytimes.com/2008/07/06/health/06avastin.html?pagewanted=1&_r=2&ref=health) > [@](#): > > For colorectal cancer, Meyer wrote in the New England Journal of Medicine that bevacizumab extended life by 4.7 months (20.3 months vs. 15.6 months) in the initial study, at a cost of $42,800 to $55,000. The addition of bevacizumab to standard treatment can prolong the lives of breast and lung cancer patients by several months, at a cost of $100,000 a year. [Wiki article](http://en.wikipedia.org/wiki/Avastin) > [@welby](#): > > Also, I’d disagree that drug costs are as astronomical as everyone seems to beleive. In fact they only account for [10 percent (PDF)](http://www.bcbs.com/blueresources/mcrg/2007/chap1/MCRG_chap1.pdf) of the U.S. healthcare dollar. Given the benefits we receive by paying high cost for drugs in exchange for excellent research on same, that’s a pretty good deal. Actually, most pharmaceutical research is tax funded, either directly through NIH and universities or with tax subsidies and grants to drug companies. The U.S. pharmaceutical industry spends money to lobby, sue each other over copyright infringement, and advertise. > [@](#): > > Industry R&D risks and costs are often significantly reduced by taxpayer-funded research, which has helped launch the most medically important drugs in recent years and many of the best-selling drugs. **According to the NIH, taxpayer-funded scientists conducted 55 percent of the research projects that led to the discovery and development of the top five selling drugs in 1995** (see Section III of report). PhRMA has not challenged the NIH document… > > …Drug industry R&D is made less risky by the fact that only about 22 percent of the new drugs brought to market in the last two decades were innovative drugs that represented important therapeutic gains over existing drugs. **Most were “me-too” drugs, which often replicate existing successful drugs.** (See Section VI)… > > … **In addition to receiving research subsidies, the drug industry is lightly taxed, thanks to tax credits.** The drug industry’s effective tax rate is about 40 percent less than the average for all other industries, according to the Congressional Research Service. (See Section VII) [Cite](http://www.citizen.org/congress/reform/drug_industry/r_d/articles.cfm?ID=6532) > [@](#): > > The share spent on R&D in those six firms in 1999 was matched in a recent **Kaiser Foundation analysis which looked at the 10 largest firms in 1998, again finding 11 percent of sales going to R&D—and finding similar percentages over the whole decade.** Comparable figures were reported for 2000 by Public Citizens… > > …Drug makers say they have to charge high prices to earn high profits to finance > research, or else we’ll all die. In fact, the industry’s widely-reported high profits don’t pay for research. They are what drug makers retain after paying for research and all their other expenses. It’s useful to recognize that the profits on prescription drugs themselves are higher than is suggested by the published and publicized figures from their annual reports and Fortune 500 data. [Cite (pdf)](http://dcc2.bumc.bu.edu/hs/sager/pdfs/020402/Pharmaceutical%20Marketing%20and%20Research%20Spending%20APHA%2021%20Oct%2001.pdf) > [@](#): > > The researchers’ estimate is based on the systematic collection of data directly from the industry and doctors during 2004, which shows \*\*the U.S. pharmaceutical industry spent 24.4% of the sales dollar on promotion, versus 13.4% for research and development, as a percentage of US domestic sales of US$235.4 billion. \*\* [Cite](http://www.sciencedaily.com/releases/2008/01/080105140107.htm) > [@welby](#): > > I think that the partisan slant has obfuscated this issue on both sides. Do we need reform? Sure, and I say that as a guy who’s damn happy with both the amount I pay and the coverage I receive. I think there should be no dispute that without reform the whole system will collapse. The number of people unable to pay and the number of businesses unable to cover the cost is going to rapidly increase. Less people on the insurance rolls only increases the cost more. The federal government will not be able to subsidize the system much longer. Most people are happy with their insurance until they suffer a serious illness. It gets really complicated for people with a chronic disease or parents of children with a chronic disease. [There is always the risk that you have insurance but not covered](http://health.usnews.com/articles/health/2007/09/16/insurance-coverage-caps-hit-cancer-patients-hard.html) [Previous page](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175.md?page=14) [Next page](https://boards.straightdope.com/t/would-universal-healthcare-be-more-expensive-or-less-than-the-current-us-system/487175.md?page=16)