You often hear conservatives rail against obamacare and medicare/medicaid, but I did some napkin math on a couple of stats and I wanted to get your thoughts.
Take a look at this healthcare expenditure index from many countries:
The US is around 17% of gdp
Canada? around 11% gdp
That’s a 6% gdp spread in total expenditure. I am sure there would be cost issues with adjusting the healthcare model in the US and that there are issues of path dependency on which system would be easier to transition to (for example it might be easier to switch to a swedish model ~ 10% gdp) But the point is not which exact model would be best, but what could be done with the cost savings?
I took the 6% spread of healthcare costs (while not even covering everyone in the US btw for that increased expense) and that savings totals around a TRILLION dollars of capital across the nation freed up to be used on other things.
My basic question is… wouldn’t that much excess capital freed up for more productive use lower the deficit more than any other factor?
You’re comparing apples to oranges, budget to GDP.
In other nations they have shifted the burden from the individual to the national budget/taxpayer, meaning higher taxes (or national debt) but lower costs all around.
It seems like a easy fix, but in American, many are used to and demand their family doctor who they have go to for decades. We also demand short wait times and the best care- which is not always there in other systems.
The demand for keeping your family Physician is one of the things that made Obamacare so kludgy.
Probably…eventually. The thing is, our busted system has been with us for literally decades. It’s going to take quite a lot to shift it. Look at all the issues we’ve had with ObamaCare™, and that wasn’t as much of a fundamental shift as what you are proposing, more just some tweaks to the existing system. And even there, we STILL don’t have all the tweaks in just for that. What you are talking about is a pretty fundamental shift that’s going to affect businesses, processes, taxation/take home pay, the entire medical establishment and how they process and give medical care and a whole slew of other things. It’s not going to be simple or easy, and it’s going to initially cost quite a bit to just start the shift.
Hard to say. I don’t think it would translate into lower Government debt though. Even assuming it saves Americans money and is more efficient then that would simply translate into more money in the average Americans hands. Personally, I have my doubts that a Canadian system would save the US that much money…I think that, if we implemented a Canadian system we’d find that we haven’t been giving all the care to everyone we should, so what we saved would be spent on giving more care to more people, and it would be a wash. But it’s hard to say, since I’ve never seen an actual soup to nuts plan to take us from where we are to where we want to be that realistically models what all that would actually entail…and what the final costs would be when we got there. Looking at Canada or some other country and saying that they spend X and get Y would translate into the same thing for the US is unrealistic to me, since they aren’t and didn’t start where we are after as long a period with our system and with our political system or our corporate system…or the expectations of our voters. All of this has to be taken into account, and it never is.
As a moderate, at least in my own mind, I think it should be a high priority, yes, regardless of the above. Our system is definitely broken. It should be fixed. Even if, in the end, we don’t save any money, we will have a system that will scale to our needs in the future, and one that will be much more efficient and fair, I suppose, to everyone. So, to me, that makes it worthwhile to do.
Right, gdp is not the same as the budget as it captures all economic activity, public and private, but still, taxes are not necessarily higher in a place like Canada.
No mortgage interest deduction up north, but for lower income people and people who rent, taxes are usually lower. I’d call that mostly a wash.
The demand for keeping the family physician is the most unreasonable thing to me. Just because changing the system to a new model would disrupt some doctor patient arrangements means we should stick to a model that sucks out a trillion more dollars a year from the economy? Is that right?
If keeping the exact same doctor costs a trillion more in health expenses a year, then I say too bad to those people. Deal with it. Or don’t and bankrupt the nation, then blame liberals for what they chose to live with.
And no one ever mentions people having to change their doctors due to some private insurance deals that might shift coverage to other hospitals or doctor networks. It’s not like that never happened, but that’s ok because government was not directly involved in the disruption?
These objections seem too anemic to take seriously. Do people care more about seeing the same person, or seeing a different person for radically lower costs and allowing poorer people to do the same?
Perhaps people don’t care about anyone other than themselves, so long as I can see my doctor with no perturbations then who cares about medical bankruptcies being the most common way people go under, who cares that tens of millions of people have no coverage other than the emergency room.
I want to see MY doctor with ZERO alterations, ME ME ME, I I I, and if that produces a worse system over all? Keep it? That is the conservative response?
Incidentally, I looked up national debt for different nations, and both Canada and Sweden have less national debt as a % of gdp compared to the US.
A lot of countries are, especially compared to so called socialist nations.
I’d be curious to see how much disposable income people have in other nations once adjusted to their purchasing power within that country compared to the US.
True, the overall tax burden in Canada is about the same as the USA. Of course that is because the USA has a huge military budget. However, of the 34 OECD nations, 25 have a higher tax burden than the USA. So, overall, the taxes in the US are fairly low, almost half that of Belgium, for example
I don’t like it either, but that’s the way it is in the USA. You might as well be King Canute vs the tides.
Not sure I understand your comment about family doctors. We get to choose our family doctors in Canada. It isn’t like they are assigned to us. Perhaps I have misunderstood…
On the other hand European countries have better social welfare systems than we do and perks like free colleges. So the comparison is not trivial to do.
DrDeth, are you under the impression that people are assigned doctors in Canada? That’s not the case. I was actually under the impression that setups like HMOs in the US were more restrictive as far as choosing stuff like that.
Well, a couple things- Canada is just one of many nations with socialized medicine. Not every nation has that feature, nor are all systems the same (Canada doesn’t cover prescription medication, which is a rathe rhigh cost).
Altho I know you get to pick- is every MD in Canada part of the system? There are universal healthcare systems where many MD’s opt out and are Private only. You can’t “choose” them, then. That’s the issue here- not that you can’t pick from a list, but that the list may not include your own family doctor.
All family doctors are part of the system. It’s illegal for an MD to accept private payment for a government covered procedure. If a doctor specialized in something not covered he would sort of be “opted out” but that wouldn’t be the case for a GP.
Eta: and what Rickjay said. Doctors’ practices are private businesses. The government runs the insurance/payment program.
I don’t think I’m ready to assess future defense department spending levels as non-negotiable. But I do indeed have a lot of my fellow countrymen to convince of this. It starts here.
You also need to convince all those Canadians and European types to spend more if we spend less, which is even more unlikely. Basically, you might as well go on out and order the tide to stop coming in after all.
Well, if you managed a perfect switch-over to the Canadian system, there would be some savings to the government. The tax cost per citizen in Canada to provide universal healthcare is lower than the tax cost per citizen for the US to provide government care to some of the people. Through Medicare, Medicaid etc, more money is spent per citizen than in most UHC systems.
However, the major savings would be to 1) people who would no longer have out-of-pocket healthcare expenses, 2) businesses who would no longer have health insurance as an extra expense, and 3) the nation, as the higher average performance of the Canadian system would have knock-on effects on people health.
At the moment, the US spends about 4200 per citizen for government healthcare, and 4400 for private healthcare. Switching to the Canadian system would mean the new status quo would be $ 3600 per person, borne entirely by taxes. (Note: Number is from 2006, US numbers more recent).
Canada may not be a good model to switch to, though. It is a bit of an outlier on the opposite side of the US.
Over fifteen years in healthcare, I have never heard the term “socialized medicine” except from US conservatives. When we look at national healthcare systems, we talk about Beveridge style, Bismarck, or National Insurance. Plus various hybrids of these, and out-of-pocket.
No one says “socialized healthcare” Thats not actually a real thing.
I think one of the objections to UHC/single-payer is that once the government becomes involved in healthcare issues, they will adopt an insurer-like approach, attempting to mitigate expenditures by reducing risk. To some, this appears to lead down the prevention path, making the government, in all its powerful glory, the arbiter of potential high-risk behaviors and diet choices. Those evil bureaucrats will start telling us what we can/should do/eat and punishing us for straying off the path. Of course, Canada still has poutine and ski slopes, so maybe the idea that UHC leads to tyranny needs more careful examination.
It seems to me that’s a complete non-issue. I don’t know how every single country with a UHC system works, but over here and I’m pretty sure in the overwhelming majority of countries with an UHC system, people pick their doctor freely and stay with whatever physician they want (and if I remember correctly, in the specific case of Canada, the main problem people have is to find a physician who’s willing to take new patients).
In fact, the only times I’ve heard about people being unable to stay with the doctor of their choice were in reference to the USA, when their insurer have lists of doctors and/or hospital they must pick if they want to be covered. So, it seems that not being able to pick you physician/keep seeing your family doctor is a problem privately insured American people have, not people living in countries with an UHC system.
And finally, worst case scenario, assuming you switch to a system where you would have a doctor assigned to you (and again, why would they want to do that?), you could still see another physician of your choice, you just would have to forget about the visit being covered by the UHC system. Again, theoretically, your system couldalso forbid physicians from being paid by patients outside of the UHC system, but how likely is it that the USA would pick a system where you’re assigned a doctor and can’t see any other privately, something that to my knowledge doesn’t exist anywhere?
So, this “people are opposed to UHC because you couldn’t see anymore your family doctor” is complete nonsense. If anything, if it’s what people really are worried about, they should want to switch to UHC so that their insurer won’t tell them someday “we’re not working with this doctor anymore”.
Someone is currently paying huge sums for healthcare in the U.S., so much so that nationalizing the health insurance industry would still be cheaper over ten years than continuing with the current system. Emergency room care to the uninsured is paid for by higher room rates, care costs, supplies charges, etc. The private sector has been absorbing these costs for some time. I spent 4 hours in the E.R., was given a shot, and then discharged and it cost me 600 dollars. In 1998.
Something which the conservatives have glossed over is that when you have national health insurance, your family doctor goes on treating you, he just gets paid by the state instead of by your insurance company. The insurance companies always seem to be profitable, which makes nationalizing them even more difficult, because it will reduce the incomes of the wealthy investors who don’t work for a living.
Nothing is going to pay off the American national debt, the only hope we have is to stop running the total higher. This will mean ending intervening in other countries affairs with military force, which has been the primary reason our debt has exploded. The healthcare costs are forcing the states to their knees, though, as they pay the insurance for their workers and some of their low-income people. And people are still going bankrupt because of health care costs.
Nationalizing the health insurance industry sounds a lot different than ‘social medicine’, doesn’t it? All it really means is that you can get care when you need it, and you don’t have to worry about being in debt for the rest of your life.
It’s a non-issue when you’re born into a UHC system. It’s a huge issue when transitioning.
As for whether it would lower the deficit, no. We already have a way to contain Medicare costs(IPAB) and whether or not it works will depend on political will to contain costs. A single payer system would face the same problems. Given what Americans expect from health care, we would probably save some money, but still have the most expensive single payer health care system in the world.
Vermont tried to switch to single-payer but had to give up because it was too expensive. There are a lot of path-dependent elements like doctor compensation and hospital design that would not go away with a switch to single-payer. Look at the difficulty Congress always has with setting reimbursement for doctors under Medicare, for instance. The US now controls the growth of its health-care costs as well as most other Western nations, but it’s stuck with higher numbers because costs increased more in the past.
Also, the cost savings of single-payer are somewhat overstated; taking Medicare as an example, much of the cost of collecting “premiums” is off-loaded to the IRS, and the costs associated with fraud enforcement to the Justice Department.
