Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")? Can a capitalist case be made for their existence? Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?
There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is very much in the pocket of the health care industry. As such, the markets were a compromise measure enacted by congress to make it easier for people to choose health care. Before Obamacare, it was sort of a black box where only HR people could figure out pricing structures and health care providers didn't really compete in any way with each other.
Obamacare did do some good things that needed to be done, but essentially, everything about it was a bandaid intended to kick this shitty system down the road to the next person who had to deal with it. But hey, at least health care companies can't just turn you down because you have Diabetes or are too fat anymore.
There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.
The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player.
A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.
Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with.
The difference is that with most socialised systems there are two system in parallel:
A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years".
And a private system, whose priorities are, like in the US, based on how deep your pockets are.
For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator:
If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up".
If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers).
The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.
Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government.
Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.
Yes you can. In the UK people sue the government, or specially the NHS, over treatment decisions all the time. Including over things like denied coverage of specific drugs etc. (usually when there's no proven benefit from a given drug).
And as I pointed out: If you think they are too strict, then you can pay for a private insurer to cover things the NHS doesn't cover or won't do fast enough for you.
In Hillary Clinton's proposed health care plan in 1993, no, you weren't allowed to sue. You could get an appeal from a Board, but that's it. The proposed legislation explicitly said there could be no other review.
Note that this is a very good cost containment strategy. Note also that this can probably not reduce patient outcomes at all. Note also that it is extremely unpopular.
The named defendant was the Secretary of Health and Human Services. The suit was over practices followed by Medicare contractors, but it's not like they were operating outside the knowledge of Medicare, they were acting as Medicare had directed them to act. The settlement agreement has Medicare changing the procedures the contractors will follow.
Except the very first paragraph states that the reason for the suit was that the contractors were not appropriately following Medicare guidelines.
"...in which the plaintiffs alleged that Medicare contractors
were inappropriately applying an “Improvement Standard” in making claims determinations for
Medicare coverage involving skilled care..."
You've got that almost completely backwards, though few people are aware of this (in the United States).
I'm hazy on the details myself, but briefly:
1. Healthcare insurers are covered under ERISA, the Employee Retirement Income Security Act, of 1974. Among the provisions of that act are limitations on the right to sue, under the theory that a retirement fiduciary is an agent of the employees. It's been a long time since I've looked at this, and I don't recall all the specifics, but yes, there are some limitations on suit for lack of coverage.
2. Lawsuits against the government are possible and happen all the time. I'd have to see what specific limitations apply, if any, to Medicare, Medicaid, Disability, and VA care, but you'll find numerous instances of suits:
You can have the procedure done then sue them when they won't pay for what they're contractually obligated to. You don't generally get a hospital bill until the procedure is done.
> Except you can sue your insurance provider if they deny
> you coverage for something that they're obligated to
> cover.
There's an enormous information and power imbalance in the health insurance contractual relationship. The large number of medical bankruptcies by people that had health insurance is surely a testament to this fact.
Yes, there are trade-offs. In my opinion, they are worth the switch, and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." The latter being the single payer option.
Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.
> and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty."
No, it tends to be a lot of care that isn't worth the cost that gets denied. This is very different from what an American expects, which is that everything they "need" (or what their doctor says they should do) ought to be covered.
The lap-band often passes, because it can be a relatively low-cost way to add a bunch of QALYs to a patient's life.
NB: I think having care decided on a cost-basis is a pretty good approach, at least to start from, but it is immensely unpopular in the US. On both sides of the aisle.
> Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.
Often. Not always. In Canada only recently could a doctor offer the same services the government offered, and that was against the will of the legislature. Their supreme court had to rule on it. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)
Of course, the constituencies which oppose single-payer seem often to be composed of the same people who will vote out anyone who messes with their Social Security, Medicare, or VA benefits.
> I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age.
I hope you understand that to Objectivists that sounds like saying "I often wonder if Frederick Douglass ever found himself suffer an accident at work with no master to take care of him because he isn't a slave".
I am sure there are better arguments possible against objectivist position, but the one you made is rather naive one.
Well ... you're strictly right, but just like the idiotic provision that forced Congress to give up their employer sponsored insurance and use the exchange instead was forced by the GOP, so to were these provisions dropped due to GOP pressure.
You see, the GOP continually promised, on one hand, to tie the ACA up in legislative hurdles so it couldn't pass, or, on the other hand, vote for it if it met their requirements.
So, foolishly it turned out, the Democrats played ball with the GOP. In the end, the GOP still did everything they could to block it and voted against it en masse.
I think the error was that the Democrats believed the GOP would vote for the bill if they changed it enough. It was naive.
Um, no. Those provisions were the Democrats negotiating with themselves. At the time the Democrats had the votes to force the issue regardless of the Republican opposition.
It was people like Ben Nelson, Joe Lieberman, and Max Baucus that played a rotating merry-go-round of scapegoats that the Democratic Party used to trump up reasons why they couldn't support more progressive reforms in the healthcare legislation.
Also, it wasn't Republicans that put a WellPoint Executive Lobbyist (Elizabeth Fowler) in charge of writing large portions of the actual legislation and acting as the liaison between the White House and the Senate.
In the end we got a big pageant and self-aggrandizing back-patting session from the Democrats who called it the greatest Democratic legislative accomplishment since the Civil Rights Act... which is ironic considering that the ACA is almost the spitting image of Republican Bob Dole's Heritage Foundation sourced (and AHIP sponsored) reform plan from just a few election cycles prior.
So... the greatest Democratic policy achievement in at least a generation was to pass a Republican policy proposal. Well played Democrats. Well played.
It's true that Sen. Lieberman, in coordination with Sen. Snowe, threatened a filibuster. At the time, Sen. Lieberman was an independent, not a Democrat. So, it was an independent and a Republican.
I know that's splitting hairs, but these are valid hairs to split.
He caucused with the Democrats and was only an Independent because he got primaried out of his seat by Ned Lamont, so to stay on the general ticket he switched to being an Independent.
While we're splitting hairs.
Anyway, HN is a place I relish usually being devoid of pointless political conversation, so I'm just going to drop it now and go back to reading about Zippers in Erlang.
A Republican policy proposal that wasn't passed back when it was proposed. Just because the Republicans proposed this first doesn't mean it's a bad idea. We're all human beings and we all have a lot of common ground. Not everything a Republican proposes is automatically hated by Democrats, and not everything a Democrat proposes should be automatically hated by Republicans (I say "should be" because lately the Republican party does seem to reflexively hate everything Democrats propose, even if it was originally a Republican idea like the ACA).
You can't get rid of the individual mandate without completely destroying the whole law.
It's the unpopular part of the law. But pretty much anything that works is going to have some unpopular component that needs to be swallowed in order for the whole thing to work.
When Republicans talk about getting rid of the individual mandate, it's because they are, in actuality, trying to kill the law. When Democrats talk about it, I really don't know what's going through their heads. Leftist wonks like Krugman or Klein keep on telling them exactly why it's needed.
Sure, but not really what I meant. Adding public option and subtracting individual mandate would basically be a step towards having single payer with secondary private market.
> Adding public option and subtracting individual mandate would basically be a step towards having single payer with secondary private market.
I don't see how it would be, unless by "subtracting individual mandate" you mean "replacing an individual mandate backed with a fee/tax/penalty for failure to comply with a universal tax, an option to select a private option with the tax refunded as a subsidy, and a default of using the public option if no private option is selected". Which, really, is retaining the individual mandate, but making it impossible to break rather than penalizing breaking it.
And yet the current front runner of that party has been strongly in favour of a single payer system over the years. (Though I'm guessing recently there's a shift away from that, publicly anyways.)
Pardon my use of words but I think it is foolish not to accept that there are pretty serious trade-offs involved here and there are perfectly legitimate reasons why single payer is a very bad idea. I personally think a single payer system in USA would pretty much resemble Veterans Affairs. Corrupt, inefficient and something that makes consumers profoundly unhappy while taking away a good chunk of your hard earned wealth.
>which leads to the situation where poor people who desperately >need health care and can't afford it still oppose single-payer >even though they stand to gain the most from it.
I'd think education is the way around this. Start off with a "whats the worst case that could happen" then move to "whats the best that could happen." To me, you can convince people as long as you explain that their not going over a cliff. To me, this argument was never made. All I heard on the news was "it's socialism" or "it's good" but no selling the public on why it was in fact good. In this case, our leaders who were the proponents of single payer failed us. Single payer will happen, it'll just take a bit longer. The commercial healthcare industry is on a path to failure....there is no fixing it for the US. Eventually we'll end up with a system, that likely looks like what Germany/UK have (some mix of public/private).
I think you'll be remiss to find that the majority of insurance company donations go to the Democratic party. Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor. Que Einstein quote.
> I think you'll be remiss to find that the majority of insurance company donations go to the Democratic party.
I'm not sure what you're saying here. Are you saying I'll determine that to be the case if I'm lacking attention, or are you saying that I'm lacking attention and therefore don't know that? I'm also not sure what the point is either way, why the truth or falsehood of this statement is relevant to my comment.
> Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor.
This also doesn't make any sense. Nobody said that voting for either party would make you rich. Making health care accessible to the poor doesn't make them less poor, it just gives them health care.
I am still waiting for the Republicans vote for abolishing Medicare and the VA. Those programs are pure evil and seniors and vets must be liberated from them.
Obamacare has had one significant, lasting effect: culturally, the idea is now that everyone should have access to health care. That's the default. Bringing in a public option will be an easy, natural next step, if not for Clinton, then for whoever succeeds her.
I believe statistics say that expanding Medicaid added 8 million covered folks, about 15% of uninsured Americans, and otherwise Obamacare has only gotten an additional few percent of uninsured Americans to become insured. I don't think the norm is that everyone should have access to health insurance any more than it was before due to Obamacare's negligible increases in coverage.
Oh, I'd agree completely that, as an implementation of universal health care, Obamacare falls far short. I always say, it's better than what preceded it, but that is a pretty low bar to achieve.
(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)
But while the implementation is pretty poor, the idea behind it is significant: everyone should have access to health care. Not just tied to a job, not just if you've got lots of money. It isn't working great, but that's the goal at least.
I know there are still lots of people who come back with opposition to that idea (even in these comments a few people are trotting out the whole "universal health care is slavery" junk), but whatever, there are people who oppose all kinds of things. Obama shifted the playing field of expectations, and good things will come as a result of that. That's all I'm trying to say.
Same exact scenario here, except a kidney problem. It was a nightmare to get back into coverage and required ultimately working for a large company.
Since that happened I've always thought the lack of universal healthcare was a major cultural lever against entrepreneurship and small business ownership, because stable healthcare coverage is probably the number one draw of working a corporate job. It seems so culturally odd to me that employment and healthcare are so linked in the U.S.
Unfortunately I think some people don't understand how existentially frightening it is to get a bunch of rejection letters from insurance companies until it happens to them.
(My own story: I had my gallbladder out in 2004, and from that time on was denied personal health insurance for BS "pre-existing condition" reasons...until Obamacare.)
Probably you were denied personal health insurance not for BS reasons, but because the insurance companies knew they would (probabilistically) lose money insuring you. But now under Obamacare, if they participate on the exchanges, they are obligated to sell to you. So, shockingly, we see that most companies operating on the exchanges lose money doing so.
Your inability to get coverage before and the problems that Aetna is having today are very closely related.
Well, not really. I had my gall bladder out about '08. I couldn't eat properly before it got out. It wasn't emergency, but the pain put me in the emergency room more than once. I didn't have gallstones, it quit working. It has been years since I got it out. I still have a few problems eating greasy foods (especially meat), but now generally avoid those and am mostly vegetarian. No other complications, and I have not required any sort of care for that surgery outside of that. Neither has my brother, who got his out about 5 years ago. Neither has my mother, who got hers out in 1978.
This type of thing isn't so much a pre-existing condition as much as they are "I had a health issue that was more severe than a simple infection". It isn't the same as "I have diabetes" or "I have chronic issues with x", which can cause expenses.
About being rejected from buying my own health insurance, based on a surgery I'd had, I think that the question of whether it's "smart" or "dumb" for insurers to do so is irrelevant.
Especially in a modern society, that decision-making process is no more relevant than asking whether it's OK to dump toxic waste into the river, because the fines could be cheaper than processing such waste safely.
Private companies refusing to sell insurance to someone where they will lose money on the transaction is not at all like dumping toxic waste into a river.
If insurance companies can't make money (or at least break even) for a certain population then they are't a viable means of making sure care is payed for, and we need to develop alternate policies to make things work.
So it's actually very very relevant to understand the decision-making process of insurance companies in these situations.
True, but Frondo also has a point. If insurance companies can cherry-pick individuals and refuse to sell to specific individuals where the insurance company is more likely to lose money, that's... not good. It kind of defeats the point of insurance, in fact.
If Obamacare-as-a-block is business they don't want, they shouldn't have to take it. If it's a subset of individuals, I'm less sympathetic.
Indeed. Obamacare-as-a-block was specifically designed to try to eliminate this cherry picking of individuals. But it's turning out that the solution might not be adequate because insurance companies are choosing to just abandon the whole block. That's what I meant with my "closely related" comment above.
And if the Obamacare exchanges don't work, that's no good either!
As I said elsewhere, the economics of health care are very challenging.
This is a discussion the rest of the western world has had and solved in various ways over the last fifty years. The economics of health care isn't a new mystery the world has never before seen, for us to unravel here, it's a matter of policy where we're just lagging behind the rest of the west.
When the marker they use to draw a dot on where they need to cut you during surgery costs $50, it's hard for me to believe that the problem with health care is insurance companies not making enough money. Why does all this stuff cost so much in the first place? Medical equipment prices seem so far separated from reality that it's seriously laughable, and it'd be funny if it wasn't everyone who had to find a way to afford this junk. Go look at some prices for medical equipment (where you can even find prices) and see if those prices seem reasonable to you for the equipment.
Let's find a way to fix that? This doesn't even touch how some hospitals / networks must buy from a specific vendor, or how vendors sell packages which include things the buyer doesn't need (at the same exorbitant prices).
> When the marker they use to draw a dot on where they need to cut you during surgery costs $50, it's hard for me to believe that the problem with health care is insurance companies not making enough money.
The insurance companies are the ones paying for that $50 dot. Well, after their discounts it's probably a $10 dot.
It was either Time or Newsweek a few years back which had an excellent long-form article on where health-care spending goes. As I recall, it's not the insurance companies: it's the hospitals, physicians, nurses, other staff and an army of hangers-on and middlemen.
If Clinton brings us single payer, I will worship at her altar forever. She used to promise this stuff in the 90's, but basically gave it all up when she actually went into politics and gained public office, later saying single payer will not work.
If she does get us single payer, she's the greatest trojan horse ever in American politics.
I'm torn. Sometimes I think Trump would be the most average President ever, and sometimes I think we have no idea at all what he would do. I'm quite sure it's unlikely he'll do anything that he's campaigned on. Wall-building is work.
I have low-income friends who have no more access to health care now than they did 8 years ago. They either wade through Medicaid paperwork, or have huge deductible plans, or just have no insurance at all. (I don't know what they are doing about the penalty.)
> Our Congress is very much in the pocket of the health care industry.
When you question some group's integrity please show restraint and back it up with solid evidence. Without that these statements are on part with racist statements like "all blacks are criminals".
It is absolutely true that government regulation is hurting healthcare in USA. It has drove the prices up and made understanding healthcare far more difficult. Hospitals do not benefit by these regulations, Insurance providers don't benefit either, Patients don't benefit either. The shi*load of these regulations has already crossed the mark where anything makes sense.
Government regulation is driven less by healthcare industries willingness to get hurt in the butt but by the voters who want government to do "something" everytime someone dies.
Profit margins of insurance companies are nothing worth boasting about. If the congress is really in pocket of insurance companies let me say they are doing a lousy job for their masters.
The benefit vs how they happened are very different things.
Initially, the benefit was that people paid all medical expenses out of pocket and could purchase insurance in case of extreme medical issues.
Businesses started offering health insurance as a perk to attract employees and would negotiate a group rate. This benefits the business by both helping to attract / retain employees as well as helping to keep those employees healthy.
Labor unions campaigned to have employer sponsored health insurance which lead to insurance lock-in to a business, usually on 3-5 year agreements, without the employee having any say in where they were getting their insurance from or how much it cost. In effect, this removed health insurance from the consumer market. Compounding the problem, businesses could tax deduct the cost of insurance while employees could not.
So both the cost and quality of insurance was removed from the consumer market. Insurance removes the cost of medical care from the consumer market. Federal tax deductions only for businesses incentivize this arrangement.
The problem here is not caused by capitalism.
This is also before we take into account sheer supply/demand factors around doctors and the regulatory bodies involved in the supply side.
We used to have much less medical care available; the best treatment for most diseases was "do nothing". That is no longer the case.
We buy car insurance and fire insurance expecting to never or rarely make a claim. We buy health insurance knowing we definitely will be making claims.
Supply and demand only works when you can establish a price equilibrium which absolutely requires that some people are priced out of the market. In healthcare that means massive disability and/or death. I don't think a fully free market in healthcare is in any way ethical.
Like infrastructure or universal mail/electricity/water, healthcare is one of those things where at least some elements cannot be efficiently delivered by a free market.
And yet, the most dramtic improvements in healthcare outcomes (life expectency, mortality), came in the period before intensive medicine. Robert Gordon's The Rise and Fall of American Growth (2016) describes this in detail. Progress since 1970 has been particularly abysmal and almost totally due to increased access for the most under-served populations.
It turns out that there are very sharply diminishing returns to intensive medical care. And that getting the basics right -- pre-natal care, effective childbirth, well-mother-and-baby care, vaccinations, good nutrition, an environment clear of pollution and contamination (especially lead, mercury, asbestos, smoke, and miscellaneous hazards) has a tremendous effect on improving infant survival and adult capabilities in both physical and mental health.
The same precise services which lack of healthcare limit.
There are also specific interventions which can be hugely impressively. One doctor I know entered the profession after witnessing what a single dose of narcan could do to an ODing heroin junkie. (Mind, you've still got an addict to deal with after ripping them out of Death's Cold Hands, but you've got a live addict, not a dead one.) Wound care, reconstructive surgery, bonesetting, and treatments for at least some diseases and conditions are pretty amazing.
But people still eventually die, and putting of the inevitable is extremely expensive. The share of Medicare (and total) healthcare expenditures invoked in the last 12 months of life are quite high, though I've not the specific figures.
And the US healthcare industry, in cost for outcomes achieved, is horrendously inefficient. It remains unavailable for far, far too many people.
It's hard to tell if there are inefficiencies and waste or if health care is just simply really expensive.
Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending.
Is that due to waste or inefficiencies? I honestly have no idea. I just know that it's a big number.
Another thing to keep in mind is that, at least in Canada, the government provides some base amount of health services, but there are still other things that aren't covered. In Alberta, someone might go to the ER for a severe asthma attack and that's covered, but the prescriptions to keep the asthma under control are paid for out of pocket or from a benefit plan (which could be an individual plan or through an employer). Similarly, dental is not covered, but may be covered under a benefit plan.
Why do you say inefficiencies? 40% is entirely out of context, because you haven't listed what other budgeting responsibilities Canadian provinces have.
Canada spends far less per capita on health than the us, and gets better outcomes.
It's certainly expensive, but it's hard to make the case that Canadian care is expensive relative to the US.
It's all relative. Alberta is "high" compared to other provinces though in the ball park of the other prairie provinces (Sask & Manitoba) per capita, though BC only spends $18B-ish for a higher population.
Ontario spends $50.8B, pop 13.1m, which seems more efficient per capita than Alberta; France is inline with that per capita ; the UK spends $195.8B (CAD), pop 64.1m, which is even lower.
> Health care is done by the Provinces in Canada, with transfers from the Federal Government to help out. The most recent Alberta budget[0] puts the cost of health care at about $20B. This represents approximately 40% of Alberta government spending.
> US health spending reached $3.0 trillion in 2014, or $9,523 per capita, and accounted for 17.5% of gross domestic product (GDP).
The Population of Alberta is around 4,196,457 per a statscan estimate for 2015.
4,196,457 * 9,523 = 39962860011
So we're spending ~20,000,000,000 CAD = ~15.5 Billion USD, versus 39,962,860,011 USD for the same population in the US.
edit: The US number seems to include prescription drug spending. Per http://www.statista.com/statistics/436305/medication-spendin..., it's $867 per person in Alberta, or $3,638,328,219 CAD -- so it's closer to $18.5 Billion USD for health spending in Alberta.
That's a better deal any way you look at it, especially when you bear in mind that Canada has better overall outcomes than the US.
I'm Canadian and can't get a family doctor (nor can my wife). I don't consider that a "good deal". Maybe if it was more lucrative (read: doctors made more money, budgets were higher) we could attract more talent and I could?
The US system has the same issue -- many people don't have a regular family doctor and rely on clinics. It's a more complicated problem than pay -- family medicine simply isn't an attractive speciality to many medical students. Money could move the needle a bit, but treating strep throat is never going to be a prestigious pursuit versus a lot of other specialties. And if it doesn't improve overall longterm outcomes, it's not worth spending the money to move that needle.
At any rate, it's rarely impossible to find a family doctor, but it can take some persistence to find one accepting new patients. Almost every provincial medical association maintains a list of family doctors accepting new patients. If you're in a small town it might be a challenge, though.
Where do you live that you are having these problems? I was able to find a family doctor within a month of searching and reading reviews. Granted I'm based in a major city (Ottawa), but I was normally directed to other physicians when I called one that wasn't accepting patients.
I would really like to see a breakdown of the actual costs to provide a given service. Take something simple like removing an appendix or gall bladder. You have one surgeon, one or two surgical assistants (typically med students / interns), plus a couple nursing staff, and the anesthesiologist, for about an hour. 6 people, assume 200K per year, that's $100 per hour, so $600 in people salaries. (Throw in another couple hours total for prep time, consultation, planning, etc, still you are talking less than 2k).
Then you have amortization of the equipment and operating room, and some fraction of the hospital support staff during the prep and recovery stages. But even with that I still don't see where the $80,000 for the surgery cost comes from.
They are the person most able to kill you when they screw up, so a significant portion of that bill is insurance. They also make $300-500k.
Also recovery room or ICU time is very expensive -- something like $1000/hr in some cases.
That type of procedure (gall bladder) will cost something like $15-20k.
When I had a spinal fusion, it was a 4-5 hour procedure involving a neurosurgeon, his PA, an anesthesiologist and his nurse, and 4-5 others. That procedure cost ~ $125k.
Aren't healthcare list prices in the US really really distorted and nonsensical, due to decades of messed up incentives between hospitals and insurers?
Cannot speak for the cause, but the prices are distorted. I was taken to ER a couple of months ago and x-ray of chest cost $3500 and CT of chest $5500. The equivalent prices at the private sector of my home country would have been $70 and $120 and I could have gotten those done just as quickly as in ER in US.
I've actually found that you can get list prices from hospitals. The problem is that they're distorted and sky-high and not necessarily very reflective of what you will have to pay if you have insurance, because the insurers have negotiated their own rates. Those rates are treated as top secret by everyone involved (that is, until you get a bill).
It's because in healthcare, the vendor never knows if or when they will be paid, and how much it will cost to get paid, so the strategy is to charge as much as possible and just hope for the best. That means people who are dead broke get their care for free since they have nothing to pay with, insurance companies and the government strong arm the vendor into discounts since they buy in volume, and the person that gets screwed is the little guy who makes enough money to not be poor, but not enough money to have gold plated insurance but he also can't fight the hospital.
1. Health care is, indeed, really expensive. Most places with government-provided health care try to make sure the most expensive items aren't over-bought, reducing waste. For example, MRI machines. Some folks have to travel quite far to get a non-emergency MRI in Canada and wait some time, yet in the states, there might be 3-4 places in a city with 50k people. Neither extreme is ideal.
2. There are always going to be a few inefficiencies in health care, just like every other business. Some of these can't be helped as much. We want well-stocked emergency rooms and pharmacies to visit after the 2am visit said emergency rooms, for example. Drugs expire: Pharmacies take manpower even in slow times.
3. The other thing with health care is that it does somewhat cost what it costs. There are ways to reduce some of the costs by public education, generic drugs, not providing antibiotics when they aren't needed, and other such things. But folks get sick and hurt regardless.
Side note: The bit about the prescriptions is interesting. I'm in Norway. Private health care is available, but everyone is covered by the state health care. You pay a certain amount per year, then the government covers most things. Prescription coverage vary once the government starts paying. Things you need for life - such as heart medicines - will wind up covered, but some things like allergy meds you might have to pay a portion of the cost regardless. Most hospital expenses are free.
Dental is free for children under 18: 18 and 19 year olds get 75% covered and adults have to pay out of pocket.
The prescription thing is a pain in the butt. My mom had to pay out of pocket for her medication for years, until she got a job with prescription coverage.
A market allows for innovators to find ways to deliver better service for less money and thus offer a more competitive product and gain market share. This competition forces all players to improve, or be forced from the market.
A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.
In the US we have two examples of public insurance providers Medicare and the Veterans Administration (VA).
What we haven't tried as far as I can tell is to apply regulatory pressure with marketing forces. So for example if we made it illegal for pharmaceutical companies from preventing generics to be sold or marketed. If we required by regulation that all facilities publish their costs, and to whom those costs were paid, for every procedure. If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database. Etc. It might help in making the market more efficient.
> A publicly owned and operated business has no incentive to improve its operational efficiency and little to no incentive to respond to complaints in service.
In the UK, the NHS has the incentive to improve its operational efficiency that it simply gets told regularly "we're cutting X billions of your budget. Deal".
The NHS is also split up into a range of trusts that have independent management teams. While there's a lot of cooperation and shared resources, this means there is a lot of opportunity to compare cost and outcomes, and so they can't just hide behind "but that's how much it costs", because the government will know it if there are other trusts delivering similar outcomes at a much lower cost.
And they have the incentive to respond to complaints in service that the NHS Trust in questions board of director will find campaign groups talking to MPs and cabinet ministers, tabloids calling them murderers and the like if they don't keep quality under control, and if they don't respond appropriately, the trust will get put under special measures which can include letting another trust take over management.
There are plenty of ways to apply pressure in addition to markets.
But you have some points: You can certainly make things better by e.g. requiring more transparency.
> In the UK, the NHS has the incentive to improve its operational efficiency that it simply gets told regularly "we're cutting X billions of your budget. Deal".
The trouble with this approach is that we've reached the point where they really can't deal and are consistently blowing through their budgets and talking about refusing non-urgent referrals for months at a time, and the government is just blaming them for overruning their budgets and punishing them with even more budget cuts.
> If we required that all medical procedure costs and options at every facility had to be made available at a publicly searchable database.
Well, there's a couple of problems here:
1) People who fail to pay their bills cause financial losses, which have to be covered by the hospital. Therefore, given identical personnel/equipment/etc costs, a hospital in a "poorer" (= more unpaid bills) area will always be higher in cost than a hospital in a "richer" area, since losses have to be distributed among the fully paying customers.
2) You cannot just compare different hospitals on pricing alone. Factors that make this impossible include rent, personnel costs, and equipment costs (e.g. a hospital which uses an old MRT will operate at a cheaper rate than one which buys a new MRT every year).
3) Medical procedure costs can not be estimated at all, given just the diagnosis. Right now my cat is at the vet hospital, turns out the (relatively simple) laying of a pipe to the stomach (she doesn't eat/drink anymore due to liver inflammation, and syringe feeding a cat is cruel for both owner and cat) isn't so simple at all for this unique cat. (For the fellow cat owners, the only thing not healthy about this cat is the liver. The rest of her is in a pretty good condition, and the vets believe she'll make it and purr on for years).
Case 1 and 2 are the same whether or not you tell people up front, and if so it is downright unethical not to, as e.g. in scenario 1, poor people end up being charged more for something they might have been able to save massive amounts on by travelling to a different hospital for non-emergency treatment. Yes, you'd need to include other information, like information about outcomes.
Regarding #3, I find that peculiar. Yes, for major operations there are always potential outliers, and you need to give a range and there may be potential large exceptions. But e.g. UK private providers will happily give you a quote in advance for most non-emergency care, and for anything with a straighforward diagnosis they will be willing to give you a fixed fee quote with certain exceptions. Not least because they have the volume to either self-insure, or get insurance to cover exceptions.
This meme that private businesses are always better than government because of market incentives has been proven false time and time again. Cities starting municipal broadband services are far, far better than the private businesses that should have been more efficient and more innovative, should your meme hold true.
IMHO if VA, Medicare and federal employee coverage were a gov't backed NPO insurance company, that could provide a baseline and competition. Of course, that would have to also cover the administration and congress. That would act as both a baseline and incentive to compete, with that corporation open to state, company and individual plans.
As to pharmaceutical costs, there's two things that need to happen First is that extension patent approvals must be significantly reduced (requiring moving more of the patent fees up to the application stage to cover more review/appeal costs). The second would be statutory licensing for all patents on medication after say 5 years, allowing for generics at a fixed patent licensing fee after the patent is 5 years old.
The only place I know that actually has a market is Switzerland. Insurers are required to offer "basic insurance." Everyone in the country is required to buy it. If you are below poverty line, it is paid for by the government. What is covered by basic insurance is set by the government, and so independent of insurer. Likewise, what insurers can ask to set rates is set by the government (age, income, sex, and smoking status basically). Insurers are required to sell basic insurance to anyone who wants to purchase. All insurance billing uses the same set of forms, so there's very little office overhead. This actually produces something that looks like a market. You can get on a website, put in a couple of values, and get a lot of quotes instantly, pick one, put in your credit card, and you're insured. Companies also sell further insurance beyond basic, and compete on quality of service for basic.
Swiss healthcare is regarded as decent but far too expensive for what it is compared to the single payer systems in all its neighbors.
Paying for healthcare isn't the place you worry about inefficiencies and waste. It's going to get paid for, and the possible efficiencies of pushing paper around are dwarfed by the cost of actually delivering medical care. So what you actually care about is delivery of health care. Italy does this really well. They have public hospitals and clinics and private ones, too. If you go to a public one, you're covered. If you go to a private one, the government pays the same to the clinic that it would pay to the public clinic. So the public system serves as a reference that the private system has to match in efficiency, performance, and price.
There is no medical or macroeconomic justification for private insurance companies. It's historical accident perpetuated by monied interests.
I always go for a high deductible (and lower monthly fee) for example.
Edit:
(1) Costs for individual: It does cost me around 80 euros, my deductible is 800 euros (maximum allowed) and I'm 100% covered for medical costs at the physician and at the hospital.
The general consensus is that the U.S. spends more on health care than other high-income countries but has worse outcomes.
"Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%)."
If there are benefits to a private system, we aren't seeing them. (That may be because we don't have a private system OR a public system. We have a frankenstein hybrid that's the worst of both and works for no one.)
The biggest problem is all the attention has been focused on who pays, rather than how much. The cost system for US Healthcare is so opaque, so disjointed that no one--not the providers, not the customers, not the insurers--have the required understanding or motivations to control costs.
I absolutely think that a national policy should focus on maximizing outcomes across society, but it is easy to imagine that some people don't care about the outcomes that other people receive.
> Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance (government, aka "public option")?
Government provision of health insurance means that every procedure covered is a political issue (e.g. abortion for the left, sexual-orientation counselling for the right). This means that there will be nationwide winners and losers, and no-one but the rich will be able to simply change providers, as with a private market. As an example, look at how public schools are run: only the rich are able to opt out of government schooling.
American governments are not capable of running efficient programmes, because to a first approximation American government employment is a make-work program for people who can't get hired at anywhere that cares about competence. That means that a government insurance provider will be incompetent and inefficient.
To make things worse, the employees of said provider will be unionised, and that union will do its best to make it even more inefficient (e.g. take a look at the prison guards' unions).
> American governments are not capable of running efficient programmes, because to a first approximation American government employment is a make-work program for people who can't get hired at anywhere that cares about competence.
American governments are not capable of running efficient programs because to a zeroth approximation Americans keep electing politicians that not only promise that government can't do anything right, but also work to ensure it.
"American governments are not capable of running efficient programs" - that's simply false, and your statement about government employees is insulting.
Insulting to whom? While it's a generalization, it's pretty much accurate in the entirety of my personal and professional experience. Some good competent folks work for the government, but they are drowned out to the point of absurdity by the masses of folks doing enough to not get fired. Which generally means showing up on time and not doing something the other bored employees in the office can complain to your manager about.
I have pretty extensive experience with it at both local and state levels, with some experience on the Federal side. There are certain agencies and careers that seem to still attract decent folks, but they seem exceedingly rare.
It was insulting to every person that works in the government, and especially to those people you mention that are "good competent folks".
If your only experience with government employees is asking them to provide service to you, then all you can comment on is how effective they were at doing that job. You cannot know what their general competence level is, nor can you know how they'd do outside of government employ, because you don't know what their job actually entails. I'll give you a hint, though - it's a lot more then helping you.
Even if you've worked for a government agency, which sounds unlikely based on your most recent post, you've only seen a tiny sliver of government employees. You can talk about the competence of that tiny sliver if you care to, but not all government employees.
Look, I get it, it's easy to complain about government workers. It's like complaining that all used car salesmen and mechanics are crooks. Using it in an attempt to prove a point though, is foolish, and that's exactly what you did.
I'm surprised at how many people think the answer is "no benefit" or political expediency.
The hope is that insurers will compete with each other and find ways to reduce costs. Obamacare has regulations designed to prevent the most egregious cost-saving measures (denying claims, rescission, etc), so insurers will have to find ways to reduce costs other than simply not paying. Because many insurers are small, they can try experiments that would be prohibitive in a larger insurer. We'll get a lot of data about what works and what doesn't, which will filter up to larger insurers (like Medicare!).
One example of a way that an insurer could save money is pay-for-performance, that pays health care providers based on the health improvements of their patients instead of volume of services. Aetna is trying this.
That's the case for a market. (There's definitely a case against it too.)
One thing missing from this discussion is the fact that the health care exchanges are small relative to the rest of the market: around 10 million enrollees on the exchanges, compared to ~150 million in employer sponsored plans. This is because Medicaid expansion covered more people, and fewer employers dropped their employee-sponsored health insurance, compared to predictions. So the exchanges aren't really a big player.
> Can anyone succinctly explain the benefits of having a market for private health insurance companies, rather than a single provider of health insurance
For the citizen, none. For the insurance companies, they get forced signups.
> Does the lack of a large private insurance market in countries with government-provided health insurance cause lots of inefficiencies and waste?
The US spends the most of any nation on health care. The US is the only western nation with increasing infant and maternal mortality rates.
The increasing infant and maternal mortality rates are caused more by increasing obesity than any other factor. Improving prenatal care would help a little but doesn't get to the root cause of the problem.
Actually, that's false. I can assure you that having lived in Canada and having moved to the US because of health care, having options beyond "deal with it" when not getting any sort of care or service is wonderful. Single-payer is great if you are actually getting the care you need. But when it fails, you are left with little to no alternative.
What's worse is that because of the perception that single-payer is so great, people don't really push for real solutions to solve its many problems. People would rather stick their head in the sand and ignore the very real problems, pretending everything is ok.
Until then, we happily live here in the US where we get more services for less than what it would have cost in Canada.
You must be pretty healthy or never actually had to pay for care in the US. You also probably shouldn't assume you're the only one in the room who moved to the US from another country.
I moved to the US from Canada, thankfully I am pretty healthy and don't need the healthcare system beyond my yearly checkups. The first place I lived had someone who lived down the street who will be paying off a $100k bill until they die because of a heart surgery they had to have. Wonderful system.
On the other hand my father, who still lives in Canada, complained of shortness of breath one Thursday. Called his doctor and was told to go into the emergency room right then. He did, because he didn't have to worry about how much the visit would cost. They found a 90% blockage in his aorta. Was immediately admitted for surgery that occurred Friday. Was free to leave the next week. Total cost, $150.
So I agree the US health care system is pretty crap - but as a trans person it was still better than my options in my home province (and by options I mean option). I think we can all agree that there are corner cases for each system where they outperform the other.
Apparently we can't agree that there are no benefits. =/ Every time I suggest issues with Canadian healthcare and how in some cases, the US healthcare system is better, people assume it's all a lie. And, well, frankly, that's why it won't get better.
> You must be pretty healthy or never actually had to pay for care in the US.
Wrong. You probably shouldn't assume you know anything about me, or the situation I'm in.
> You also probably shouldn't assume you're the only one in the room who moved to the US from another country.
You probably shouldn't assume that it matters.
> The first place I lived had someone who lived
I was referring to problems with the system as a whole for entire groups of people, not just individual stories. My children being one of those where the Canadian system fails them horribly.
But no, continue believing that Canadian Health Care is perfect for everyone and that there are no benefits the US system for normal citizens.
> I was referring to problems with the system as a whole for entire groups of people, not just individual stories.
This person is not an isolated incident. Major medical care in the US is far more expensive than any other nation on the planet and for a large number of people in the US life saving care means financial ruin.
> My children being one of those where the Canadian system fails them horribly.
You can't be serious. Need your child to see their primary care physician in the US because it has a fever? That appointment is probably a week or more out, in Canada, they will see that child that day. And that visit will not cost money.
Simply posting as an American on HN I can make a good guess you are paid far better than the majority of the nation. Do you not know people that are not? When a child gets sick, it is a question on whether or not to call the doctor or go to urgent care because that visit costs money. If it's not the visit that is too expensive, its a question of if whatever treatment can be afforded.
The US system is entirely around how well you can afford to be. There are no benefits to the US healthcare system unless you are rich, a doctor or an insurance company.
> You can't be serious. Need your child to see their primary care physician in the US because it has a fever?
I'm not referring to a simple thing like a fever. I'm referring to more serious things, like autism.
> That appointment is probably a week or more out,
We got assistance from the US before we moved here.
> in Canada, they will see that child that day.
The wait time was years. Literally.
> The US system is entirely around how well you can afford to be.
The services that specifically benefit my children's autism has nothing to do with how much I can afford, or my level of insurance. In Canada, however, it would have cost me $30k+ a year to get assistance in the shortest amount of time, and that was still after a 1.5 year wait.
You are making assumptions, all wrong, about the situation my family is in. If you want to pretend that Canada offered better care for them, be my guest. I just hope you never have to go through what we had to go through. It was horrible, and your blind assumption that Canadian health care is superior in all cases is because you choose to remain ignorant of it's problems.
> There are no benefits to the US healthcare system unless you are rich, a doctor or an insurance company.
Or, in my case, I love my child and don't want to see him abused by a corrupted system.
I read the other comments to this comment, and I'll agree that you must either have money or decent health care coverage, probably a combination of the two.
I read differing stories about the Canadian health care system: Some places it works out better than others, no system is perfect. I'm American, I live in Norway. The system isn't perfect here either, but I never want to go back. Here it is mostly single payer, with some blips, but folks can choose a private doctor if they'd like to and can pay for the difference in cost.
Not having money/health care coverage in the states means things like suddenly having to change your children's doctor because they no longer accept the governemnt health care. Not being able to get surgery for cancer or your bum knee because you can't pay upfront. Considering bankruptcy because you had a heart attack and surgery for it. The hospital 'nicely' dropped the payment to 200k, but you were a flooring installer making less than 25k a year - which you are advised by the doctor that you can no longer do. Paying out of pockets for medications might be an issue, especially if your loved one's anti-psychotic costs 2,000 a month or the injection you take for your MS costs between 2,500 and 5,000 per month.
The market is great if you can pay to get the care you need, but when that fails, you are left with little to no alternative.
> I read the other comments to this comment, and I'll agree that you must either have money or decent health care coverage, probably a combination of the two.
That's incorrect. The benefits I receive have nothing to do with my insurance or my salary.
> Here it is mostly single payer, with some blips, but folks can choose a private doctor if they'd like to and can pay for the difference in cost.
Autism support in Canada falls into this "blip." Unfortunately, it's not as easy as going to a private doctor. Just because you need services now doesn't mean you can pay to get it, even if you had the money.
Sorry, but the idea that there are no benefits to the US system over the Canadian system is simply false. In my case, the US was cheaper, faster, and superior in ever way.
What I was lucky to have was the ability to make that decision to move. Canadians generally don't have that choice.
Somewhat off topic, it seems to be easier for Canadians to permanently move to the US then for Americans to move to Canada. In your experience is that true?
Not sure. I'm American. My wife is Canadian. My children, by virtue of being my children, have dual citizenship.
Edit: Just to be clear, I can't fairly compare. My wife has an easy time because of me and my children, and I had an easy time moving and working in Canada because of my skills.
Remember that the existence of private players doesn't mean that you have a free market, which tends to drive efficiencies.
In the US, it's more of a planned/command economy.
A retail consumer gets the worst price. (Think the "rack rate that you never pay that's in the back of a hotel door) The government through Medicare/Medicaid/Tricare gets the best price. Everyone else is in the middle, on a spectrum of discount based mostly on size or some other market power.
In a single payer system, you end up controlling costs by compelling the providers to work for the system (similar to an HMO like Kaiser), prioritizing certain services and using regulation to discourage bad vendor behavior, like drug profiteering.
> you end up controlling costs by compelling the providers
This is the basic premise of socialism. But it never works out. What you end up getting is either very low quality at high prices or very low availability.
Obamacare attempts to do exactly that, and as a result the providers are simply leaving the "market". Meanwhile, price has skyrocketed, and quality of coverage has dropped dramatically.
My marketplace plan would likely bankrupt me if I got a serious condition, however the coverage I had before Obamacare was very good and very cheap. I'm not that much older!
Except that's not the case in other single payer systems ...
The NHS has its flaws (having to wait for non-urgent or non life-threatening issues to be treated, but they are in fact treated, just at a lower priority) but if you present at the hospital with chest pains you'll be sorted out straight away, without having to pay up front - free at the source of treatment, one of the founding tenets of the service.
It also doesn't preclude a private system that works alongside it, which many companies offer to their employees. This allows you to get seen quicker for the non-urgent stuff - if it's life threatening you'll be taken straight to an NHS hospital, but have your follow up care privately.
We pay less of our GDP on healthcare, yet have comparable, if not better, outcomes.
With the current "privatisation" that's occurring, vendors are invited to bid for the work, no compelling, it's there if they want it. If nobody comes forward to provide it, the NHS will do it instead.
That's republican health policy. It was essentially the Romney plan rolled out in Massachusetts, and the only thing that would pass.
Obamacare is actually working very well in compelling the providers to participate. In most regions, private practices are rolling up into regional health systems, often around anchor hospitals.
The main issue with healthcare in the u.s. actually has to do with Medicare, Medicaid, and social security.
All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices. Private insurance options pay larger percentages: 12 - 50%. People without insurance usually will pay either 100% or 0%, with some people negotiating in between.
Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates.
Fyi I worked in a medical billing office for 5 years. We did payment processing for about 30% of all hospitals on the east coast and Midwest
> Honestly, the easiest way to fix it is to get rid of Medicare, Medicaid, and social security or force everyone to pay 100% as opposed to negotiating lower rates.
Bullshit. This isn't an easy problem, and you're casually dismissing systems that support millions of people.
> All of the state options pay only ~10% of what they are billed no matter how large the bill (there is also usually a cap). This forces hospitals to charge exorbitant prices.
I think the point was if everyone had to pay "full price" the full price would be lower, but right now the prices are inflated so 10% of the price is what they actually hoped to make.
Supports millions of people in what way? I "casually" wrote off millions a dollars a day in the billing office for people who didn't have insurance. I "casually" wrote off 90% of people's bills who were state funded.
The only people we actually were forced to try and collect on were private companies and people making over $X per year.
I have no idea how much experience you have with this stuff, but the unfairness comes from the fact doctors/hospitals can effectively charge outrageous prices, knowing they will only make a percentage. On the state payments, they lose money and on the private insurance companies, wealthy and naive honest people they will make more. They have to charge that much to make up for the difference caused by the state options, and people who never pay.
Just like any system with a (semi)guaranteed payment (college tuition, healthcare, government contracts, minimum wage, etc.) Prices will inflate capturing the free market rate + the guaranteed amount. If you want to fix that, you have to force deflation by forcing everyone to pay equally. You can do that by removing the guaranteed payment and create competition.
Seriously, this is econ 101...
Also, antibiotics, insulin, and many of the other standard drugs doctors prescribe could essentially be free for everyone for half the cost of Medicare. Insurance companies only pay like 10% on the dollar for that stuff. So I would much rather "support" everyone by providing the basics, and having the rest be a free market. It would solve probably 80% of the issues with the current healthcare system.
1. In theory, a competitive marketplace should be able to cut costs and improve outcomes by incentivizing innovation and efficiency (of course, you also have to try to guard against incentivizing insurers to cut costs by reducing access to care).
2. Switching to a single-payer model would be incredibly disruptive to the economy. It would need to be done gradually to minimize the pain.
I actually work for a health insurer, but I've also been a big proponent of healthcare reform for quite some time (I see the ACA as a step in the right direction). I'm definitely not opposed to single-payer, but I don't think it would be a silver bullet, either.
> In theory, a competitive marketplace should be able to cut costs and improve outcomes
Outside of theory, can you think of any example where this has actually happened in US health care?
The only cost cutting I can think of are notably lower payments to doctors, the insurers fighting every claim, and higher deductibles and co-insurance for the patients. So I guess that cut costs for the health insurer, but the providers and patients costs have gone up directly and dramatically.
The US health care market is not competitive in that way because of the incentives do not work that way. The US health care market is not consumer driving it is employer driven, and employers want all the things you bring up because it lowers their costs. What employers fear is that someone will offer a health insurance plan that is competitive to theirs, which makes it easier for my to change jobs.
Employers like the fact that I pay $200/month for my health insurance, they pay $1000/month. If I want a health insurance plan that improves outcomes and which costs $1500/month I have to come up with the $1500/month, not just the $300 difference. (the above numbers are all made up, but they are realistic)
I have long believed that we cannot solve the US health care problems without removing the incentives that force me to use my employers' policy like it or not.
In short, you don't see those examples in the US because the system is not competitive on outcomes, only costs. Since cost is the only thing they compete one insurers offer lower payments to doctors, fight every claim, add higher deductibles (which is a hidden cost on me) and co-insurance for the patients. These are innovative, not all are innovations that I would want my insurance company to come up with, but since I'm not a customer they don't care what innovations I want.
#1. This is going to generate useless flame wars, because most people on both sides don't know very basic facts.
#2. Using a private insurance company means you get, in theory, to pick a provider that matches up with your desires on how to determine what is and isn't covered.
To answer your question, the way we think of health insurance isn't compatible with a free market system. Insurance pools risk and money to cap your losses in rare, ruinous events. But that's not how we use health insurance. We use health insurance to pay for low-cost, common, certain-to-happen events (blood work, checkups, X-rays, sprained joints, etc.). To borrow an example from the book, imagine we had grocery insurance. Every month, you paid $500 to the grocery insurance company, and you could go to the store to pick out any covered groceries. The market for food would quickly take on all the negative features we find in the market for healthcare. Prices that are crazy and only get higher, minimal competitive forces against low-quality providers, no transparency for consumers, etc.
Market forces are great at lowering prices while increasing quality, but they only work if people personally decide how and where to spend their money. If you give your money to a third party who then makes all the spending decisions, it smothers all the price/demand/competition signals that providers should naturally get. (And which, in a healthy market, automatically put providers out of business when their prices get to high or their results dip too low.)
To borrow from the book again: it seems crazy to expect people to pay for healthcare out of pocket. But add up your premiums. You're probably paying $6-10k per year right now. That's many times more than enough to cover typical healthcare in most years. With plenty left over to buy catastrophic coverage for high-cost low-probability stuff. And in a market where people are making their own decisions with their own money, prices would quickly drop, which would stretch your out-of-pocket dollars much further than they go today. Every $2500 MRI would go out of business, replaced by $500 ones. (We already see this kind of price deflation in the corners of medicine where people do pay out of pocket, namely laser vision correction, plastic surgery, and to some extent walk-in checkup clinics.)
Competition is very important. Government provides free education. Is there a case for private educational institutes ? Surely yes there is. Catholic schools, schools focused on gifted children, schools focused on differently-able children etc. that diversity is important in all spheres of life.
Also, please note that when you use words like "government provided insurance" the word insurance can mean something totally different under government just the way we have learned that government's definitions of "traitor", "whistleblower", "sex offender" are different from what common sense might tell us.
If only government provides insurance government also ends up deciding what health services we can use or not use. For example Liberals might say "sex change surgery" is essential procedure and force tax-payers pay for it. Conservatives on other hand might say any health issues occurring because of anal sex will not be covered.
I think one big problem is that American's who support single payer system fail to see that "healthcare" is a lose term and under the "single payer" that definition might change to suite the payer instead of consumers.
First of all, it makes no sense if you've mandated the specifications of the product being sold via legislation. Having said that, a huge benefit would be the ability to buy insurance: actual insurance, in which you're paying a subscription fee for the service of protecting you from the risk of a huge surgery bill, rather than a payment plan that covers everything inside the walls of a hospital. As a young adult, I would be happy to pay for a service that would insulate me from risk I can't handle, because it would make me financially stable. But if the plan also covers predictable things like obese people needing diabetes meds, children being delivered, and obscenely expensive cancer treatment that only slightly extends a low-quality end of life, that's a different question. Suddenly (probability of medical emergency) X (expected cost) << (cost of insurance premium), even if you add a $500 penalty to the left side of the equation. Bankruptcy seems like the smart insurance if I'm not amassing significant savings, in that case.
Everything outside of those complicated, expensive procedures would suddenly be susceptible to price sensitivity, since the users would also be the people paying. Faced with that pressure, routine procedures would fall to prices that don't look like typos.
Having said that, what I've read about the British system seems like it could be effective, if it were politically feasible: procedures have to stay below the cost per unit of increase in life expectancy or quality of life, or else you have to fund it yourself. When the current American system was being battled into law, it seems like that number was about 30kpounds per year of life.
> rather than a single provider of health insurance (government, aka "public option")
Those aren't the same thing at all.
It's impossible to debate health care at all because everyone believes a bunch of fairy tales. HN is an extremely poor place to discuss this, because people here are smart enough to think that they aren't being influenced by politics.
There's no benefit I can see. Our present system combines everything that is bad about "socialized" medicine (loads of regulation, bureaucracy, inflexibility, etc.) with everything that is bad about private medicine (inequality, high cost, fragmentation).
It's not just the rich who do well, it's the middlemen at every step of the process. Everyone skims a little extra off the top when medicine or medical equipment is so expensive. Bring costs in line with any other western nation and you're looking at a massive wealth transfer away from everyone with their finger in the health care pie--not just the rich.
Switzerland, Germany and other countries lack single player plans. Israel has 4 different integrated health providers that compete to provide care. I am sure there are many other examples of health care systems that choose not to use a single payer.
The best is probably a mix, like Singapore. The citizens win in the case the government provider is efficient or inefficient, because in either scenario the government sets a floor of efficiency that private companies can't go under and survive. In a purely private market there's the potential for collusion, or in a heavily regulated market there's the potential for forced inefficiencies. When you just have the single government provider, you cut off the possibility of doing much better, and you create a big incentive for everyone in the industry to inflate their costs because the government always pays.
Independent of the presence or absence of a public option, the benefits of a private market largely depend on whether an actual competetive market with consumer choice and pricing comparison can exist. In the US it cannot due to regulatory capture and occupational licensing plaguing the industry and creating massive market distortions. Consumers are completely disconnected from pricing.
Single payer and private markets can be complimentary, with private insurance funding more personalized care and a recourse from the dreaded death panels.
Single payer with private markets seems to be the model many countries are converging on.
I'm not well enough informed to give a complete opinion on what's better, because it's a complicated solution. I do know some reasons why a public option might not be good. (This doesn't mean it's the wrong option - just considerations)
1 - When you eliminate competition, you lose innovation and smart cost control. Look at most monopolies for evidence of this.
2 - You wind up forcing a "one size fits all" on everyone. What if some people prefer a bare bones service, and others prefer an advanced one?
3 - How many things does the government really run well?
If the government is going to be making all the decisions there's no benefit. But I doubt we would have had Obamacare at all if he'd proposed a single-payer plan. Insurance companies, which have a lot of clout in Washington, helped push it through because they expected to make more money.
Which, quite frankly, was stupid. It was pretty clear from the outset the ACA would break the US health care system so badly single-payer is the only option going forward.
If by "sponsors" you mean the political leaders, then yes. They knew they were fudging the books. They explicitly abused the GAO ten year window to make it look like there would be enough money even though the wheels were due to start coming off after seven years.
They also had enough political experience to know getting the (delayed) more unpopular parts (like cuts in payments to doctors accepting Medicare, increases to penalties for people who don't buy insurance, and extra taxes for "Cadillac plans") might be too difficult to get through when the time came. That's why they were delayed.
I suppose I can give them enough benefit of the doubt to say many of them may have believed once the system was in place they could solve the problems by closing the gap with something something.
that wouldn't happen. since it's monopolism.
You would end up in a system like germany. And at the moment these "public" health insurance companies raising their fee's every year. Not better than having private ones, since their regulators just don't care.
They praise their reduces with taxes but they don't care if everything else got higher we still end up in a loss.
Everything the government provides causes lots of inefficiencies and waste, and unintended consequences to boot.
That said, some things may be worth the sacrifice, healthcare may be one of those things. One question to ask, will the quality of care improve (whatever the cost) if the government takes over?
Since the US is made up of states, what is stopping one state from providing single-payer and proving the model works?
I was under the impression that the purpose of the private healthcare marketplace was to satisfy the right-leaning Democrats who were on the fence about passing Obamacare and as a pacifier against a full-scale filibuster by Republicans. I think the architects have known it's going to fail, and want to use this failure as leverage for the creation of the public option.
From the point of view of people opposed to single-payer, you're not even asking the right question. It's not about which is more beneficial on the balance. It's about whether the private sector solution is so broken as to overcome the presumption against a government-run solution.
Anecdotally, while Britain's medical system has less wait times, doctors working for the NHS are chronically overworked and underpaid. Many move to Australia or go into private practice after completing their residencies.
Note the date. He did studies in the 1970s and updated them in the 1990s with consistent results. This was all well known and the case was made repeatedly before Obamacare was passed.
The healthcare system in countries like France, Canada, Germany is much more efficient and provides better healthcare to most of it's citizens than the US healthcare system pre and post obamacare.
There's this cartoon understanding the health care system, where the US has system A, and every other country in the world has system B. You will find people on both sides of the aisle believing this. Even though Germany is closer to the US than it is to France.
The big difference with respect to Germany, though, is that they are not afraid to regulate their health sector. The problem with the US model is not so much private vs. public, but a matter of lobbyists and ideology getting in the way of regulating it in the way that makes sense for people instead of for healthcare providers and insurers.
(France also has a mix of private and public healthcare insurance)
Yeah I'm not buying this and never have. You're going to need to cite some kind of scientific statistics or stats or studies.
When people get sick they come to the US for treatment if they can. You don't see world leaders and those with money going to Canada or Europe for treatment. Not when it's dire. The US is hella expensive for many reasons one is that we have the most bleeding edge medical technology.
> You're going to need to cite some kind of scientific statistics or stats or studies.
There are plenty of studies that support his position.
But there are also lots of studies that oppose his position.
And everyone will listen to the studies that support their prior viewpoint and say that the others are bunk.
You could have a good debate about health care if everyone gave up their priors, was willing to listen to opposing evidence, and was willing to accept their preferred system has real honest-to-God not-said-sarcastically tradeoffs. Let us know when that happens.
You can find other articles and studies echoing the same conclusions.
> When people get sick they come to the US for treatment if they can.
No they don't. And many Americans go to other countries for treatment because they can't afford it in the US.
> You don't see world leaders and those with money going to Canada or Europe for treatment.
'Those with money' is a tiny portion of the population, which is why I said 'most citizens' get better healthcare in other countries (developed ones).
> The US is hella expensive for many reasons one is that we have the most bleeding edge medical technology.
Not really, US has some bleeding edge medicine, not the best for every aspect of health, and the bleeding edge stuff is only available to a very tiny portion of the population.
The purpose of government is not to require the most efficient option. Government isn't capable of it anyway. Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will. For example, in Canada (until recently) people were prohibited from using private health care even if they want to.
The health systems in Europe are not radically different from the US system. The efficiencies of each are difficult to quantify without context. For example, the US invents most of the drugs and medical technology used by the world. Would this still happen if there was more invasive regulation? We can't know.
Besides all of this, think of every other area of the market where the government insinuates itself. Are public schools better than private schools? Almost never. Is the US postal system better than FedEx? Of course not. The government is not a commercial entity. The incentives and influences on it are not conducive to producing quality products at good prices.
Until recently. This means that all people can obtain health care regardless of their ability to pay, and that the system is flexible enough to continue to experiment with the ideal implementation.
Are public schools better than private schools?
Public schools are exactly 100% better than private schools for students who can't afford to attend private schools.
Is the US postal system better than FedEx?
They are if you want to get a letter delivered anywhere in the world cheaply.
You have made a lot of good arguments for socializing care here.
1. Try getting an MRI in Canada. Canada rations care via wait lists.
2. Your argument implies that there wouldn't be low cost schools in the absence of public schools. The evidence is overwhelming that the opposite is true.
3. I live in Panama. When I need something mailed here I use FedEx or DHL. The USPS is unreliable and takes far too long. If there weren't laws against private first class mail in the US they'd be undercut in that market as well.
Firstly, diagnostic care is often privately managed throughout the provinces, so if you don't want to wait, you can often pay to expedite. It's about $900 for a joint MRI.
Secondly, if you really need an MRI for a critical diagnosis, as I once did in 2012 as a hospital inpatient, I got it within 2 days.
Canada's health system is a point of national pride.
It depends where you live. I know many Canadians who've had different experiences. This points to a major problem with socialized products - how they perform depend not on merit or ability to pay, but where you live, how good your representative is, etc. That is much worse.
I really don't agree. I've lived in three Canadian provinces, and four U.S. states, from towns of 1000 people, small cities of 10k, medium cities of 100k, to large cities of 1m+.
Having lived through the Ontario cuts in health care in the 90s ("the Harris common sense revolution"), I don't really think political reps Federally or Provincially had any say on quality of care or what hospitals we got, it was all redesigned top down (not all that different from an HMO really, in my experience). Did care access and waits times suffer at the time? Yes. Still wouldn't trade it for a private system.
The difference in access and amount of supply between a rural market and a city in Canada is not too different than in the US. There's a lot of land mass to cover in either country if you're not in a major population centre.
The Canadian system blows away the US system by an order of magnitude, IMO, in terms of what really matters - access and outcomes. Obamacare made the US a bit better, but that's not a tall order.
What's the worst condition (if you don't mind saying) you've had where you had to use the Canadian system? Generally, socialized medicine works fine for routine care but badly for catastrophic (i.e. expensive) care.
- Severe pneumonia (1 day in emerg, 9 days in ICU followed by 8 in an inpatient ward)
- Total pericariectomy (2 days in postop ICU, 3 days in ward)
Among other stays/issues prior to these.
The latter surgery was the culmination of outpatient medical care over 3 years with multiple specialists (cardiologist, internist, and cardiac surgeon), along with multiple CT, MRI, cardiac catheterization, countless blood tests, many of which were sent to Winnipeg (the equivalent of the CDC) for rare disease scanning, and over a dozen echocardiograms ... none of which I had to wait for longer than a day or two ... And none of which I had to pay for (just my medication through private insurance). In fairness the surgery itself wasn't critical, so I waited 6 months. They were willing to expedite if my condition deteriorated (it didn't). And after regular cardiologist visits , after I was stable, it could take 8-10 months. If I had an issue they'd expedite me in though.
I am not saying the Canadian system is ideal. Just that it is a reasonably functioning system.
There are some cases where it is both very frustrating and inspiring. I have a dear friend who has a child with a congenital heart defect due to an extremely rare genetic connective issue disorder that is similar (but different) to Marfan syndrome. The Canadian system has been fantastic to senior levels of provincial administration in managing this case, involving international hospitals, breeding zebrafish to replicate the specific mutation, working to manage the treatment of this complex child who is close to turning 5 but likely would have died in the first few weeks after birth in another era.
Keeping this child alive (he is in and out of the hospital about 50%) has easily cost a tremendous amount of public money, but the insurance system risk pool is designed to handle these sorts of outlier cases to ensure future cases can benefit and that this child can have (mostly) a good life in between and during hospital stays. This child gets world class care and has been kept alive due to the system mostly working.
That's the good part. The bad part is that managing complex care in general is a mess as in many health systems, making it a full time job for at least one parent to juggle the various specialists, appointments, tests, medications, history, etc... Which is difficult if you're a single parent. It's almost easier to go on welfare than to work if you are a parent to a critically ill child. So you can get nursing staff to help at home but it's debatable what is covered and what is not, medical expense deductions have some arcane regs like you can't expense a trip under 40km, yet this child has on average 280 trips to the hospital or a clinic a year... Adding up to a lot of expense. Some things like specialized child formula weren't covered by health insurance either until recently (which can cost upwards of $1400 monthly, really sucks when your child can't eat anything due to esophageal issues and has a G-tube and needs this formula to stay alive..)
So, not ideal... But Is this all socialized medicine ills? Sort of I guess? I can see the same problems in a private system.
I live in Hawaii. When I need something mailed to or from here, I use USPS. FedEx or UPS are an order of magnitude more expensive and, in my experience, not faster or more reliable.
>Try getting an MRI in Canada. Canada rations care via wait lists.
Exactly. Health care in Canada is a crap shoot. If you're in a major centre and are able to get a family physician I'm sure you think the system is great. Try being sick somewhere where the only option is an over-worked ER staffed by locums.
> Government is force - nothing more. The purpose of government is to protect our rights. "Single payer" (a euphemism for socialized medicine) by definition violates rights by forcing people to do things against their will.
"Rights" are basically just freedoms we've decided we like a whole lot and want the government to guarantee, so that's not exactly a static category. So on the one hand we can just decide whichever rights are being violated are—at least conditionally—not rights. Boom, done.
On the other hand, is there any such thing as a government that does not force people to do things they wouldn't voluntarily do? I'm pretty sure if you take that away what's left has lost the single most important trait of a government, and what's left is... I don't know, a non-profit begging for money on TV and utterly incapable of fulfilling any of the usual roles of a government? In that case, the fact that single-payer would force people to do things doesn't per se remove it from the realm of legitimate government activity.
As for the utility of the term "single payer", I believe it's distinct enough from the much broader "socialized medicine", which could include things like seizing hospitals and making doctors exclusively state employees, to make it substantially more than just a euphemism.
"'Rights' are basically just freedoms we've decided we like a whole lot and want the government to guarantee" - as I said below, the logical conclusion of that argument is not a world you'd want to live in. -- "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.
> "'Rights' are basically just freedoms we've decided we like a whole lot and want the government to guarantee" - as I said below, the logical conclusion of that argument is not a world you'd want to live in.
How is that not the world we live in? What is the alternative? At some point someone's deciding what's a right and what isn't. Other people may disagree. Rights aren't a law of nature, they're a fuzzy category, subject to conditions and caveats and shifting over time.
> "is there any such thing as a government that does not force people to do things they wouldn't voluntarily do?" - no there isn't. That's why it should be limited to protecting other people's rights.
But a lot of the things government does that don't fall within that narrow limit really, really appear to make my life and the lives of the people I care about much better, at relatively little cost (for a broad definition of cost). Few or none of the OECD states seem too bad, to put it mildly. None are unqualified disasters, or even close. Meanwhile a "drown it in a bathtub" government coexisting with an advanced economy (correct me if I'm wrong) remains hypothetical—indeed, I think it's fair to call mainstream the view among experts that governments' special ability to overcome coordination problems and take action to nurture markets is vital to an advanced economy—as do the effects of such a system. So it's definitely going to be an uphill battle convincing me that our government "should be limited to protecting other people's rights", without some other state practicing that and full of citizens telling me "no, really, it's pretty great".
"What is the alternative?" - a system of rights based on the nature of human beings. Human beings survive by producing the things we need to survive. We need governments to protect others from initiating force against us in opposition to our primary needs of living.
Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.
> "What is the alternative?" - a system of rights based on the nature of human beings. Human beings survive by producing the things we need to survive. We need governments to protect others from initiating force against us in opposition to our primary needs of living.
I'm having trouble figuring out how this doesn't still boil down to people making judgement calls on what is and isn't a right, just with a level of indirection, so maybe this other question will help me see what you mean:
> Will we ever see this in reality? No. But, the closer humans have gotten in history the better off they've been.
Do you have an example in mind of when and where we've come especially close to this ideal?
"I'm having trouble figuring out how this doesn't still boil down to people making judgement calls on what is and isn't a right" - at the end of the day we're ruled by people. But, there should be a standard by which decisions are made other than "whatever the majority decides".
> But, there should be a standard by which decisions are made other than "whatever the majority decides".
It seems like a standard is just a reason for choosing a given set of things to call rights and a given role for government, and we're all set to circle right back to where we were—the people with the power to affect government choosing those things, based on reasons (which was implicitly the case before, anyway). At some point there must be compelling evidence for selecting a given standard over any other, and one would hope that standard may change in the face of new evidence.
"Do you have an example in mind of when and where we've come especially close to this ideal?" The USA of course - though it's quickly moving away. Hong Kong (though China is ruining it). England before the Fabians took over. Japan after the war. There are many others.
How can you logically have a right to the services of someone else? Health care is a product - doctors, hospitals, medicine, etc. These must all be produced by people.
You can't divine rights out of some fundamental logic. The only ones who can decide what rights humans have are the humans themselves, and then we structure our society to make sure those rights aren't violated.
Maybe I should have been clearer: Just because you say it's derivable "from logic" doesn't mean it is. No logic system can do anything without axioms, and the adoption of those axioms is an arbitrary choice.
Also, here in Connecticut (the place where the rich historically sent their kids to school), there are plenty of public schools that are at least as good or better than at least some nearby private schools. When you get into preschool, for instance, the public schools are a HUGE improvement over all but the top-tier private ones. Likewise, the "magnet" program schools are a public option that is as good or better than most private schools nearby (they are special, well-funded by the state, and use a lottery to get in, though).
This is coming from someone who agrees with you in principle, too. Reality is nuanced, though.
I believe your examples of public services being worse than their private counterparts is a specious argument. Most private schools are paid for by rich people. The cost to attend is higher than public school so it would reason that the quality is better. Same for USPS vs FedEx. The shipping rates for USPS are much cheaper.
Some people are price sensitive. Cheaper is all they can manage to afford and are willing to accept less quality in return. As a healthy person I'd rather take a two percent annual increase in insurance premiums for lower quality of care since I do not have much need for services.
Where's your evidence that most private school is paid for by rich people? Anecdotally, the people that I know that use private schools are middle class. Also, if there weren't public schools there would be more varieties of private schools.
"As a healthy person I'd rather take a two percent annual increase in insurance premiums for lower quality of care since I do not have much need for services." --
And I wouldn't. Why do your views trump others who disagree?
People state this as if it's some obvious truth, and it makes no sense to me. My statement would be:
Government is a mechanism which we, as a group, have decided should handle certain functions of society.
It's the logical extension of a group of people in the jungle deciding "you know what, it would be awesome if we got together and built a trail between all our huts so we can visit each other."
Part of that agreement might be "hey, when these barbarians show up we should all protect each other", but to arbitrarily say that the only purpose of government is those kinds of agreements I think speaks to a very warped sense of community.
The purpose of government is about whatever the governed of the current day decide that purpose is. Your view of government is just that, your opinion, not a fact. Liberals in particular tend to see the purpose of government as providing options for those who don't have any other options because the market fails many people. As such social programs have existed for decades, it's factually self evident that the purpose of government as decided by the majority of the population, far exceeds protecting rights.
> Are public schools better than private schools?
Yes, they are far better than private school, for those who can't afford private schools.
> Is the US postal system better than FedEx?
Yes, it's far better than FedEx for those who live in place FedEx wouldn't and couldn't operate profitably because the postal system's aim isn't efficiency, it's coverage to "everyone" everywhere, something no market solution will offer because that's not a profitable mission.
So it sounds to me like you don't understand the purpose of government and don't understand why government is necessary in such situations, because you can't think outside of your own self and realize that markets don't serve everyone.
"The purpose of government is about whatever the governed of the current day decide that purpose is" - I believe you can see that the logical conclusion of that point of view is not a world you'd want to live in. In the US, at least, we have a Constitution that prevents the worst uses of government (though not as much as it used to).
Wrong, it's exactly the world I want to live in and the Constitution happens to agree, which is why we've amended it many a time, because the governed decided it was outdated. The notion that we should still be living by the dictates of men long dead is simply absurd, every generation has a right to decide for itself how its government works as it should, and as we have done.
So, if the majority votes to take away the rights of, oh I don't know, Japanese citizens -- that's a world you want to live in? You're not thinking clearly about the issue.
No, you're not thinking clearly; the constitution requires a super majority, and yes, if a super majority of people want to be governed a particular way, then they deserve that right, even if it's stupid; but you'd never get a super majority to agree to such a stupid bigoted rule and it conflicts with other parts of the constitution and would be ruled unconstitutional by the courts. Without the notion that the rules can and do change for each generation, we'd still have slaves, thankfully, we don't live under a set of rules that can never be changed.
The will of the majority, and especially the super majority, is far better a thing to live under than the will of a handful of people from 238 years ago and any suggestion to the contrary is the definition of not thinking clearly.
"you'd never get a super majority to agree to such a stupid bigoted rule and it conflicts with other parts of the constitution" - oh really? Please open a US history book.
Personal attacks like this (and "you're not thinking clearly", above) are not allowed on Hacker News. We ban accounts that do this, so please don't do it again. Instead, please (re-)read the HN guidelines and post civilly and substantively, or not at all—regardless of the clarity of someone else's thinking.
Please try and think for 2 seconds instead of responding to the first stupid idea that jumps into your brain; obviously I'm referring to passing such a law today, what happened historically isn't relevant. But you've shown your colors, you have no intention of actually hearing anything said to you because you're more interested in arguing utterly stupid diversions of the main topic. You ignored everything said except the one thing you could find to disagree with, you're a child. Goodbye.
As we've told you many times, you can't comment like this here. And certainly you can't create separate accounts to do it with. I've banned this one.
You're a longstanding user and we've bent over backwards not to ban you, despite serious abuses on your part. The situation isn't going to stay this way.
You're being absurd, all I said was "no you're not thinking clearly" in response to being accused of not thinking clearly. I was perfectly civil, and I created another account because of your unjustified slow ban on me. I've bent over backward conforming to your absolutely inhuman and ridiculous civility rules that expect people to never ever ever have the slightest conflict with one another. I behaved fine, check yourself, I didn't start this conflict, he did.
As you seem to be dying to ban me, then ban me already; I'll just bounce through a proxy and open another account, you know as well as I do there's really nothing you can do to keep me off the site and that your best option is to keep me civil, which I've been doing for quite a while, so drop the empty threats please.
So you'd be perfectly ok with certain people being counted as only 3/5 of a person, and only white, landowning males having the right to vote? What about that whole slavery thing? Cause the Constitution shouldn't be changed and all.
Personally, I would have split the difference... I would have created an NPO insurance corporation that was the default for all government paid access programs (employees, retired va, medicare/aid, state programs backed by federal funding)... this likely would have cost less than was already being paid out, in effect consolidating the management of several government programs as well as opening that corporation up to the states, businesses and individuals.
Following would have been mandated coverage by employers, and from there would probably have been room to cover most of the rest or provide tax incentives to do so.
As it is, when people are paying the entire premium cost directly, they're far more likely to use that resource more, effectively raising costs... the lockin is another negative issue.
Creating a publicly sponsored baseline would establish more competition and as an NPO incentive to drive down pricing. The larger issue is IP surrounding medications and medical equipment. Much of which could be improved by front-loading patent application fees, reducing the approval rates for extension patents, and statutory licensing fees for medications more than 5 years old.
In the end government should encourage competition, with innovation as a side effect instead of trying to encourage innovation by expanding upon misguided protectionist extremism.
But that's my thought on a pragmatic solution that could have worked better with a libertarian mindset.
That's not how government works; it's not about pragmatic solutions or logical solutions; it's about what you can get enough people to agree on, which is what Obamacare is, the most enough people could agree on to get it passed. Whatever isn't in there, isn't there because it wouldn't have passed so all Monday morning quarterbacking about what it should have been entirely misses the point about how government works.
Governing is about consensus among ideologically opposed members, not about correctness or efficiency.
And the problem is that everyone in congress is trying to push for their own optimal interests, so the compromises are less ideal than a more pragmatic approach that would have the same effect as compromise from all parties. It's not either's ideal, but still better.
If I had the financial independence to run for Congress, I absolutely would.. unfortunately I need to work for a living, and being able to sustain a living while even trying to run isn't something I'd be able to do. Beyond this, running as a Libertarian would be even more difficult.
First, I'm in favor of voting for no incumbents for a few election cycles... from there, I'd love to see actual politicians working to sell pragmatic choices towards consensus instead of the give/take we get today, with the boatloads of pork that come with it.
Before the pitchforks come out, keep this in mind: before Obamacare increased access to affordable individual plans, employers were the typical purchasers of health care plans. When you have a 100+ person company, the company pays a rate that averages out their employee pool's healthcare needs. Now we have a situation where more people can more efficiently participate in the healthcare market. Individuals who are young and healthy will opt for a lower cost plan, and those who already have illnesses or higher risk for illness will spend more for their healthcare. This efficiency on the consumer side is destroying revenue for the healthcare companies.
I am not saying that anything was even close to perfect before, but we're seeing the private sector responding to Obamacare - it's not profitable enough or even sustainable in some cases. Now the government wants to block companies from trying to salvage their profits? Yes, consumers are benefitting now, but what happens when there are 2 options left for healthcare in each state?
I think in this case, it's clear that the hybrid Capitalist / Socialist approach is not the way to go. Either the government needs to let health care companies operate the way the market allows them to, or move to a single payer system.
I fail to see how I as a consumer am personally benefitting. I have more expensive healthcare that covers less and it gets more expensive and covers less every year.
I'm sure there are a few very sick people out there who are benefitting. I'm glad that we as a society are able to help them out. But it's clear that I do not have choice in needing healthcare, whereas these providers do have a choice in providing healthcare.
I agree with you that the hybrid approach is not working.
> Individuals who are young and healthy will opt for a lower cost plan,
This doesn't jive with the Obamacare marketing: They specificially needed to get a lot of young healthy people to sign up, because their fees would pay for the older generations who have higher health care costs.
If you think a ~$100,000 a year to a politician (plus another couple million to some other politicians) is largely responsible for the rules that govern how 20% of our economy functions you are quite mistaken.
There are huge economic and political forces at work that render Aetna's tiny expenditure irrelevant in the grand scheme of things.
> If you think a ~$100,000 a year to a politician (plus another couple million to some other politicians) is largely responsible for the rules that govern how 20% of our economy functions you are quite mistaken.
The average member of the public doesn't care at all about copyright terms so policy in that area is much more susceptible to this sort of thing.
The average member of the public cares a great deal about their health insurance so policy in this area is much much less susceptible to influence with small political donations.
I'm no expert in this at all, but I do know a number of people who work in government and across the board they are all of the opinion that most people would be shocked if they knew just how cheap it was to buy major influence, even at the national level.
There are people that are experts and they generally agree that the effects of political contributions are much smaller than is generally believed by the public.
This is precisely why single payer is desperately needed. And proof that Obamacare is a Rube Goldberg machine. I remember listening to a Kentucky senator who said they were gobsmacked that no insurance company signed up in his state. The program is based on wishes, not good practices. Having Justice tinker with antitrust to keep it alive will never work. Insurance companies could give a F about their policy holders, their shareholders and profits are the only ones who count.
This is not proof at all that "Obamacare is a Rube Goldberg machine." This is a major insurer pulling out the markets, but over trivial amounts of losses.
I don't know what you mean about Kentucky. There are plenty of health insurance companies with offering on the Kentucky exchanges (Anthem BCBS, CareSource Kentucky, Humana, Aetna, and Bluegrass Family Health). And in any event, even if there truly were no insurance companies with offerings on the Kentucky exchanges, I find it very implausible that either Mitch McConnell, or Rand Paul would have claimed to be "gobsmacked." They were leaders in the fight against ACA, and they certainly claimed before passage that the law would destroy the health care industry.
I don't think it's fair to categorize Aetna's annual loss of ~300M as trivial. That represents about 12.5% of their profits. If someone cut your salary by 12.5% I don't think you would think that was trivial.
I should clarify, I didn't mean it was trivial to Aetna. I meant it was trivial compared to the cost of the existing subsidies and risk corridors in the ACA, and that this is not an existential problem for ACA.
Over the past few months, several major insurers have either reduced or ended their participation in the ACA exchanges. That is troubling news. However, setting aside the political feasibility, it's hardly an unsolvable problem. If the risk pool does not improve, and insurers keep losing money, then we can raise funding for the risk corridors.
To put this in perspective, Aetna, one of the largest insurers in the marketplace, is losing about $300 million. We're spending about $200 billion/year on ACA currently.
OK that's fair. I pretty much agree with everything you say here.
I think I am more concerned than you are that the structure of the exchanges will make them untenable in the long term but that's certainly a judgement call and we won't know the real answer for several years at least.
I'd say a public option would be the way to "soft introduce" single payer. Just expand Medicare to anyone who wants it on the exchanges. Once the premiums shake out, "big bloated government" likely will be pretty competitive.
Of course that would require a major shift in the House of Representatives, which probably won't happen until the 2022 election, after electoral maps are redistricted in 2020 post-census, and the rampant gerrymandering might be fixed. And some kind of political cover from the caterwauls sure to emanate from the health insurance industry.
So how can consumers respond to this corporate chicanery? In a capitalist system, the natural recourse is for citizens to turn to the private market for alternatives. Could this provide an incentive for Aetna's competitors to make it easier for Aetna's customers to switch to them?
One would assume that libertarians and free marketeers would cheer the concept of boycotts, as it is one of the mechanisms that citizens are empowered with in a laissez-faire society.
What corporate chicanery? They took a loss on exchange plans last year. They have every right to pull out of the exchanges until the government makes them stay.
I'm a supporter of single payer. But the health care market is a sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services, they try to get companies to do hidden cross-subsidization, propping up money-losing individual plans with profits from group plans. And then they berate companies for pulling out of money-losing enterprises, as if providing healthcare for people who can't afford it is the job of private companies rather than the government.
> ... sterling example of the "worst of all solutions" espoused by the Democrats. Instead of simply raising everyone's taxes to pay for public services ...
Nope, I'm not letting this slide by. The Democrats did try to do exactly what you propose in the 90s. If it had worked, we would've had a first-world health care system two decades ago. But it was screamed down by the Republican Congress with the usual taxes-liberty-communism-Stalin rhetoric. The ACA was intended as an improvement over the nightmare we had pre-2010 that was still digestible to Republicans. Remember: it's fundamentally a Republican idea. It's similar to what Gingrich proposed as a counter to Clinton's plan (which is what really boils my blood about conservation opposition to it), and it's more-or-less identical to what Romney implemented when he was governor of Massachusetts.
So yes, the ACA is a "worst of all worlds" compromise, and of course it sucks. Almost all the Democrats I know agree that it should be scrapped and replaced by a single-payer system tomorrow. But since that doesn't seem likely to happen, the ACA is what we've got. And your blaming of the Democrats for the failure of a Republican idea implemented because the Democrat's much better idea isn't politically possible is despicable and disingenuous in the extreme.
You're a supporter of single payer? Health care is something like a fifth of the whole US economy. You're comfortable with the USG setting prices for it?
He has his gallbladder out and all of a sudden he's a super risky person to insure. How do we get him in a risk pool where his premiums won't be unaffordable?
By shifting more of the group insurance market onto the individual market, perhaps mostly by eliminating current incentives for employer group coverage, to minimize the adverse selection problem.
Incidentally: two members of my immediate family have the same problem he does. No history of serious illness, no current health problems, probably healthier than the median in both cases for their age cohort, but uninsurable outside the exchanges due to bogus pre-existing condition rules.
1) Can we make the individual mandate in the individual market strong enough to really eliminate (or at least minimize) the adverse selection problem?
I am unconvinced that we can. Perhaps though.
2) Are you really convinced that the pre-existing rules you encountered were bogus? Are insurance companies just dumb when it comes to this sort of thing? I tend to assume, absent other evidence, that insurance companies will be profit seeking so would only turn people down if they expected to (probabilistically) lose money on the deal. Perhaps they're just not smart enough to discern differences at this level though? I don't have much experience in this area.
I think penalties need to be sharply increased, but the problem isn't so much free riders as it is that statistically the most attractive segment of the market is overwhelmingly likely to be employed at a firm that offers group coverage.
I certainly agree that employer provided health care coverage should be taxable income (I assume that's the mechanism by which you would shift people).
It's interesting to note that McCain proposed this as part of his campaign in 2004 and Obama pilloried him for it.
Yep. Clinton wanted to tax employer-provided health care too. McCain and Clinton were right about that --- but Baucus, and I guess by extension Obama, was right about the individual mandate.
1.) It might be possible, but that would probably take time, a lot of work, and likely intervention with laws and money. I'm not all that hopeful that it could be done. Right now there are a lot of people with inadequate to no health coverage. They have issues and problems that are going to need taken care of, which means that the first 3-5 years are probably going to be more expensive than later on. Some are just things folks have been putting off - surgery for carpal tunnel, for example. A few folks will have much larger problems that they can't do much about without insurance. Maybe they don't take care of their diabetes well enough or should really be taking heart medicine or anti-depressants.
Basically, gotta get everyone caught up to the healthiest they can be, and afterwards there would be a lot better maintenance, which in return would mean that the companies have a chance of not needing to worry about the adverse selection.
It would probably also help to get rid of the networks and simplify the insurance end at the doctors offices to both reduce costs and get rid of some of the redunancies in addition to having some sort of care and coverage standards that spread across insurances, just so that people are able to get the care they need instead of going with not-quite-so-good-for-them alternatives because they happen to have a crappy prescription plan.
Other changes I would make would be to require all insurers to sell directly to consumers and decouple insurance from employment - much like most folks get their car insurance. In addition, I'd require insurers to use the exchanges if they want to be in the business and make it so that insurers have a national license instead of needing certified in each and every state they sell in. This would not only standardize coverage, but reduce overhead.
Unfortunately, this sort of thing requires planning on a rather large scale and fixing a lot of problems such as affordability of care. The current political climate hasn't been so keen on that sort of long-term planning nor cooporation, not to mention that the companies themselves might not be too keen on that last one either.
2.) I tend to think all pre-existing rules are bogus. Though they say they help with their risk, I'm skeptical. Most the plans I saw wanted folks to have continuous health care coverage to go around some of the rules (I've always gotten insurance through and employer when I lived in the US). Yet having coverage doesn't mean you take care of your condition. The opposite is also true. Obviously, some folks don't take care of x,y, or z because of lack of coverage as well. And things such as gall bladder surgery are more one-time events with few lasting needs after the surgery for most folks.
I think it's the least bad of a set of various bad solutions. Healthcare seems so essential that we can't let poor people go without it. And it seems like demand is totally inelastic. So maybe it's better to have no market than to have one where government is excessively entangled with insurance companies.
But I admit that I'm not super well educated on the issue.
It's more about opposing their attempts to thwart antitrust law. After AT&T's merger failed, T-Mobile used the money and the public fallout as an opportunity to reinvent themselves as a company that caters to the public. I'm wondering if this could be a similar opportunity for Aetna's competitors.
If the government is unable to prevent monopolies, then consumers should step in by punishing companies that seek to monopolize.
Edit: Again, that's one of the concepts behind libertarianism, isn't? The idea that instead of relying upon government regulation, there's almost some economic reputation system in place which would cause consumers to reject doing business with bad actors. So in theory, the recourse here would be for the individual consumer to reject Aetna directly in response for their monopolistic practices.
The headline is misleading. Aetna didn't threaten to pullout if their merger wasn't approved, they said that they would be forced to do so because they would be losing too much money. That isn't "attempting to thwart antitrust law," it's simply stating the facts.
Then so be it. If Aetna is unable to withstand the rigors of the post-Obamacare climate, then they should fail accordingly. Their competitors seem to be able to hold on without resorting to monopolistic tactics. Better they fail now, before they become too big to fail through mergers and acquisitions.
The issue is not that the ACA is causing Aetna to fail. Aetna makes an enormous amount of money on employer sponsored health care plans. Where Aetna was losing money was on the public exchanges, a new line of business that didn't exist before the ACA.
And it's not just them. Nearly all of the large insurance companies are pulling out of the exchanges because they're losing money. A lot of people believe this is because, as they are currently constructed, the public exchanges are untenable. And that's a very big deal if it's true. Not for the profitability of insurance companies, but for public health care policy in this country.
You make it seem like forcing a company to serve an unprofitable market is the same as regular market competition. It's not. It's extremely distortionary. And it hurts competition--it basically means only huge insurance companies that make big profits on group plans they can use to offset losses on exchange plans can afford to enter the market.
Them having to scramble for dear life in an inequitable market situation doesn't justify them engaging in anti-competitive actions. The problems with public exchanges in the ACA should be addressed without resorting to monopolistic practices. Let them fail.
Without a law requiring insurance companies to participate, why should they? Let's not pretend they have anything other than self-interest at stake.
Why not pass such a law? Because that would effectively mean semi-nationalizing a fairly large industry, and if we're going to do that, why not just create an actual single payer and a risk pool the size of the US population and skip the idea of having private firms involved at all.
The biggest problem with the idea of single payer "insurance" is that it's not actually insurance. It bundles in a variety of things such as pre-payment for services, wealth redistribution, price controls for services, and some actual insurance.
A social safety net is a good thing. But if we expect to benefit from the benefits of a competitive system, we have to let firms actually compete.
The core issues have to do with the lack of "insurance" market for things that are actually prepayment (like giving birth, dying of old age after $50K worth of end of life care, etc).
By mandating that consumers buy the "insurance" and mandating that insurers bundle all the non-insurance services into the package, the government essentially controls the market and avoids both the benefits of market competition and accountability for tough decisions such as which care should be covered, etc.
There have been many threats from industry and government. Government can nationalize and can pass laws that reduce profits, and firms can pull back, can merge with each other, and do other things to increase their market power.
The bottom line is that the entire system is ripe for corruption and lack of accountability. Let's face it, for a healthy young person, catastrophic insurance is next to free. Yet all of us are paying fairly high premiums so that old people can be exploited by a healthcare system that happily gives them ineffective surgeries and sells them overpriced and largely ineffective pharmaceuticals.
The system was already corrupt before Obamacare, Obamacare simply cemented many of the most lucrative public/private deals. Both sides intended to scheme a bit after the programs got underway. So we'll see a bit of tit for tat with regulators and perhaps watch one or two of the entrants leave the market allowing the profits to be divided fewer ways.
The public is starting to get a peek at the 2017 rates. To put it lightly, they're not pretty. This post shows the proposed premium increases, averaging around 24%. It's likely these may land somewhere below those numbers, but the cost of simply being insured before any co-pays or paying any deductibles has rapidly become unsustainable for a huge percentage of the population, especially the middle-class who earn too much for subsidies but not enough to cover the costs of proper insurance and care.
The "leaked" numbers have always been higher than what actually happens.
The insurance companies always propose higher increases in order to have a stronger bargaining position, and those numbers have historically been bargained down to something decent.
Absolutely. But I'd wager the vast majority of the increases land well above the rate of inflation. And since open-enrollment begins a few days before the Presidential election, it'll be interesting to see how those numbers are managed given that Hillary has hitched her campaign to the Affordable Care Act as an extension of her original campaign for universal health insurance when she was First Lady.
As it's unlikely to be a competitive race by then, I would expect that certain people will be reminded of certain aspects of the power of the executive branch and that will be that.
You can either have a system where everyone is covered at great relative expense to the healthy, or one where everyone is covered at great expenses to taxpayers. Either way, quality of care, breadth of services and speed of access are going to suffer. Demographic reality is inescapable.
I don't understand why so many private insurers participated in the exchanges in the first place. It seems pretty obvious that the people who need to purchase from the exchanges are less likely to be healthy than the general population, because they probably haven't had much preventative care in the past, due to their prior lack of insurance, and also because poverty and poor health are highly correlated.
Imagine that you ran a car insurance company, and the government set up an exchange where the least-skilled drivers could purchase insurance. Would you participate?
This is a worst case scenario for Obamacare -- the leverage that empowered the insurers to dictate the terms of the ACA never went away, and it won't anytime soon.
Anything less than the Federal government threatening to nationalize Aetna would be insufficient, lest the Obama administration wants to appear weak and invite further dissent.
Just another reason why single-payer is the best option.
It does have the distinct smell of the broadband subsidies: "Give us money if you want us to roll out high-speed broadband."
"Thanks for the check. Oh, BTW, we decided high-speed broadband wasn't really working for us, so we nixed it."
Aetna deal goes through: "Shockingly, we're still losing money on exchanges, so we're not going to do that anymore. Thanks for letting that merger go through, though."
That's silly. Insurance is a great method of hedging risk. If my apartment burns down it would cost me A LOT of money to replace my stuff. But the chances of it burning down are really small. So I can purchase renters insurance for just a couple hundred bucks a year, an expense I can easily afford.
That benefits me a great deal!
Maybe when you said insurance you meant to say "health insurance" but the same principle applies. If I have a heart attack then treating it will be hideously expensive, but that's also unlikely to happen.
RISK seems to be the least mentioned word in this entire thread. "Insurance is a great method of hedging risk." Spot on. I wish we had education in RISK Management rather than what we have now.
Except a building isn't almost certain to burn down during its lifespan. Humans, metaphorically, burn down at a much higher rate. Cancer, heart disease, systemic infection ...
"Spreading the risk" doesn't work when the likelihood of something bad happening approaches a percentage in the high double digits, especially with an ageing population and falling birth rates to keep paying into the ponzi scheme.
That actually raises an interesting question: what have the changes in building fire risk been over the past 150 years or so?
Historically, instances of entire cities burning were commonplace enough to be noted: the Great Fire of London (1666), the Great Chicago Fire (1871), the Baltimore Fire of 1904, the Great Fire and Earthquake of 1906 in San Francisco.
The Oakland Hills Fire of 1991 was actually the biggest urban fire in the US since the 1906 San Francisco event.
2. Standardisation. Baltimore and Oakland Hills both saw incompatible hose-hydrant couplings.
3. Building standards. Everything from fireblocks and exits, to sprinkler systems.
4. Replacement of candles, oil lanterns, and gas lighting by electricity. Electrical fires happen, but they're far rarer. The Great Chicago Fire was caused by a lantern.
5. Safety and certification ratings of equipment, appliances, and wiring. "Underwriters Laboratories", the source of the ubiquitous (in the US) "UL" logo, was created by insurance companies.
That is: appropriately collectivising risks can result in reduced overall risk.
Sure, we're all gonna die. But the amount of money we spend on medical expenses between now and then varies by at least an order of magnitude between different people.
If there weren't risk differences then we wouldn't need insurance at all.
I was referring to health insurance specifically. I edited that in just now to clarify.
Health insurance should work exactly as you describe, but far to often I've seen it cover the little things like colds, and then fail to adequately cover big things like a heart attack.
It seems to me that 'insurance' has become more like a group pre-paid debit card for predictable medical expenses than a lower cost hedge against statistically rare events.
If there was say a more market based price tier and that tier to Obamacare was made up of both US Federal workers plans and State workers plans than there would be a huge amount of healthy people in the whole group and private ins co's would be striving to be part of ObamaCare as their costs than would not exceed their revenues.
If we are unwilling to confront the bloody, economy-crashing hellscape that is the foreseeable result of a system that only provides non-emergency care to people who can pay, then it seems like socializing the costs of care is the only method that could be made to be sustainable.
I don't really understand how this is a threat without understanding whether Humana is on the same exchanges and what other providers are on those exchanges. Journalists seem to get really excited when they get some inside scoop.
Good. Block their deal, let them drop out of obamacare, and then give us the Single Payer that we've always deserved and watch those fuckers go bankrupt like they've always deserved.
Anyone who thinks this is leading to single-payer is dreaming. Whether you think it's a good idea or not, the political will wasn't there for in 6 years ago, and there is much less political will for it now.
There's a lot more political will for a "public option" now (largely because the people who have said it wasn't necessary in the ACA-style setup and that private insurers -- augmented by the coops that the ACA created a framework for -- would step up have increasingly been proven wrong.) Whether a public option is a step on the road to single payer depends on a number of things, including how private insurers respond.
A proper public option receives no more government support than a private company does. If answering to political pressure instead of answering to a board of directors turns out to be an amazing thing for health care efficiency, single-payer could be on its way. I think that's dreaming by people who have never run anything in their life, but I also think that they should be free to try and fail, as long as it's a genuine same-as-a-private-company public option.
When you want something to happen politically, you need to work from a position of strength. If you have had a bunch of failures recently, people will not trust whatever new promises you are making. (And saying the failures were someone else's fault is the worst excuse of all. It's not like all those people you blame the problems on have died.)
The most likely outcome is a public option in the exchanges. I don't expect that many private insurers will continue to participate in the exchanges if they have to compete with a public option, so the public option will end up being a de-facto single-payer system for poor people who have to use the exchanges.
The public option isn't supposed to be government supported. It's run by the government, but with a private budget, taking all their operating fees from users. A lot of people on the right are skeptical that it will become either de jure or de facto government supported, and comments like "I don't expect that many private insurers will continue to participate in the exchanges if they have to compete with a public option" are the reason.
I'm skeptical of that the public option will work as well as its proponents say it will. We already have non-profit health insurance companies, and they haven't completely eaten everyone else's lunch. But it's worth a shot, as long as it really truly sticks to that mandate of not being government supported. The argument would need to be really convincing given how many of its backers think it ought to be government supported any way.
By walking away from the exchanges they are just walking away from a money losing business. That isn't twisting in the wind.
The ACA established programs to make payments to insurance companies that got unusually expensive customers but the funding for those payments has been blocked.
The issue with those blocked payments is that the program was established to deal with an uneven distribution of unusually expensive customers. Insurance Company A makes more than expected so it pays into the pool. Company B loses more than expected so it draws from the pool. Thinks were expected to even out overall.
But what has happened is that all (or most) companies are losing money on the exchanges so there is no one to pay into the pool. Congressional Republicans have blocked funding the pool with government money because the pool wasn't supposed to cost money in the first place.
So your earlier comment is entirely irrelevant then, seeing as we're not talking about bread delivery, but delivery of healthcare, where - irrespective of whether we'd agree on the feasibility of efficient delivery of "singlepayer bread" - it has been conclusively proven by example that efficient delivery in a single payer model is possible.
In fact, not only is it possible, but almost every country in the world that has it does it cheaper than the US (depending on currency fluctuations, Norway is ironically one of the less than a handful of countries that is occasionally more expensive than the US - largely driven up by high salaries).
Ask yourself what those studies measure and if you can honestly consider those measures fair measures of quality, quantity and equity in providing care.
It usually boils down to $5,000 for surgery X in one country, $8,000 for same surgery in another. What an analysis like this always skips is the care that wasn't provided that should have been provided.
A large proportion of developed countries use single-payer, single-provider, or insurance vouchers. Including... Canada where you live.
Serious question: are you a refugee or emigrant from an oppressive communist country? Often this can color one's thinking to reject all aspects of those regimes, even including the few positive things.
Edit: I don't think it's insulting to ask a question. Context helps us to understand each other and the world around us. Downvote, but also reply.
the idea that SS and medicare are great and have done wonders is what's causing the country to go broke and costs to skyrocket.
it was never good in the first place. you see the benefits when the programs are implemented, but everyone fails to see the costs and lost future opportunities.
The irony that you are blaming social security and medicare on the US costs while US healthcare is far more expensive than almost every socialised healthcare system in the world is astounding.
The difference between the US and the single-payers is that more care is given and better care is given vs. the rest of the world where gov't budgets are constrained so care is constrained.
I'm in Ontario and I can't even get a general practitioner. This is worse than communism.
The US healthcare system consistently gets a mediocre ranking by the WHO for a reason: It's great when you have lots of money. For everyone else, almost every other developed country is an as good or better place to get healthcare.
As for your problem getting a GP, that sucks for you, but that is a local political problem and not a systemic problem with single payer. E.g. in Norway everyone has a legal right to a named GP, and gets one. I live in the UK now, and while there is no guarantee here I've never had a problem finding a GP.
I can afford private insurance here if I'd like it, but I've never had any issues with the NHS that'd justify it. On the contrary the treatment has always been stellar (I've not had to use it all that much myself apart from a "mystery infection" t
If you have the money, nothing stops you from getting supplemental private insurance in Canada either, so I wonder what you mean when you say you can't find a GP. Do you mean that you're unwilling to go private? Or that you actually can't find one either way?
More care may be given, but I can't find any way that the statement "better care is given" could be taken as a true statement. The US falls far below every other western nation in terms of money spent vs patient outcomes.
free market systems are dynamic and adjustable to real-world inputs in a way that no planned system can match in terms of providing the most service/product to the most people.
what people really want when they push for socialized medicine is equality over improvement.
Eastern Europe didn't have equality. It had less equality than Western Europe and the US - the party elite basically carved up their countries as fiefdoms.
To blame equality for problems caused by systems that never implemented anything like equality is quite bizarre.
…the story about the two fellows in the Soviet Union who were walking down the street and one of them says: Have we really achieved full communism? Is this it? Is this now full communism?
The other one said: Oh no, things are gonna get a lot worse.
Liberalize healthcare to allow anyone to provide it.
Did you know that before the AMA was created that doctors had to do house calls or face living in abject poverty as a result of the market being flooded with healthcare professionals?
Given the appalling amount of quacks already providing "alternative" therapies that have no medical value: No thanks. I'd rather live a long, healthy life.
I find it almost comical that you want to opt for such an extreme measure rather than accept systems that have a proven track record of delivering much cheaper care.
And as I've pointed out: Both in Canada where you live, and in the UK where I live (as well as in unlikely places like China, which doesn't have a proper socialised healthcare system) you can pay to go private if you for some reason don't get to see a doctor fast enough, or isn't happy with the service. But at least in these countries there is something in place for those who can't afford to.
Actually they do here as well in the states. My wife and I just had to deal with the rapid loss of our dog to skin cancer.
Her treatments were cheaper than paying a doctor here in cash. Normally I pay a doc $150 or less for a routine walk in with "I have the flu".
Our dog got chemo pills, checkups, hell the vet even called us each week to check her status between treatments cheaper than that $150 I would pay for fifteen minutes of doctor time.
I never understood this mindset. It assumes that the govn't is incompetent (which it often is in many areas, fair point), but then ignores the most obvious response, which is to diagnose and fix the problems at hand. Simply abandoning the government solution is not the only option. In fact, one of the government's biggest problems is that so many people are obsessed with neglecting/sabotaging it just to prove some point that it's bad.
> It assumes that the govn't is incompetent (which it often is in many areas, fair point), but then ignores the most obvious response, which is to diagnose and fix the problems at hand.
It's utterly impossible to fix the problems of government competence because Americans don't want their government to be competent. They want it to be supportive, and diverse, and all sorts of things, but competence is not one of them.
If American government were competent, it would hire precisely the people whose unions donate so much to American politicians.
Government isn't a company, isn't competing with them, and shouldn't be measured in the way companies are measured; that you're even making this comparison speaks to the fact that you don't understand the purpose of government.
Why do I want centrally planning in my healthcare, because it can accomplish something companies can't: full coverage for all citizens rich and poor alike. No market solution can or will ever provide that, government CAN.
