> Imaging paying 10%+ of your salary just for health insurance
I decided to actually look at my budget from the last year and see how this compares to my costs.
In Australia I pay about ~28% of my salary in tax. 2% is for medicare, and I have private health insurance on top of that for roughly the same cost again (for dental, which isn't covered in our system because of dentists lobbying an exception back in the 80s). You still have to pay part of most costs in Australia, looking at my budget that's come out to about another ~1% of my income in the past year.
So I pay 5% of my salary for health services. It's pretty much inline with other costs like food and utilities. Doubling it to 10% would be doable, but it would suck.
It seems that the US system doubles the cost and the extra money serves as the very healthy profit margin of their private health industry. Keep in mind Australia manages to sustain a private health sector off that 5%, this isn't abolishing private health by any means.
A proper government health system could probably be even cheaper than the 5% I pay because the US has much better economies of scale. Not to mention the benefit of untying it from employment.
I'm not really making a point here, your comment just inspired me to compare the numbers and it sure is grim...
> In Australia I pay about ~28% of my salary in tax. 2% is for medicare ...
This is a common misunderstanding in Australia.
The Medicare levy, as it's called, is an administration levy, not a 'this all goes to healthcare, and healthcare is only funded by this' tax.
Originally set in 1984 at 1% and guaranteed to never to go up <tm>, it is now at 2%.
(Aside - within two years it was raised to 1.25%, then in 1993 bumped to 1.4%, in 1995 raised to 1.5%, in 1996 the Howard government set a temporary <sic> increase to 1.7% (ostensibly related to gun control costs) which did drop back in to 1.5% the following year, but in 1999 there was an attempt to bump it up again to 'cover the costs of our military involvement in East Timor' - this didn't happen, but it speaks volumes. In 2010 we suffered the regrettable corruption of 'if you earn more than ~$100k AUD you will pay an additional 1.25-1.5% unless you buy private health insurance'. Further fiddling got us to where we are now. Much sad.)
Point being it's incorrect, and quite misleading, to assert that 2% of your salary 'is for medicare', as a simple breakdown for public health shows that, per-dollar, it's somewhere in the range of 10-25%, though because money is fungible, budgets are intentionally fuzzy, and definitions of healthcare somewhat flexible, an exact figure isn't easy to determine.
Fair point, I was looking up pay withholding breakdowns and that's all that's directly paid to Medicare.
> Point being it's incorrect, and quite misleading, to assert that 2% of your salary 'is for medicare', as a simple breakdown for public health shows that, per-dollar, it's somewhere in the range of 10-25%
I want to push back on this a little though.
The implication that it actually costs 10-25% of your salary is just as misleading, as individual taxes only account for <50% of government revenue [0]. 60% if you include other taxes reasonably attributed to an individual (GST and Superannuation).
So maybe a better middle-ground would be to say it costs 5-12.5%? Even then, I'm not sure where you're getting that upper 25% figure from, a cursory search shows _total_ expenditure on health care (medicare + private together) was <10% of GDP in 2013. [1]
Looking at the budget, it's ~14% of expenditure [2]
So if we assume that all this money is fungible we could expect that ~7% of my salary, or 8.5% of all tax I ever pay, goes to government health expenditures.
Adding on my private cover and out-of-pocket expenses get me to about 10%, exactly what the OP is claiming they pay...but that was paying for _just_ insurance. The US government still spends huge amounts on health care, so a chunk of their taxes are going there too, and there is the out of pocket expenses etc.
As you say, an exact figure isn't easy to determine. But comparing the 2% medicare levy + my private health insurance to the 10% OP's US insurance cost seems pretty reasonable. They are paying more than that for healthcare out of pocket and their other taxes, so am I. The deal in Australia still seems much better than the US one.
You're absolutely right, and my apologies. I failed to heed my own warning about the complexity of trying to reverse engineer these numbers.
I believe I was thinking - if not typing - that it was anywhere from 10-25% of the average person's income tax burden.
I found figures similar to the ones you did - around 14% of federal expenditure. There's local, as well as state, health costs, and those are funded via disbursements originating from federal budgets, but not tracked in detail in same. There's also aged care, which will come under this, much of which is semi-funded through ersatz religious groups that have their own tax avoidance schemes in place, and other complexities.
But the ~14% figure seems about right -- and reminds me that I also forgot to tie that back to OP's figures, which, prima facie, aren't too horrendous in light of that figure.
However, that assumes those insurance payments cover all (or the vast bulk of) costs for health care ... which they clearly do not within the USA health system <sic>. Copayments and exclusions appear, from what little I've heard, to be a significant cause for concern even for people with 'good' insurance coverage.
Just as an aside i think dental care in Australia is ripoff expensive. As anecdotal evidence; with the ban on international travel local dentists are apparently very busy as people can no longer fly abroad for more cost effective care.
I read somewhere that dental issues are universal enough that you don't get nearly the same cost averaging that you can get for other medical problems.
When I looked into it, dental insurance basically amounted to "a payment plan for dental expenses you would pay anyway"
Meh over a large population that is not actually true. Some people just don't make that much salvia for example and get dental problems way more than others, even with identical dental care behaviors and diet of someone with pretty much no dental problems.
Also it prevents bigger issues in the future that a socialized healthcare system would have to pay for. Cheap socialized dental care basics I think is a net positive for a society in general. The poor will be more productive and create more tax revenue than the amount of money put into it.
That’s because most dental care is predictable: prophylaxis. Insuring against it is just adding an admin fee. Insurance is good for unpredictable things.
As context for non-Australians, dental care has only very limited funding in the Australian public healthcare system. I have read that the government of the day thought that opposition from dentists might jeopardise the battle for public health cover. It is the policy of at least one party (The Greens) to expand dental cover under Medicare in Australia.
Part of the issue here too is that not only is US health insurance very expensive, but for all practical purposes it doesn’t kick in until you’ve had a fairly significant issue. So you are paying a lot of money for insurance you hope to never use, and in the event you need some kind of basic care you are still paying out - and have no meaningful negotiating power. I’m under the impression in most countries with single-payer / government run health schemes, you might also pay a great deal for your coverage, but that it’s all inclusive.
Also not a single mention in this subthread of what happens if you aren't poor enough to qualify for medicaide (in most states you have to be near-homeless levels of poverty), but not anywhere near rich enough afford a $1500 a month plan for your family.
In Canada the waiting lists for mri and other advanced testing can be long where the same tests/operations can be done as a walkin option that day in the US.
A substantial difference is that healthcare tends to be incredibly regressive in the US. People with good jobs that have good pay tend to get pretty good company insurance. People in jobs that don't pay very well tend to have bad insurance, if they have it at all. Bad insurance typically means you pay a lot of out of pocket costs, meaning lower earning people often pay more out of pocket for the same medical treatment. It's more poignant in reverse though; high earners should expect to pay less than low earners for the same medical care. If it didn't work that way, why would any of us pay for more expensive health insurance?
If you have bad insurance, your options are usually to do the walkin option and pay whatever your insurance won't. That's probably more than you can afford unless you're sick enough to get a doctor to order it (which often means you've missed a critical window in treatment options). Or you can try one of the clinics, and wait for forever trying to get it looked at. Or you can do what many Americans do and ignore it, hoping that it goes away on its own.
We do have better options than other countries, but whether those doors are open often depends on your income level. Socialized healthcare does equalize that, even if it means dragging down the standard of care for the wealthy in exchange for bringing up the average.
waiting lists "can be long" – it's time to stop parroting these misleading statements. They can be, if your test/operation isn't urgent. Urgent things are treated right away.
Frankly, as an American, I think we have shit quality of health service, based on the insurance cos' red tape and restrictions and paperwork alone. Getting healthcare in this country is a bureaucratic nightmare. Maybe the docs and meds and tests are good, but the overall service is bad.
(Disclaimer that I insist on Kaiser, an HMO – I would not live in a US area without it – which is pretty good, but helping family through health issues who had "gold standard" normal PPO was... different).
My friend in Vancouver had lung xray show up something weird and the doctor scheduled her for an MRI. The appointment was in 7 months. Instead she got the MRI in a private clinic for a pretty reasonable cost and came back with the results for her doctor.
If that's not indicative of something broken, then I don't know what to tell you.
If she was able to get the MRI at a reasonable cost, doesn't that suggest that the system isn't that broken? As far as I can tell almost nothing comes at a reasonable cost in the US.
I think the criticism is probably of the Canadian health care system a la "She had to go to another country to get her scan in a reasonable period of time (and that country has a terrible global reputation for being insanely expensive and broken itself in the health care department)."
>“In Canada, the absence of a private system is not due to the illegality of private health care per se,” reads a 2001 analysis in the Canadian Medical Association Journal. “Rather, the lack of a flourishing private sector in Canada is most likely attributable to prohibitions on subsidization of private practice from the public plan.”
> Extra billing is defined as additional fees charged by a physician or a clinic for a publicly-funded health procedure that is medically necessary, or when a patient pays out of their own pocket for such a procedure in a private facility
This is about extra billing, not per se about MRI. So still seems fair to me.
What do you think the odds were that it was something that would cause problems in fewer than seven months, or that if she experienced symptoms that they would move her up in line?
Genuinely asking, since I don't know any details about her situation or much about lung ailments.
I don't know the specifics, but there's also the mental cost of the doctor seeing something concerning enough that warrants an MRI and waiting 7 months just for the test; praying nothing gets worse in the meantime.
What were the results? If it was a serious issue that needed treated urgently there is a problem. If it was not then she was prioritised correctly and there's no issue.
I'm in Canada. In 2010 my son was unwell, having issues with lethargy, balance and vomiting. We took him to the local children's hospital and he had a CT scan within 2 hours and an MRI an hour after that.
As part of his ongoing treatment the hospital scheduled an MRI every 3 months for a year, then every 6 months for 5 years, and now it's annual. The scans happen on time every time.
Each province administers it's own health care. So the level of service and time you have to wait varies significantly depending on where you live in Canada. Waiting six months for a specialist appointment is not unusual, for example, in say Quebec.
Not so easy in the US. My sister is in the first trimester of her pregnancy. She had to go to ER last week because she couldn't eat (keeps vomiting and lose sleep because of vomiting). She was in a bad state (very weak and was almost passing out) when they (her in-laws) brought her there. They had to wait for 2 hours to be attended by the nurse/doctor eventually. It's not because the hospital was crowded with COVID patients (Rochester, NY isn't overwhelmed with COVID at the moment). It's mostly because there are few doctors assigned for each shift at the hospital (the supply of doctors in the US is scarce--partly because of the artificial restrictions put in place by American Medical Association [https://www.washingtonexaminer.com/thanks-to-doctors-there-a...)
When I broke my nose, I went to ER and registered at around 12am. A doctor finally treated me at around 8:15am. That's at the Strong Memorial Hospital in Rochester, NY ~6 years ago.
> In Canada the waiting lists for mri and other advanced testing can be long where the same tests/operations can be done as a walkin option that day in the US.
Are there no private MRI machines in Canada? In many countries with free healthcare, you can still "just walk in" to any private hospital/clinic and get an MRI done.
They did however bring some under the provincial healthcare fold, so general turnaround times have improved with more scanners... And they are running more often (they weren't running 24/7.
I work in imaging, visited 100s of hospitals in Canada and mainly USA.
Would be uncommon to see a unreported list in USA with exams 24 hours or older.
In Canada it was common to see months.
These are scans performed but not interpreted by a radiologist .
So for urgent cases(like dieing in the hospital), there is hardly any wait and read right away.
But if it's somewhat none urgent (friend waiting 1 year for a MRI for nerve/back pain), you might have to wait awhile for the scan and then the report.
If you in a population dense area, you might be waiting awhile, but may get quicker service in smaller nearby towns(I had a 3 month wait for. Knee scan, went for a 2 hours drive for a scan a week later)
Our public healthcare has caps on how much a radiologist can read/get paid, so there is no incentive in Canada for radiologists go full force.
In USA they are paid per exams, and depending on case types could be reading 100s per day.
It wasn't specific to MRI clinics, but they elimited two tiered healthcare opti9ns as some perception it benefited the wealthy, and would attract doctors to privatized healthcare, further impacting public healthcare.
Same thing for non-elective surgeries.
You can't goto a private clinic for a surgery offered under public healthcare
Basically removed being able to pay to skip the queue, some people felt it was unfair, and to uphold integrity of public healthcare...
In Ontario, private MRIs aren't allowed except as a third-party service — such as an employer paying through private insurance. Think professional sports team ordering an mri for a basketball player.
We all pay taxes that build and maintain our roads, but that's no reason to not shell out for an airline ticket if we want to get somewhere faster.
In my country I can see a doctor for free after a 0-4hr queue in a hospital waiting room or pay USD$10 to immediately see any of the dozen private doctors within a 5 min drive of my home.
My taxes already pay for free healthcare, but I'm more than happy to pay more to avoid wait times.
But I live in the "third world", so I understand your experience might be different.
I think the waiting lists can be exaggerated sometimes. There are definitely waiting periods, but if something is a priority, things can move pretty fast.
As well, I'm basing this off not a lot of evidence other than doctor shows (which I recognize are probably ridiculously inaccurate), but I get the impression that (for those who have the right insurance) in the U.S. that testing and imaging is overprescribed, and doctors will often order an MRI when an ultrasound or a CT scan would be perfectly fine. So even if MRIs have a relatively longer waiting period, it's overall rarer that you'll need to get one in the first place (and CTs can usually be ordered fairly quickly - I had one today that was booked within a week for relatively minor symptoms)
> I think the waiting lists can be exaggerated sometimes
In fact, you can view it this way: the waiting lists are long because the important things are prioritized. People who really need treatment fast are being consistently moved to the front of the queue with no option to pay to get ahead of them for people at lower priority.
My reference point is Australia, and it was awe inspiring to see how fast things moved for a relative with breast cancer.
I was on a 5 month waiting list to see a provider that took my insurance in a major metro area in the US. Even if I chose to pay for visits upfront and in cash, there were still 3+ month long waiting lists from other providers.
I've also learned from friends who have family members with substance abuse issues that there are 6 or more month long waiting lists for even out-patient rehab, and for doctors that specialize in treating substance abuse. Addiction is often deadly, so it's pretty urgent to treat.
I just looked into it now. As of 2018, apparent 38% of Americans are obese and 28% of Australians. So it's probably a difference that _does_ factor into costs, but I wouldn't know how much.
That is such a big difference. Is it food suply related or lifestyle? The states with larger cheese production tend to be heavier than hotter states which could mean location might be the cause but it might be genetic.
A related factor: US sugar subsidies make sugar expensive, so a lot of manufactured foods in the US contain High Fructose Corn Syrup (HFCS) instead. On a kilojoule-for-kilojoule basis, excessive intake of HFCS is a lot more harmful to health than excessive intake of sugar is. By contrast, Australia has a long history of being anti-agriculture subsidies, and fewer foods here include HFCS (most of those that do are imported from the US)
> excessive intake of HFCS is a lot more harmful to health than excessive intake of sugar is
That's mostly an inaccurate myth that has persisted for decades. Despite the "High Fructose" part of the name HFCS, the balance of fructose and sucrose in HFCS is roughly the same as regular table sugar, 50/50. HFCS 90 is actually worse for you than table sugar due to it's high fructose content (which is primarily only absorbed in the liver, unlike sucrose), but it is rarely used and the taste is very sweet compared to normal HFCS or sugar.
You can easily search for tons of sources (queries as simple as "HFCS vs sugar" will give you decent results), but including one to back up what I said above:
There's chemical differences and some HFCS is a lot more fructose than sucrose. But, yeah, I also haven't been able to find any conclusive evidence that it's any worse with your garden-variety HFCS
In the US a good chuck of federal & state taxes go to government employee health care, active soldier & veteran health care. This added to medicare tax and health care premiums and medical expenditures gets me fairly close to the 18% of US GDP spent in the medical sector.
I decided to actually look at my budget from the last year and see how this compares to my costs.
In Australia I pay about ~28% of my salary in tax. 2% is for medicare, and I have private health insurance on top of that for roughly the same cost again (for dental, which isn't covered in our system because of dentists lobbying an exception back in the 80s). You still have to pay part of most costs in Australia, looking at my budget that's come out to about another ~1% of my income in the past year.
So I pay 5% of my salary for health services. It's pretty much inline with other costs like food and utilities. Doubling it to 10% would be doable, but it would suck.
It seems that the US system doubles the cost and the extra money serves as the very healthy profit margin of their private health industry. Keep in mind Australia manages to sustain a private health sector off that 5%, this isn't abolishing private health by any means.
A proper government health system could probably be even cheaper than the 5% I pay because the US has much better economies of scale. Not to mention the benefit of untying it from employment.
I'm not really making a point here, your comment just inspired me to compare the numbers and it sure is grim...