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A bit OT, but this post made me think: how do countries provide good health care? does it always have to be government sponsored, otherwise it would be not affo

A bit OT, but this post made me think: how do countries provide good health care? does it always have to be government sponsored, otherwise it would be not affordable? And how does the government pay for it, given that the money has to come from taxpayers? Because otherwise I don't understand why the market can't provide good health insurance in the US? Isn't that a classic insurance problem, take a group of people and spread out the risk? What is going on? Is medicine too expensive because of state subsidies, so private insurers can't compete? Or are there regulations preventing private insurers from entering the market?

anewhnaccount2 9y ago
I mean isn't one factor that healthcare simply costs more in the USA in the first place?
- hellofunk 9y ago
  This is the main problem. American health industry (doctors, pharmaceuticals, etc) cost a vast amount more than in other countries, thus insurance is also high to compensate for this. I've heard that a big part of this cost is due to the highly litigious culture in America that requires doctors to carry very high malpractice insurance, which they must then pass on in their patient costs. Americans love to sue, and this drives prices up. I don't know if this is true, but its the one argument I've heard over the years that makes the most sense to me. I once had a worldwide health insurance plan while living in Asia, and it covered all countries EXCEPT the USA, because of the absurd costs there.
  - patryn20 9y ago
    Strangely enough my primary income is writing software for the healthcare industry. A significant portion of my firm's income goes to insurance and lawyers to ensure compliance/protection in the event of a lawsuit.
- anothercomment 9y ago
  But why does it cost more, and how are employers able to provide health insurance anyway?
  - inopinatus 9y ago
    One reason it costs more: people with serious conditions may delay presenting because they fear the cost of healthcare. And unfortunately, many serious conditions are dramatically more expensive, and potentially more lethal, when presenting late. It's a nasty piece of positive cost feedback inherent to the current US system, and one that disproportionately affects patients from lower income brackets. Other reasons include the massive costs of running and staffing the billing infrastructure, cost of compliance & provider insurance, and uncontrolled drug pricing. These factors are not present in most other first-world healthcare systems, or are present but minimised by effective regulation.
beefsack 9y ago
National health care systems are incredibly common outside the US, and they're often in countries with sliding scale income tax so it impacts the poorer much less than those well off. A lot of countries have hybrid systems where there is partial privatisation, but it's rare to see private insurance necessary for required treatments. I don't mean for this to be antagonistic so please don't take it that way, but it seems so many outside the US see the US as almost a form of extreme capitalism, where an almost dogmatic belief in the ideal has resulted in sub-optimal infrastructure and services.
- anothercomment 9y ago
  But why - I still don't understand what is causing the problem in the US? Even in the non-US systems, somebody has to pay, so how can they afford it, given that all other countries are poorer than the US? In my view, insurance is completely compatible with capitalism. It is simply a business, based on statistics. So why should the US have a special problem with insurance?
  - beefsack 9y ago
    > But why - I still don't understand what is causing the problem in the US? Even in the non-US systems, somebody has to pay, so how can they afford it, given that all other countries are poorer than the US? Perhaps the issue isn't that the US as a whole can't afford it, but more that medical treatments are expensive and the rich aren't willing to subsidise for the others. In countries where it's funded essentially via sliding scale income tax, the rich don't have a choice but to subsidise it.
    - anothercomment 9y ago
      That would be another issue than the "medical care is especially expensive in the US", though. Are the numbers even known, I mean, how much would proper health insurance cost per person?
      - youdontknowtho 9y ago
dejv 9y ago
I am no doctor, but I guess when you run health care as a for profit adventure you will try to extract more money from your patient. Maybe not the direct way, but you might buy a lot of very expensive equipment and send your patients there even when there is another way of diagnosis that is cheaper. Or you might be even doing a lot of additional screenings just to be sure (you really want to be covered in case of some lawsuit).
- anothercomment 9y ago
  This seems to be more of a problem with insurance - there often is little transparency and doctors simply charge all sorts of things to the insurer that the patient has no idea about. I think that is one of the main challenges of health insurance. In my country (Germany) I have actually shied away from switching to private insurance, because they pay doctors more, and doctors are known to do as many tests and procedures as possible (not always a good thing, but in the end it is a gamble - too many examinations/procedures or too few?). The "public" health insurance is quite regulated as to what gets paid and how much. The downside is that doctors have to waste a lot of time on bureaucracy (every examination has to be entered into the computer to determine the costs), and transparency is still missing (patients typically don't even know how much their treatments cost). And some committee decides what procedures get paid. I don't trust committees. I trust the market (I mean I trust "in" markets, not necessarily any given market as markets can be broken by regulations, lack of transparency, all sorts of things). I have also spent a lot of money on things that weren't covered by public insurance. One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. I think it is actually unavoidable that insurance will have to make a cut at some point, because medical procedures can become arbitrarily expensive. Perhaps even now for the right money, people could be kept alive indefinitely. I would have no problem with a doctor trying to be profitable - just as with other businesses. I guess the classic assumption is that to be profitable, businesses have to provide good service.
  - DanWaterworth 9y ago
    > One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.
ollifi 9y ago
I think that's how insurance works on a basic level, but when it is run as business you try to maximize the profit. Healthcare is one of the best businesses around because in the event your client gets very sick they are willing to pay pretty much everything to get better. You can design the insurance around these events and average customer does not really pay attention. State run healthcare ruins the market by basing the cost of treatments to pretty much what they cost to perform rather than how much person is willing to pay for them. Of course it does not work quite so smoothly in the real world, but enough that countries with public healthcare seem to be cheaper.
- anothercomment 9y ago
  In theory, competition should take care of the escalating costs, though?
  - patryn20 9y ago
    In a "market" in which costs are unpredictable and not disclosed until AFTER care is complete, there is not truly competition. Try asking a cardiologist or neurologist for a fixed price estimate before a test is run. If you press the issue you'll be labeled a "confrontational" or "hostile" patient and rejected from the practice.
    - anothercomment 9y ago
      They will reject you as long as they have enough other patients who don't care about the price. Somewhere the systemic error is injected into the system. There has to be a way to fix it or improve it.
      - eeZah7Ux 9y ago
        In some countries it's illegal to refuse service to customers unless they are doing something illegal. This applies to shops and restaurants as well.
    - sjg007 9y ago
deleted 9y ago
[deleted]
maxerickson 9y ago
There are all sorts of structural limits on providers entering the marketplace. Not just doctors, but hospitals and the like. In many states, opening up many types of medical facilities requires a certificate of need from the state regulator (exactly what sorts of facilities vary by state and some states don't require them). Another factor is that many people don't shop for their insurance, they take whatever their employer offers (and if they have much leverage, they demand that their employer offer something with broad coverage and minimal copays and deductibles).
Delmania 9y ago
> Because otherwise, I don't understand why the market can't provide good health insurance in the US? Isn't that a classic insurance problem, take a group of people and spread out the risk? No, your mistake is in assuming that insurance companies exist to spread risk and reduce costs. Insurance companies like most publicly traded companies exist to transfer wealth from customers to executives and shareholders. As a result, they will do whatever they legally can to raise revenue (increasing premiums) and reduce costs (deny coverage, push the burden to the consumer). The other aspect is that healthcare in the United States does not lend itself to a free market solution. There's no transparency in prices, so you can't exactly shop around when you need a procedure done. In addition, you also have times when a person needs treatment due to a life-threatening condition. He is not interested in looking at alternatives, he's interested in staying alive, so he's going to take whatever provider is around. Well, if that provider is not "in-network", he's going to get hit with a massive bill. The United States is literally the only developed* nation that has the concept of medical bankruptcy. * The United States is not truly developed. From an economic standpoint, we are, from a social standpoint, we're not.

anewhnaccount2 9y ago

I mean isn't one factor that healthcare simply costs more in the USA in the first place?

hellofunk 9y ago
This is the main problem. American health industry (doctors, pharmaceuticals, etc) cost a vast amount more than in other countries, thus insurance is also high to compensate for this. I've heard that a big part of this cost is due to the highly litigious culture in America that requires doctors to carry very high malpractice insurance, which they must then pass on in their patient costs. Americans love to sue, and this drives prices up. I don't know if this is true, but its the one argument I've heard over the years that makes the most sense to me. I once had a worldwide health insurance plan while living in Asia, and it covered all countries EXCEPT the USA, because of the absurd costs there.
- patryn20 9y ago
  Strangely enough my primary income is writing software for the healthcare industry. A significant portion of my firm's income goes to insurance and lawyers to ensure compliance/protection in the event of a lawsuit.
anothercomment 9y ago
But why does it cost more, and how are employers able to provide health insurance anyway?
- inopinatus 9y ago
  One reason it costs more: people with serious conditions may delay presenting because they fear the cost of healthcare. And unfortunately, many serious conditions are dramatically more expensive, and potentially more lethal, when presenting late. It's a nasty piece of positive cost feedback inherent to the current US system, and one that disproportionately affects patients from lower income brackets. Other reasons include the massive costs of running and staffing the billing infrastructure, cost of compliance & provider insurance, and uncontrolled drug pricing. These factors are not present in most other first-world healthcare systems, or are present but minimised by effective regulation.

beefsack 9y ago

National health care systems are incredibly common outside the US, and they're often in countries with sliding scale income tax so it impacts the poorer much less than those well off. A lot of countries have hybrid systems where there is partial privatisation, but it's rare to see private insurance necessary for required treatments. I don't mean for this to be antagonistic so please don't take it that way, but it seems so many outside the US see the US as almost a form of extreme capitalism, where an almost dogmatic belief in the ideal has resulted in sub-optimal infrastructure and services.

anothercomment 9y ago
But why - I still don't understand what is causing the problem in the US? Even in the non-US systems, somebody has to pay, so how can they afford it, given that all other countries are poorer than the US? In my view, insurance is completely compatible with capitalism. It is simply a business, based on statistics. So why should the US have a special problem with insurance?
- beefsack 9y ago
  > But why - I still don't understand what is causing the problem in the US? Even in the non-US systems, somebody has to pay, so how can they afford it, given that all other countries are poorer than the US? Perhaps the issue isn't that the US as a whole can't afford it, but more that medical treatments are expensive and the rich aren't willing to subsidise for the others. In countries where it's funded essentially via sliding scale income tax, the rich don't have a choice but to subsidise it.
  - anothercomment 9y ago
    That would be another issue than the "medical care is especially expensive in the US", though. Are the numbers even known, I mean, how much would proper health insurance cost per person?
    - youdontknowtho 9y ago

dejv 9y ago

I am no doctor, but I guess when you run health care as a for profit adventure you will try to extract more money from your patient. Maybe not the direct way, but you might buy a lot of very expensive equipment and send your patients there even when there is another way of diagnosis that is cheaper. Or you might be even doing a lot of additional screenings just to be sure (you really want to be covered in case of some lawsuit).

anothercomment 9y ago
This seems to be more of a problem with insurance - there often is little transparency and doctors simply charge all sorts of things to the insurer that the patient has no idea about. I think that is one of the main challenges of health insurance. In my country (Germany) I have actually shied away from switching to private insurance, because they pay doctors more, and doctors are known to do as many tests and procedures as possible (not always a good thing, but in the end it is a gamble - too many examinations/procedures or too few?). The "public" health insurance is quite regulated as to what gets paid and how much. The downside is that doctors have to waste a lot of time on bureaucracy (every examination has to be entered into the computer to determine the costs), and transparency is still missing (patients typically don't even know how much their treatments cost). And some committee decides what procedures get paid. I don't trust committees. I trust the market (I mean I trust "in" markets, not necessarily any given market as markets can be broken by regulations, lack of transparency, all sorts of things). I have also spent a lot of money on things that weren't covered by public insurance. One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. I think it is actually unavoidable that insurance will have to make a cut at some point, because medical procedures can become arbitrarily expensive. Perhaps even now for the right money, people could be kept alive indefinitely. I would have no problem with a doctor trying to be profitable - just as with other businesses. I guess the classic assumption is that to be profitable, businesses have to provide good service.
- DanWaterworth 9y ago
  > One story I heard is that for example in the UK they won't pay for dialysis after a certain age. So public health insurance is not an automatic solution to every problem. A quick Google search reveals this claim is spurious, so maybe don't believe everything you hear.

ollifi 9y ago

I think that's how insurance works on a basic level, but when it is run as business you try to maximize the profit. Healthcare is one of the best businesses around because in the event your client gets very sick they are willing to pay pretty much everything to get better. You can design the insurance around these events and average customer does not really pay attention. State run healthcare ruins the market by basing the cost of treatments to pretty much what they cost to perform rather than how much person is willing to pay for them. Of course it does not work quite so smoothly in the real world, but enough that countries with public healthcare seem to be cheaper.

anothercomment 9y ago
In theory, competition should take care of the escalating costs, though?
- patryn20 9y ago
  In a "market" in which costs are unpredictable and not disclosed until AFTER care is complete, there is not truly competition. Try asking a cardiologist or neurologist for a fixed price estimate before a test is run. If you press the issue you'll be labeled a "confrontational" or "hostile" patient and rejected from the practice.
  - anothercomment 9y ago
    They will reject you as long as they have enough other patients who don't care about the price. Somewhere the systemic error is injected into the system. There has to be a way to fix it or improve it.
    - eeZah7Ux 9y ago
      In some countries it's illegal to refuse service to customers unless they are doing something illegal. This applies to shops and restaurants as well.
  - sjg007 9y ago

deleted 9y ago

[deleted]

maxerickson 9y ago

There are all sorts of structural limits on providers entering the marketplace. Not just doctors, but hospitals and the like. In many states, opening up many types of medical facilities requires a certificate of need from the state regulator (exactly what sorts of facilities vary by state and some states don't require them). Another factor is that many people don't shop for their insurance, they take whatever their employer offers (and if they have much leverage, they demand that their employer offer something with broad coverage and minimal copays and deductibles).

Delmania 9y ago

> Because otherwise, I don't understand why the market can't provide good health insurance in the US? Isn't that a classic insurance problem, take a group of people and spread out the risk? No, your mistake is in assuming that insurance companies exist to spread risk and reduce costs. Insurance companies like most publicly traded companies exist to transfer wealth from customers to executives and shareholders. As a result, they will do whatever they legally can to raise revenue (increasing premiums) and reduce costs (deny coverage, push the burden to the consumer). The other aspect is that healthcare in the United States does not lend itself to a free market solution. There's no transparency in prices, so you can't exactly shop around when you need a procedure done. In addition, you also have times when a person needs treatment due to a life-threatening condition. He is not interested in looking at alternatives, he's interested in staying alive, so he's going to take whatever provider is around. Well, if that provider is not "in-network", he's going to get hit with a massive bill. The United States is literally the only developed* nation that has the concept of medical bankruptcy. * The United States is not truly developed. From an economic standpoint, we are, from a social standpoint, we're not.