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How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the ba

How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the bang for buck. In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer. http://www.who.int/healthinfo/paper30.pdf http://www.who.int/healthinfo/paper30.pdf But there are single payer healthcare systems with bad health indexes, you might say... Well, combine single payer healthcare systems and add some transparency in healthcare and you now have an unmissable correlation. https://www.transparency.org/whatwedo/publication/global_corruption_report_2006_corruption_and_health https://www.transparency.org/whatwedo/publication/global_cor... The top 20 bang for buck healthcare programs (mostly single payer systems), have an average ranking in terms of healthcare transparency of 18.7. Are you from the USA? Notice the countries with universal healthcare, who have a similar healthcare transparency ranking to that of the USA: Luxembourg, Canada, Germany, France, Belgium, Ireland, and Chile. Their bang for buck rankings are 16, 30, 25, 1, 21, 19, 33 respectively. All of these countries have a better bang for buck ranking than the USA's 37. In one sentence... Universal and transparently managed healthcare consistently gives more bang for buck. And now to quote the original article... "It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead." EDIT: Check page 18 in the first source. Check chapter 11 in the second source.

frgtpsswrdlame 9y ago
This is a really good point. One problem I think though is that not everyone will come out ahead in a single payer system. Our system is explicitly organized around the fact that you must pay for care and we have the best and most expensive care in the world. Our system is setup so that those at the top of the economic ladder can buy a level of care they could not get anywhere else. They will undoubtedly receive worse care were the US to switch to a system which diminished the effect of personal wealth.
- learc83 9y ago
  >They will undoubtably receive worse care were the US to switch healthcare systems. If the US switches to mostly single payer, but still allows for private insurance and private doctors to exist, the wealthy will probably have to pay more to access them, but they'll still be able to access them.
- galeaspablo 9y ago
  That is conjecture. I could similarly hypothesize that things would improve under a single payer system, even for the rich... because of the compounding scientific advances of government backed healthcare. BUT we could go back and forth all day with conjecture... Give me some apples to apples numbers; that's what I joined HN for.
- asah 9y ago
  Actually, the 1% would have private healthcare, i.e. pay twice. This is directly analogous to private primary education: the wealthy still pay taxes to fund public schools, while paying addition for private schools as well.
  - seanmcdirmid 9y ago
    Something else the conservatives want to fix with school vouchers....
- inopinatus 9y ago
  This is not true, and can be trivially observed to be not true by counterexample, viz. looking at other countries that have a hybrid public/private system e.g. here in Australia. Incidentally, "level of care" is almost meaningless in most first-world systems. The difference I experience, due to my private health insurance here, is not in outcomes, but in time to service for elective procedures, and access to private facilities (most notably a private room for overnight/extended hospital stays). And that time-to-service difference vanishes for emergency care. EDIT: additional insider tip. If you have private health cover in such a system, and are being treated for a major medical issue, ask for a private room in a public hospital, because that is where our clinicians spend most of their day-to-day. If you are in a room in a private hospital, there are often no specialist clinicians on site. Whilst this may make no difference for most cases, any sudden complication may be dealt with much more quickly. This is possible in our hybrid system because the hospital is a separate institution from the state and happily does both public and private billing.
- specialist 9y ago
  Word salad. Our system (the USA) maximizes rent seeking, thru obfuscation, disjoint regulation, spotty oversight and enforcement.
- abalone 9y ago
  > They will undoubtedly receive worse care You're going to have to provide a lot more support for that claim. All you've really provided is the implication that "most expensive" = "best". But expense is also a result of inefficiencies, and we "undoubtedly" have a less efficient system (more administrative overhead.. I can cite sources if anyone doubts it). Other single-payer systems, for example, also provide complementary or supplementary private options.[1] And since these private options have to compete with a baseline of quality public care, they may be more affordable. [1] https://en.wikipedia.org/wiki/Two-tier_healthcare https://en.wikipedia.org/wiki/Two-tier_healthcare
  - inopinatus 9y ago
    > And since these private options have to compete with a baseline of quality public care, they may be more affordable. In such a hybrid system the public hospitals also experience competitive pressures. I can confirm pretty much first-hand[1] that this is why pathology turn-around times in a major metropolitan Australian public health service are measured in hours, whilst in the UK they are measured in weeks. [1] I am married to the medical director of this service.
- makomk 9y ago
  Indeed. One of the core ways single payer systems achieve such great results in terms of bang-for-buck is by not covering treatments that offer bad value for money, and this is almost certainly not politically viable in the US. For example, I understand the ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs. It simply does not follow that, because single payer systems offer better value in terms of benefit gained for the dollars spent, those efficiency improvements mean it's possible for everyone to come out ahead. Those last few iotas of healthcare improvement are a lot more expensive than the lower-hanging fruit.
  - inopinatus 9y ago
    This is flat wrong mis-statement of both the facts and the outcomes. The NHS does not assess cost-effectiveness of treatment in the UK in that fashion, and does not deny it on that basis. Cost-effectiveness by QALY is one factor included in assessments by a separate body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies from offering any particular treatment. If NICE gives a treatment option the green light, then the NHS trusts are obliged to offer it in applicable circumstances. If NICE does not, then individual (local) NHS trusts can make their own assessment. If there is a local cost constraint, that is considered as a matter of simple necessity. It is a common falsehood often repeated by opponents of single-payer systems that doctors in such systems are directly prevented from offering treatments by faceless beancounters. It simply isn't so. Quite the opposite. The assessors may say "you must offer this treatment". They do not say "you must not". However, QALY itself is IMO a terrible metric mainly because it is sufficiently describable to non-practitioners to become a political football.
    - makomk 9y ago
      Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now. At best, requiring a treatment rejected by NICE leaves your fate up to a postcode lottery where your location determines whether you have access to it. At worst, nowhere will cover it. Also, cost per QALY is one of the main factors NICE uses, and the ACA means it and similar measures cannot be used as any kind of factor at all in the US.
shortstuffsushi 9y ago
This simplification seems disingenuous. Would switching to single payer solve your last sentence / quote from the article? Aka, would putting the US government in the middle make things simpler and more efficient (and cheaper) for the end user (health care patients)? I can't say I'm convinced. Compare with the current system, where any given user is still effectively dealing with a single payer -- their insurance provider. Their insurance provider is one level of removal from the health system that has to be paid. Now, the idea of transparency? That's lovely, and would force accountability and that sort of thing which could potentially have impact. I can't disagree with that. I'm not sure that just putting the government in the middle fixes that either, though. As /u/frgtpsswrdlame points out, we have the most expensive health care, which seems like the bigger issue that isn't addressed. If we lessened the cost of health care in the US, that would probably be a better start, imo. Does single payer fix that? I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate, but perhaps I've got that backwards. I'm not disagreeing with the thought on the whole, I just don't see how single payer fixes these problems.
- davidw 9y ago
  I lived in Italy for a number of years, and the Italian government is no nordic model of efficiency and propriety. And the health care system is still mostly better than in the US :-/ You're right that costs need containing though, and it's not quite as simply as "just" switching to a singly payer system.
- learc83 9y ago
  >I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate That's the biggest advantage of single payer, one buyer can negotiate better deals with suppliers because there are no other buyers. It's basically a reverse monopoly.
  - davidw 9y ago
    The term for that is monopsony. https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony
specialist 9y ago
I advocate single payer, vs single provider. What Canada has, more or less, vs Britain's NHS. http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php http://www.pnhp.org/single_payer_resources/health_care_syste... Plus a good dash of capitation, to incentivise wellness thru prevention, vs fee-for-service.
bradleyjg 9y ago
"And now to quote the original article... 'It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.'" That's a really important "possible" though. It is a near certainty that if were to transition to single payer healthcare we would not do the transfers to hold everyone profiting from the current system harmless (e.g. health insurance employees). In any realistic scenario there would be winners and losers which is why you see fierce lobbying on both sides of the issue. It's the difference between Pareto and Kaldor-Hicks (See this prior comment for the definitions: https://news.ycombinator.com/item?id=14605477 https://news.ycombinator.com/item?id=14605477 )
- galeaspablo 9y ago
  That's a matter of policy. You can set a cap of how much tax someone pays for healthcare, such that rich people don't get screwed. The question here is what's more efficient... And the numbers are there. Single payer + Healthcare transparency = Efficiency. (see sources and explanation in original comment)
  - ryandrake 9y ago
    Why do rich people need a cap in order to not "get screwed?"
    - galeaspablo 9y ago
      Like I said, that's a matter of policy. I.e. should rich people pay more tax? But I'm not here to answer that question.
deleted 9y ago
[deleted]
ML_God 9y ago
The countries, that are not US get better bang for buck, because the US overspends on healthcare. 99% of the new drugs and medical devices are brought to market first in US. After the US pays most of the R&D expenses the rest of the world gets stuff on the cheap.
dv_dt 9y ago
This is interesting data... https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus https://ourworldindata.org/the-link-between-life-expectancy-... The US is pretty divergent... and not in a good way.

frgtpsswrdlame 9y ago

This is a really good point. One problem I think though is that not everyone will come out ahead in a single payer system. Our system is explicitly organized around the fact that you must pay for care and we have the best and most expensive care in the world. Our system is setup so that those at the top of the economic ladder can buy a level of care they could not get anywhere else. They will undoubtedly receive worse care were the US to switch to a system which diminished the effect of personal wealth.

learc83 9y ago
>They will undoubtably receive worse care were the US to switch healthcare systems. If the US switches to mostly single payer, but still allows for private insurance and private doctors to exist, the wealthy will probably have to pay more to access them, but they'll still be able to access them.
galeaspablo 9y ago
That is conjecture. I could similarly hypothesize that things would improve under a single payer system, even for the rich... because of the compounding scientific advances of government backed healthcare. BUT we could go back and forth all day with conjecture... Give me some apples to apples numbers; that's what I joined HN for.
asah 9y ago
Actually, the 1% would have private healthcare, i.e. pay twice. This is directly analogous to private primary education: the wealthy still pay taxes to fund public schools, while paying addition for private schools as well.
- seanmcdirmid 9y ago
  Something else the conservatives want to fix with school vouchers....
inopinatus 9y ago
This is not true, and can be trivially observed to be not true by counterexample, viz. looking at other countries that have a hybrid public/private system e.g. here in Australia. Incidentally, "level of care" is almost meaningless in most first-world systems. The difference I experience, due to my private health insurance here, is not in outcomes, but in time to service for elective procedures, and access to private facilities (most notably a private room for overnight/extended hospital stays). And that time-to-service difference vanishes for emergency care. EDIT: additional insider tip. If you have private health cover in such a system, and are being treated for a major medical issue, ask for a private room in a public hospital, because that is where our clinicians spend most of their day-to-day. If you are in a room in a private hospital, there are often no specialist clinicians on site. Whilst this may make no difference for most cases, any sudden complication may be dealt with much more quickly. This is possible in our hybrid system because the hospital is a separate institution from the state and happily does both public and private billing.
specialist 9y ago
Word salad. Our system (the USA) maximizes rent seeking, thru obfuscation, disjoint regulation, spotty oversight and enforcement.
abalone 9y ago
> They will undoubtedly receive worse care You're going to have to provide a lot more support for that claim. All you've really provided is the implication that "most expensive" = "best". But expense is also a result of inefficiencies, and we "undoubtedly" have a less efficient system (more administrative overhead.. I can cite sources if anyone doubts it). Other single-payer systems, for example, also provide complementary or supplementary private options.[1] And since these private options have to compete with a baseline of quality public care, they may be more affordable. [1] https://en.wikipedia.org/wiki/Two-tier_healthcare https://en.wikipedia.org/wiki/Two-tier_healthcare
- inopinatus 9y ago
  > And since these private options have to compete with a baseline of quality public care, they may be more affordable. In such a hybrid system the public hospitals also experience competitive pressures. I can confirm pretty much first-hand[1] that this is why pathology turn-around times in a major metropolitan Australian public health service are measured in hours, whilst in the UK they are measured in weeks. [1] I am married to the medical director of this service.
makomk 9y ago
Indeed. One of the core ways single payer systems achieve such great results in terms of bang-for-buck is by not covering treatments that offer bad value for money, and this is almost certainly not politically viable in the US. For example, I understand the ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs. It simply does not follow that, because single payer systems offer better value in terms of benefit gained for the dollars spent, those efficiency improvements mean it's possible for everyone to come out ahead. Those last few iotas of healthcare improvement are a lot more expensive than the lower-hanging fruit.
- inopinatus 9y ago
  This is flat wrong mis-statement of both the facts and the outcomes. The NHS does not assess cost-effectiveness of treatment in the UK in that fashion, and does not deny it on that basis. Cost-effectiveness by QALY is one factor included in assessments by a separate body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies from offering any particular treatment. If NICE gives a treatment option the green light, then the NHS trusts are obliged to offer it in applicable circumstances. If NICE does not, then individual (local) NHS trusts can make their own assessment. If there is a local cost constraint, that is considered as a matter of simple necessity. It is a common falsehood often repeated by opponents of single-payer systems that doctors in such systems are directly prevented from offering treatments by faceless beancounters. It simply isn't so. Quite the opposite. The assessors may say "you must offer this treatment". They do not say "you must not". However, QALY itself is IMO a terrible metric mainly because it is sufficiently describable to non-practitioners to become a political football.
  - makomk 9y ago
    Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now. At best, requiring a treatment rejected by NICE leaves your fate up to a postcode lottery where your location determines whether you have access to it. At worst, nowhere will cover it. Also, cost per QALY is one of the main factors NICE uses, and the ACA means it and similar measures cannot be used as any kind of factor at all in the US.

shortstuffsushi 9y ago

This simplification seems disingenuous. Would switching to single payer solve your last sentence / quote from the article? Aka, would putting the US government in the middle make things simpler and more efficient (and cheaper) for the end user (health care patients)? I can't say I'm convinced. Compare with the current system, where any given user is still effectively dealing with a single payer -- their insurance provider. Their insurance provider is one level of removal from the health system that has to be paid. Now, the idea of transparency? That's lovely, and would force accountability and that sort of thing which could potentially have impact. I can't disagree with that. I'm not sure that just putting the government in the middle fixes that either, though. As /u/frgtpsswrdlame points out, we have the most expensive health care, which seems like the bigger issue that isn't addressed. If we lessened the cost of health care in the US, that would probably be a better start, imo. Does single payer fix that? I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate, but perhaps I've got that backwards. I'm not disagreeing with the thought on the whole, I just don't see how single payer fixes these problems.

davidw 9y ago
I lived in Italy for a number of years, and the Italian government is no nordic model of efficiency and propriety. And the health care system is still mostly better than in the US :-/ You're right that costs need containing though, and it's not quite as simply as "just" switching to a singly payer system.
learc83 9y ago
>I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate That's the biggest advantage of single payer, one buyer can negotiate better deals with suppliers because there are no other buyers. It's basically a reverse monopoly.
- davidw 9y ago
  The term for that is monopsony. https://en.wikipedia.org/wiki/Monopsony https://en.wikipedia.org/wiki/Monopsony

specialist 9y ago

I advocate single payer, vs single provider. What Canada has, more or less, vs Britain's NHS. http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php http://www.pnhp.org/single_payer_resources/health_care_syste... Plus a good dash of capitation, to incentivise wellness thru prevention, vs fee-for-service.

bradleyjg 9y ago

"And now to quote the original article... 'It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.'" That's a really important "possible" though. It is a near certainty that if were to transition to single payer healthcare we would not do the transfers to hold everyone profiting from the current system harmless (e.g. health insurance employees). In any realistic scenario there would be winners and losers which is why you see fierce lobbying on both sides of the issue. It's the difference between Pareto and Kaldor-Hicks (See this prior comment for the definitions: https://news.ycombinator.com/item?id=14605477 https://news.ycombinator.com/item?id=14605477 )

galeaspablo 9y ago
That's a matter of policy. You can set a cap of how much tax someone pays for healthcare, such that rich people don't get screwed. The question here is what's more efficient... And the numbers are there. Single payer + Healthcare transparency = Efficiency. (see sources and explanation in original comment)
- ryandrake 9y ago
  Why do rich people need a cap in order to not "get screwed?"
  - galeaspablo 9y ago
    Like I said, that's a matter of policy. I.e. should rich people pay more tax? But I'm not here to answer that question.

deleted 9y ago

[deleted]

ML_God 9y ago

The countries, that are not US get better bang for buck, because the US overspends on healthcare. 99% of the new drugs and medical devices are brought to market first in US. After the US pays most of the R&D expenses the rest of the world gets stuff on the cheap.

dv_dt 9y ago

This is interesting data... https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus https://ourworldindata.org/the-link-between-life-expectancy-... The US is pretty divergent... and not in a good way.