7 ms·

> This is unsustainable. It's not just unsustainable, it's absurd! $25,000 USD is most of, if not the entirety, of the TOTAL income taxes many people pay in ot

by knz 9y ago

> This is unsustainable. It's not just unsustainable, it's absurd! $25,000 USD is most of, if not the entirety, of the TOTAL income taxes many people pay in other OECD nations. How are these other nations providing all of the functions of government, including universal health care, for what Americans are paying just for insurance? This shouldn't be a partisan issue - even the most conservative of Americans should be outraged that we are being ripped off. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm - the US spends $9,800/year per capita, clearly an outlier, and yet we still can't cover everyone in a reasonable way?! I took my child in for a regular 15 minute doctors appointment recently and the cost of seeing the provider (no tests) was $350. Does it really cost $1,400/hour to operate a medical clinic? Google tells me that the average GP salary in the US is $189,000 ($90/hour), average salary for a nurse is $67,000 ($32/hour), and average for a receptionist is $27,000 ($12/hour). Add another nurse for administering shots/drawing blood and the total payroll per hour is about $166/hour. Where is the other $1,234/hour going? I'm sure there are reasonable explanations for some of it (cost of the building, cost of medical equipment in the clinic, professional insurance, and maintenance on the fish tank) but the ridiculous cost of everything is the elephant in the room that no amount of "cracking down on fraud" or "incentivizing healthy behaviors" will solve. As an immigrant to the US, it's maddening. It just doesn't have to be this way, there is half a century of evidence showing that alternative systems are cheaper and more effective. I also look at that $9,800/year per capita and wonder what our economy looks like if everyone had an extra $2-4,000/year in their pocket. Or if we eliminated the burden of health care from businesses and individuals trying to start a business.

athenot 9y ago
Not to take away from any of your points, but just a minor correction that in many OECD nations (Europe specifically), it's payroll taxes that pay for the healthcare, not income taxes. The former can be double what the latter are.
malandrew 9y ago
https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost...
com2kid 9y ago
> I took my child in for a regular 15 minute doctors appointment recently and the cost of seeing the provider (no tests) was $350. A 30 minute visit with my primary care doctor is ~$160. I now realize my local hospital is fairly reasonably priced. Also don't forget to factor in the small army in the billing department that has to deal with the insurance company. And the third party payment provider that runs the online web portal that you pay through. Interestingly enough, in Washington State all hospital finances are a matter of public record[1]. I am somewhat amused that health insurance for employees make up ~5.7% of the hospital's total expenses. Charity care was only .87% of overall expenses. [1]http://www.doh.wa.gov/DataandStatisticalReports/HealthcareinWashington/HospitalandPatientData/HospitalFinancialData/YearEndReports/2015HospitalYearEndReports http://www.doh.wa.gov/DataandStatisticalReports/Healthcarein...
nipplesurvey 9y ago
> How are these other nations providing all of the functions of government, including universal health care, for what Americans are paying just for insurance? by america subsidizing their defense spending
- virmundi 9y ago
  You're not wrong. I'm sure there are points to debate, but the US does provide a free military to the EU. https://www.cato.org/blog/us-taxpayer-subsidies-european-welfare-states-continue https://www.cato.org/blog/us-taxpayer-subsidies-european-wel...
benmarten 9y ago
well, you probably also make a lot more than in your home country ;) So that seems to be the game we're all in...
klipt 9y ago
To some degree, hospitals perform a kind of internal socialism: a poor, homeless person can't be turned away from the emergency room, but they also can't pay for its actual cost. To balance their books, hospitals then have to overcharge people with good insurance. This is similar to private universities charging rich students the full sticker price, while giving poorer students scholarships and financial aid.
- maxerickson 9y ago
  Hospitals put the costs of uncompensated care at 5-6% of total expenses: http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf (that's charity care and non payments but not any unfunded expenses due to Medicaid and Medicare)
  - creaghpatr 9y ago
    "*The above uncompensated care figures represent the estimated cost of bad debt and charity care to the hospital." Cost is the key word there and is bolded in the link. The billed amount they would have lost would be much higher. Most hospitals collect about only 25% of patient payments owed to them. When they write it down, they use the cost to the hospital not the amount billed.
    - maxerickson 9y ago
      I don't see what is important about that. What is interesting about the amount they attempt to bill?
      - creaghpatr 9y ago
        For example, if we're talking about a $5 bandaid (in terms of cost), the hospital will list the price at $20 on the chargemaster. They'll charge an in-network payer $15 and an out of network payer $20. An uninsured patient would probably get charged $10. In any case, if the patient gets charged $10 and doesn't pay, the hospital only writes off $5 as uncompensated care because that's the requirement for government reimbursement. But really they lost $10 on gross patient revenue. It scales up much higher as you can imagine. The point is that the financial cost of uncompensated care is much higher than the dollar amount and why so many hospitals are in financial danger today.
eveningcoffee 9y ago
> It's not just unsustainable, it's absurd! $25,000 USD is most of, if not the entirety, of the TOTAL income taxes many people pay in other OECD nations. In most European countries (probably in all of them, but I do have motivation to check) the cost of the health care is paid based on the solidarity principle. This means that the amount that goes for the state level insurer is proportional to the income amount (private insurances for the extra coverage usually work on the fixed amount basis). Around 500 per person in month is probably not on the very high side considering decent salary levels. The difference is that the health care of the minors is free. This splits the amount in half.
- Loic 9y ago
  In Germany, this is less. Suppose you are insured through the public system (Krankenkasse) and you have a salary high enough to pay the maximum rate, you pay 365.40€/month (your employer pay about the same amount). If you are self employed, you pay 656.85€ (employer and employee part). This covers you, your kids and your partner if he/she is not working. If your partner is working, he/she pays like you. So, imagine you are a family of four, both self employed, the maximum you pay is 656.85€ x 12 x 2 = 15764€/year. This covers 100% of the kids medications, 70 to 100% of the adult medications, 100% of the visit to the doctor and stay in a hospital. You do not have to pay and get reimbursed, you just provide your insurance card and the doctor/hospital will automatically charge your insurance (Krankenkasse). The system is working a bit differently if you opt-in for a private insurance. Edit: I cannot reply to the question about the maximum, so, answering as an edit. Yes you have a maximum and the values I gave are at this maximum.
  - trymas 9y ago
    Slight offtopic. Did I understand right that there is a limit for 'Krankenkasse' monthly payment? Where I live - there is no limit. If your _payroll_ is ~1315eur, that means your _income_ is 1000eur, because you've paid (or employer did that for you): - 15% income tax (~197eur), - public health insurance 6% (~79eur), - public retirement fund 3% (~40eur). - employer pays 31.18% of the _payroll_ to public health insurance (~410eur). Making the __whole employment price__ - 1726eur, of which 489eur goes to public health insurance. If your __income__ is 10 000eur - everything is tenfold. I do not know nuances of self employment, but you pay less for the public health insurance. From 1726eur, you'd pay ~234eur for public health insurance and ~181eur income tax - leaving you with ~1311eur.

by knz 9y ago

athenot 9y ago

Not to take away from any of your points, but just a minor correction that in many OECD nations (Europe specifically), it's payroll taxes that pay for the healthcare, not income taxes. The former can be double what the latter are.

malandrew 9y ago

https://slatestarcodex.com/2017/02/09/considerations-on-cost-disease/ https://slatestarcodex.com/2017/02/09/considerations-on-cost...

com2kid 9y ago

> I took my child in for a regular 15 minute doctors appointment recently and the cost of seeing the provider (no tests) was $350. A 30 minute visit with my primary care doctor is ~$160. I now realize my local hospital is fairly reasonably priced. Also don't forget to factor in the small army in the billing department that has to deal with the insurance company. And the third party payment provider that runs the online web portal that you pay through. Interestingly enough, in Washington State all hospital finances are a matter of public record[1]. I am somewhat amused that health insurance for employees make up ~5.7% of the hospital's total expenses. Charity care was only .87% of overall expenses. [1]http://www.doh.wa.gov/DataandStatisticalReports/HealthcareinWashington/HospitalandPatientData/HospitalFinancialData/YearEndReports/2015HospitalYearEndReports http://www.doh.wa.gov/DataandStatisticalReports/Healthcarein...

nipplesurvey 9y ago

> How are these other nations providing all of the functions of government, including universal health care, for what Americans are paying just for insurance? by america subsidizing their defense spending

virmundi 9y ago
You're not wrong. I'm sure there are points to debate, but the US does provide a free military to the EU. https://www.cato.org/blog/us-taxpayer-subsidies-european-welfare-states-continue https://www.cato.org/blog/us-taxpayer-subsidies-european-wel...

benmarten 9y ago

well, you probably also make a lot more than in your home country ;) So that seems to be the game we're all in...

klipt 9y ago

To some degree, hospitals perform a kind of internal socialism: a poor, homeless person can't be turned away from the emergency room, but they also can't pay for its actual cost. To balance their books, hospitals then have to overcharge people with good insurance. This is similar to private universities charging rich students the full sticker price, while giving poorer students scholarships and financial aid.

maxerickson 9y ago
Hospitals put the costs of uncompensated care at 5-6% of total expenses: http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf (that's charity care and non payments but not any unfunded expenses due to Medicaid and Medicare)
- creaghpatr 9y ago
  "*The above uncompensated care figures represent the estimated cost of bad debt and charity care to the hospital." Cost is the key word there and is bolded in the link. The billed amount they would have lost would be much higher. Most hospitals collect about only 25% of patient payments owed to them. When they write it down, they use the cost to the hospital not the amount billed.
  - maxerickson 9y ago
    I don't see what is important about that. What is interesting about the amount they attempt to bill?
    - creaghpatr 9y ago
      For example, if we're talking about a $5 bandaid (in terms of cost), the hospital will list the price at $20 on the chargemaster. They'll charge an in-network payer $15 and an out of network payer $20. An uninsured patient would probably get charged $10. In any case, if the patient gets charged $10 and doesn't pay, the hospital only writes off $5 as uncompensated care because that's the requirement for government reimbursement. But really they lost $10 on gross patient revenue. It scales up much higher as you can imagine. The point is that the financial cost of uncompensated care is much higher than the dollar amount and why so many hospitals are in financial danger today.

eveningcoffee 9y ago

> It's not just unsustainable, it's absurd! $25,000 USD is most of, if not the entirety, of the TOTAL income taxes many people pay in other OECD nations. In most European countries (probably in all of them, but I do have motivation to check) the cost of the health care is paid based on the solidarity principle. This means that the amount that goes for the state level insurer is proportional to the income amount (private insurances for the extra coverage usually work on the fixed amount basis). Around 500 per person in month is probably not on the very high side considering decent salary levels. The difference is that the health care of the minors is free. This splits the amount in half.

Loic 9y ago
In Germany, this is less. Suppose you are insured through the public system (Krankenkasse) and you have a salary high enough to pay the maximum rate, you pay 365.40€/month (your employer pay about the same amount). If you are self employed, you pay 656.85€ (employer and employee part). This covers you, your kids and your partner if he/she is not working. If your partner is working, he/she pays like you. So, imagine you are a family of four, both self employed, the maximum you pay is 656.85€ x 12 x 2 = 15764€/year. This covers 100% of the kids medications, 70 to 100% of the adult medications, 100% of the visit to the doctor and stay in a hospital. You do not have to pay and get reimbursed, you just provide your insurance card and the doctor/hospital will automatically charge your insurance (Krankenkasse). The system is working a bit differently if you opt-in for a private insurance. Edit: I cannot reply to the question about the maximum, so, answering as an edit. Yes you have a maximum and the values I gave are at this maximum.
- trymas 9y ago
  Slight offtopic. Did I understand right that there is a limit for 'Krankenkasse' monthly payment? Where I live - there is no limit. If your _payroll_ is ~1315eur, that means your _income_ is 1000eur, because you've paid (or employer did that for you): - 15% income tax (~197eur), - public health insurance 6% (~79eur), - public retirement fund 3% (~40eur). - employer pays 31.18% of the _payroll_ to public health insurance (~410eur). Making the __whole employment price__ - 1726eur, of which 489eur goes to public health insurance. If your __income__ is 10 000eur - everything is tenfold. I do not know nuances of self employment, but you pay less for the public health insurance. From 1726eur, you'd pay ~234eur for public health insurance and ~181eur income tax - leaving you with ~1311eur.