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Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices. The bigge

Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices. The biggest problem with the US health care system is that it's decades behind every one of our counterparts in Europe, Australia/NZ, Japan, Canada, et. al. People in other developed nation don't have to worry when they're sick. They know they can see a doctor and it either won't cost them anything, or it will always cost the same amount. If they lose their jobs, they don't have to worry about their health as well. People can chose to quit their jobs, or take long unpaid periods to work on their own projects, without having to worry about how they're going to pay for health care. In America, we're required to pay for private insurance, even if you leave the workforce. There is a huge cognitive load when health is in the background of your mind. In America, we have to work. If you don't work, you don't get services; not until you're old enough to get Medicare. In other words, you don't get medical services until you're too old to be a working member of society; until the country bleeds you dry as a resource. That is America.

txcwpalpha 9y ago
> Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices. Exactly. Everyone praising this is doing so because they think it's great that this will allow Americans to "shop around" when it comes to healthcare, but they seem to be missing the fact that even the very concept of "shopping around" for healthcare is absurd. If you're having a heart attack, or just have a broken bone, or even if you just have a stomach ache, the last thing that you are going to want to have to spend time doing is "shopping around" before getting your problems fixed. Being able to shop around isn't something that should be praised, it's something that should be relentlessly mocked and is evidence of a failing healthcare system.
- ams6110 9y ago
  Completely disagree. Providers are not all the same. Some doctors are so incompetent they should not be allowed to practice, some are excellent. People should have full information on their providers, including costs, to be able to make informed choices.
  - txcwpalpha 9y ago
    >Some doctors are so incompetent they should not be allowed to practice Which is yet more evidence of a failing healthcare system, and is certainly not reason to praise the concept of having to "shop around" just to get adequate and reasonably priced care.
    - bluGill 9y ago
      You seem to be using the wrong (though obvious) definition of what it means to be incompetent. A doctor who is incompetent because of poor treatment is handled by the system. However there are other incompetents that someone who is medically competent can not the less fall into. The doctor with poor human interaction skills makes the patient feel horribly before, during and after treatment. The doctor who takes "bribes" to prescribe a more expensive treatment when a cheaper alternative would work as well. Those are just a couple examples of how someone can be incompetent yet still not raise to the level of not being allowed to practice.
      - txcwpalpha 9y ago
        I'm not using the wrong definition. A doctor who is considered "incompetent" because they take "bribes" should certainly be terminated by the system. If they aren't, it is a failing system.
        bluGill 9y ago
        I put bribes in quotes for a reason. Outright bribes are handled by the system. However I'm implying any way to get around the rules without getting caught. Some are legal loopholes, some are illegal. The only point is by some way you got around the rules without getting caught.
        txcwpalpha 9y ago
        That doesn't change my answer. If you have a system in which doctors carry out shady tactics and are able to "get around the rules without getting caught", and that system is so rife with such issues that you have to actively "shop around" to avoid them, then the system is failing.
- refurb 9y ago
  very concept of "shopping around" for healthcare is absurd No it's not. A very large percentage of medical care is planned, not urgent. There is no reason why price comparison can't happen for those. A great example of a highly functional healthcare market is vision correction laser surgery. Every time I look around some deal is being offered. Competition is what drove those prices down. Can you do that with everything? Of course not. But you can do it with a lot of planned medical care.
  - andrewla 9y ago
    And it's not purely a race to the bottom; as expected price levels are achieved, it also becomes possible to read signals in the price, so that medical practitioners who are willing to do extra work (reduce wait times, better followup, home visits, etc.) can charge more to compensate for that, rather than just doing the minimum amount of work necessary in order to get the fixed payment.
  - omegaworks 9y ago
    >No it's not. A very large percentage of medical care is planned, not urgent. And for those procedures, a hybrid system should suffice. All Americans, should, at minimum, be able to get urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Of course, nothing is black and white. Issues that could have been treated in a planned way become urgent if they're left to fester. Obamacare started shifting the incentives to make preventative measures more palatable, and healthcare cost growth has come down as a result. ACA is a /conservative/ set of policies. Even still, it elicits extreme reactions from loud people on the fringes.
    - bobwaycott 9y ago
      I’d suggest a slight addition: > All Americans should, at minimum, be able to get routine and urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Elective procedures are obviously a thorny issue people will debate over where to draw the lines. But standard checkups, routine wellness procedures, and covering the unexpected ought to be the bare minimum—the healthcare floor of social decency beneath which we do not allow any member of society to fall without recognizing we are failing as a society.
- vidarh 9y ago
  It's absurd, but as long as it's politically untenable to go all the way to something reasonable, things like this which will presumably be a lot easier to defend is still better than nothing - a huge proportion of medical needs are not emergency care, after all.
- eldavido 9y ago
  This analysis ignores the secondary effects of the mere ability to shop around. Right now, for many insurance plans, consumers of care are 100% price insensitive. If even, say, 5% of a market starts to take their business elsewhere out of concern for price, it starts to put more cost discipline onto the system, which encourages competition. You can't suggest a huge change and then assume the world will stay the same post-change. It won't. What the health system needs is some incentive to control cost; today, it has very few.
- Consultant32452 9y ago
  Emergency care for things like a heart attack or broken bone only account for 2% of healthcare spending. So your primary case for why "shopping around" is bad is mostly irrelevant. Nothing is stopping you from creating a not-for-profit healthcare co-op, getting participants to voluntarily turn over their healthcare decisions to you, and then demanding reduced prices from vendors. All I ask is that you don't force me to join it against my will. http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ http://www.politifact.com/truth-o-meter/statements/2013/oct/...
  - txcwpalpha 9y ago
    I never said anything about emergency care being my "primary case". My comment even specifically lists 2 instances of non-emergency care. Needing to shop around is an absurd concept for any medical care.
    - Consultant32452 9y ago
      Please don't force me against my will to live by the whims of what you personally consider absurd in your own life. You are free to abdicate responsibility and choice to a third party all you like.
      - txcwpalpha 9y ago
        Your choice to live by an absurdly low standard of care is what forces the rest of us to suffer from a low standard of care as well (against our will). Your request to "don't force me against my will" is hypocritical.
        Consultant32452 9y ago
        Please don't force me against my will to be limited to what you personally consider to be an acceptable standard of care. How I choose to live or die is none of your business.
tntn 9y ago
Seems like the U.S. should adopt the Swiss system. It's much more effective than the current U.S. train wreck without quite so much political baggage as single-payer systems.
- dagw 9y ago
  They tried taking a baby step in that direction with Obamacare. Government mandatory anything is a seriously hard sell in the US. I honestly think single payer is an easier sell at this point.
  - monetus 9y ago
    I would be curious as to how well public opinion correlates with legislation in regards to healthcare. The 'selling' of healthcare seems to be mostly propaganda, not a comprehensive description of the structures, inputs, and outputs of the healthcare system. I've always been of the opinion that kind of information should be available next to the ballot box. I just have no idea how it should be presented.
    - dagw 9y ago
      I've always been of the opinion that kind of information should be available next to the ballot box. Even the quickest of comprehensive summaries about a the ins and outs of your average healthcare plan would probably run at least 30 pages (and the actual bills run 100s of pages). Do you really expect to people to read that just before they vote? Honestly, unless you are a hardcore healthcare wonk, reading the 1 page 'propaganda' summary is realistically all you can expect from people.
      - monetus 9y ago
        I completely agree, and no, it shouldn't be a prerequisite for voting. Using a mountain of indigestible information to assuage potential ignorance doesn't make much since... Like I said, I don't know how it should be presented.
  - 9y ago
dominotw 9y ago
> That is America. As someone not from America, I want to say something positive. Thank you America for inventing so many life saving drugs that people all around the world depend on.
- jackhack 9y ago
  I would like to thank America for being the world pharma profit center, as well. It is impossible to give away antibiotics for 30 pence a dosage if not for the American paying $50 per tablet.
  - zavi 9y ago
    :(
nugget 9y ago
Private insurance still exists in countries that have universal health care. In the UK, for example, a little over 10% of the population has private insurance. In the US today, about 50% of the population has free or extremely low cost health care provided by the Government. The majority of poor people in the US now receive 100% free care via State-administered medicaid. So what exactly does universal health care in the US look like? Medicaid/medicare for everyone? Based on the UK experience, we'd expect 20% of the US to still pay out of pocket for private insurance. Private insurance companies would also likely be free to discriminate on prior conditions because, after all, everyone has universal insurance as a backstop. You risk creating a two-tier system of public-private insurance where healthy, wealthy people have access to concierge preventative care and very fast specialist referrals, while the chronically sick (uninsurable) and non-wealthy are stuck in a publicly run system with less preventative care and worse referral and wait times. I'm not saying I have the answer - just raising some issues that are often lost in the debate over how to reform this market. Personally, since the medicaid expansion, I don't think insurance coverage is the problem any more. Now it's about quality and cost of care. And transparency and competition certainly seem like two reasonable ways to tackle cost.
- jbob2000 9y ago
  You are just muddying up a debate that should not be this hard. There are 2 countries in the world that do not have public healthcare; The US and Liberia. Whatever counterpoints there are to the public option, 196+ countries have already had those conversations and already solved the problems. >You risk creating a two-tier system of public-private insurance where healthy, wealthy people have access to concierge preventative care and very fast specialist referrals, while the chronically sick (uninsurable) and non-wealthy are stuck in a publicly run system with less preventative care and worse referral and wait times. Sure, if that happens, fine let it happen. 0.1% of people might fall into the bracket of wealth that use private healthcare. Would you really hold up healthcare for 99.9% of people because of this? You do not have the answer, but everyone else does. Go public. The benefits far outweigh any detraction.
- freeone3000 9y ago
  Beats what we have now, where there's a two-tier system, where healthy, wealthy people have concierge preventative care and very fast specialist referrals, and the non-wealthy are stuck in a privately run system with exorbiant fees and impossibly high medical bills.
conanbatt 9y ago
Rising costs of healthcare are also a big issue in other top-wealth countries, and for better or worse, the US also does cutting edge health science that other countries dont get close to. I find the comparison country vs country to be valuable, but somewhat limited. The U.S. is unique in a lot of aspects. For example in argentina(i know, not rich country but hear me out), that has public healthcare, healthcare spending per gdp has been cut in half in the last couple of decades: mostly because private healthcare ate up the market. Hybrid markets are a reasonable compromise. The US is also not a free market of healthcare, it has the worst of both worlds: highly regulated, intrusive and punishing state, with proteccionism and quotas. To this day I still believe the #1 healthcare policy issue is with the state's intervention. It is the FDA that makes pharma expensive, it is H1B quotas and medical licensing requirements that prevent foreign doctors to come to the US, it is Medicare that puts fee-for-service, it is the state that makes malpractice costly, etc etc.
- omegaworks 9y ago
  >for better or worse, the US also does cutting edge health science that other countries dont get close to. You're conflating two things. A large portion of "cutting edge health science" research is funded publicly. The private funding tends to focus on reformulating existing drugs and other less-risky bets. The real game changers come out of moon-shots made possible by government funding. https://www.npr.org/sections/health-shots/2015/01/13/376801357/u-s-funding-of-health-research-stalls-as-other-nations-rev-up https://www.npr.org/sections/health-shots/2015/01/13/3768013...
  - conanbatt 9y ago
    I think this conflates spending with results. I dont know enough to confirm or refute, but government science in general is pretty inefficient: yes it does things that the private sector wouldnt do that are valuable, but it does a lot of other things poorly and expensively. Not to mention that the very state makes researching drugs onerously expensive. It can take a billion dollars to get FDA approval, how is that reasonable.
    - 9y ago
harryh 9y ago
If you don't work, you don't get services; not until you're old enough to get Medicare. You left out Medicaid.
biztos 9y ago
> everyone is insured by the State and pays the same prices. Not in Germany, just to name one high income, developed country.

txcwpalpha 9y ago

> Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices. Exactly. Everyone praising this is doing so because they think it's great that this will allow Americans to "shop around" when it comes to healthcare, but they seem to be missing the fact that even the very concept of "shopping around" for healthcare is absurd. If you're having a heart attack, or just have a broken bone, or even if you just have a stomach ache, the last thing that you are going to want to have to spend time doing is "shopping around" before getting your problems fixed. Being able to shop around isn't something that should be praised, it's something that should be relentlessly mocked and is evidence of a failing healthcare system.

ams6110 9y ago
Completely disagree. Providers are not all the same. Some doctors are so incompetent they should not be allowed to practice, some are excellent. People should have full information on their providers, including costs, to be able to make informed choices.
- txcwpalpha 9y ago
  >Some doctors are so incompetent they should not be allowed to practice Which is yet more evidence of a failing healthcare system, and is certainly not reason to praise the concept of having to "shop around" just to get adequate and reasonably priced care.
  - bluGill 9y ago
    You seem to be using the wrong (though obvious) definition of what it means to be incompetent. A doctor who is incompetent because of poor treatment is handled by the system. However there are other incompetents that someone who is medically competent can not the less fall into. The doctor with poor human interaction skills makes the patient feel horribly before, during and after treatment. The doctor who takes "bribes" to prescribe a more expensive treatment when a cheaper alternative would work as well. Those are just a couple examples of how someone can be incompetent yet still not raise to the level of not being allowed to practice.
    - txcwpalpha 9y ago
      I'm not using the wrong definition. A doctor who is considered "incompetent" because they take "bribes" should certainly be terminated by the system. If they aren't, it is a failing system.
      - bluGill 9y ago
        I put bribes in quotes for a reason. Outright bribes are handled by the system. However I'm implying any way to get around the rules without getting caught. Some are legal loopholes, some are illegal. The only point is by some way you got around the rules without getting caught.
        txcwpalpha 9y ago
        That doesn't change my answer. If you have a system in which doctors carry out shady tactics and are able to "get around the rules without getting caught", and that system is so rife with such issues that you have to actively "shop around" to avoid them, then the system is failing.
refurb 9y ago
very concept of "shopping around" for healthcare is absurd No it's not. A very large percentage of medical care is planned, not urgent. There is no reason why price comparison can't happen for those. A great example of a highly functional healthcare market is vision correction laser surgery. Every time I look around some deal is being offered. Competition is what drove those prices down. Can you do that with everything? Of course not. But you can do it with a lot of planned medical care.
- andrewla 9y ago
  And it's not purely a race to the bottom; as expected price levels are achieved, it also becomes possible to read signals in the price, so that medical practitioners who are willing to do extra work (reduce wait times, better followup, home visits, etc.) can charge more to compensate for that, rather than just doing the minimum amount of work necessary in order to get the fixed payment.
- omegaworks 9y ago
  >No it's not. A very large percentage of medical care is planned, not urgent. And for those procedures, a hybrid system should suffice. All Americans, should, at minimum, be able to get urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Of course, nothing is black and white. Issues that could have been treated in a planned way become urgent if they're left to fester. Obamacare started shifting the incentives to make preventative measures more palatable, and healthcare cost growth has come down as a result. ACA is a /conservative/ set of policies. Even still, it elicits extreme reactions from loud people on the fringes.
  - bobwaycott 9y ago
    I’d suggest a slight addition: > All Americans should, at minimum, be able to get routine and urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Elective procedures are obviously a thorny issue people will debate over where to draw the lines. But standard checkups, routine wellness procedures, and covering the unexpected ought to be the bare minimum—the healthcare floor of social decency beneath which we do not allow any member of society to fall without recognizing we are failing as a society.
vidarh 9y ago
It's absurd, but as long as it's politically untenable to go all the way to something reasonable, things like this which will presumably be a lot easier to defend is still better than nothing - a huge proportion of medical needs are not emergency care, after all.
eldavido 9y ago
This analysis ignores the secondary effects of the mere ability to shop around. Right now, for many insurance plans, consumers of care are 100% price insensitive. If even, say, 5% of a market starts to take their business elsewhere out of concern for price, it starts to put more cost discipline onto the system, which encourages competition. You can't suggest a huge change and then assume the world will stay the same post-change. It won't. What the health system needs is some incentive to control cost; today, it has very few.
Consultant32452 9y ago
Emergency care for things like a heart attack or broken bone only account for 2% of healthcare spending. So your primary case for why "shopping around" is bad is mostly irrelevant. Nothing is stopping you from creating a not-for-profit healthcare co-op, getting participants to voluntarily turn over their healthcare decisions to you, and then demanding reduced prices from vendors. All I ask is that you don't force me to join it against my will. http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ http://www.politifact.com/truth-o-meter/statements/2013/oct/...
- txcwpalpha 9y ago
  I never said anything about emergency care being my "primary case". My comment even specifically lists 2 instances of non-emergency care. Needing to shop around is an absurd concept for any medical care.
  - Consultant32452 9y ago
    Please don't force me against my will to live by the whims of what you personally consider absurd in your own life. You are free to abdicate responsibility and choice to a third party all you like.
    - txcwpalpha 9y ago
      Your choice to live by an absurdly low standard of care is what forces the rest of us to suffer from a low standard of care as well (against our will). Your request to "don't force me against my will" is hypocritical.
      - Consultant32452 9y ago
        Please don't force me against my will to be limited to what you personally consider to be an acceptable standard of care. How I choose to live or die is none of your business.

tntn 9y ago

Seems like the U.S. should adopt the Swiss system. It's much more effective than the current U.S. train wreck without quite so much political baggage as single-payer systems.

dagw 9y ago
They tried taking a baby step in that direction with Obamacare. Government mandatory anything is a seriously hard sell in the US. I honestly think single payer is an easier sell at this point.
- monetus 9y ago
  I would be curious as to how well public opinion correlates with legislation in regards to healthcare. The 'selling' of healthcare seems to be mostly propaganda, not a comprehensive description of the structures, inputs, and outputs of the healthcare system. I've always been of the opinion that kind of information should be available next to the ballot box. I just have no idea how it should be presented.
  - dagw 9y ago
    I've always been of the opinion that kind of information should be available next to the ballot box. Even the quickest of comprehensive summaries about a the ins and outs of your average healthcare plan would probably run at least 30 pages (and the actual bills run 100s of pages). Do you really expect to people to read that just before they vote? Honestly, unless you are a hardcore healthcare wonk, reading the 1 page 'propaganda' summary is realistically all you can expect from people.
    - monetus 9y ago
      I completely agree, and no, it shouldn't be a prerequisite for voting. Using a mountain of indigestible information to assuage potential ignorance doesn't make much since... Like I said, I don't know how it should be presented.
- 9y ago

dominotw 9y ago

> That is America. As someone not from America, I want to say something positive. Thank you America for inventing so many life saving drugs that people all around the world depend on.

jackhack 9y ago
I would like to thank America for being the world pharma profit center, as well. It is impossible to give away antibiotics for 30 pence a dosage if not for the American paying $50 per tablet.
- zavi 9y ago
  :(

nugget 9y ago

Private insurance still exists in countries that have universal health care. In the UK, for example, a little over 10% of the population has private insurance. In the US today, about 50% of the population has free or extremely low cost health care provided by the Government. The majority of poor people in the US now receive 100% free care via State-administered medicaid. So what exactly does universal health care in the US look like? Medicaid/medicare for everyone? Based on the UK experience, we'd expect 20% of the US to still pay out of pocket for private insurance. Private insurance companies would also likely be free to discriminate on prior conditions because, after all, everyone has universal insurance as a backstop. You risk creating a two-tier system of public-private insurance where healthy, wealthy people have access to concierge preventative care and very fast specialist referrals, while the chronically sick (uninsurable) and non-wealthy are stuck in a publicly run system with less preventative care and worse referral and wait times. I'm not saying I have the answer - just raising some issues that are often lost in the debate over how to reform this market. Personally, since the medicaid expansion, I don't think insurance coverage is the problem any more. Now it's about quality and cost of care. And transparency and competition certainly seem like two reasonable ways to tackle cost.

jbob2000 9y ago
You are just muddying up a debate that should not be this hard. There are 2 countries in the world that do not have public healthcare; The US and Liberia. Whatever counterpoints there are to the public option, 196+ countries have already had those conversations and already solved the problems. >You risk creating a two-tier system of public-private insurance where healthy, wealthy people have access to concierge preventative care and very fast specialist referrals, while the chronically sick (uninsurable) and non-wealthy are stuck in a publicly run system with less preventative care and worse referral and wait times. Sure, if that happens, fine let it happen. 0.1% of people might fall into the bracket of wealth that use private healthcare. Would you really hold up healthcare for 99.9% of people because of this? You do not have the answer, but everyone else does. Go public. The benefits far outweigh any detraction.
freeone3000 9y ago
Beats what we have now, where there's a two-tier system, where healthy, wealthy people have concierge preventative care and very fast specialist referrals, and the non-wealthy are stuck in a privately run system with exorbiant fees and impossibly high medical bills.

conanbatt 9y ago

Rising costs of healthcare are also a big issue in other top-wealth countries, and for better or worse, the US also does cutting edge health science that other countries dont get close to. I find the comparison country vs country to be valuable, but somewhat limited. The U.S. is unique in a lot of aspects. For example in argentina(i know, not rich country but hear me out), that has public healthcare, healthcare spending per gdp has been cut in half in the last couple of decades: mostly because private healthcare ate up the market. Hybrid markets are a reasonable compromise. The US is also not a free market of healthcare, it has the worst of both worlds: highly regulated, intrusive and punishing state, with proteccionism and quotas. To this day I still believe the #1 healthcare policy issue is with the state's intervention. It is the FDA that makes pharma expensive, it is H1B quotas and medical licensing requirements that prevent foreign doctors to come to the US, it is Medicare that puts fee-for-service, it is the state that makes malpractice costly, etc etc.

omegaworks 9y ago
>for better or worse, the US also does cutting edge health science that other countries dont get close to. You're conflating two things. A large portion of "cutting edge health science" research is funded publicly. The private funding tends to focus on reformulating existing drugs and other less-risky bets. The real game changers come out of moon-shots made possible by government funding. https://www.npr.org/sections/health-shots/2015/01/13/376801357/u-s-funding-of-health-research-stalls-as-other-nations-rev-up https://www.npr.org/sections/health-shots/2015/01/13/3768013...
- conanbatt 9y ago
  I think this conflates spending with results. I dont know enough to confirm or refute, but government science in general is pretty inefficient: yes it does things that the private sector wouldnt do that are valuable, but it does a lot of other things poorly and expensively. Not to mention that the very state makes researching drugs onerously expensive. It can take a billion dollars to get FDA approval, how is that reasonable.
  - 9y ago

harryh 9y ago

If you don't work, you don't get services; not until you're old enough to get Medicare. You left out Medicaid.

biztos 9y ago

> everyone is insured by the State and pays the same prices. Not in Germany, just to name one high income, developed country.