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Let's back up and make this a statistic instead. In 2016 there were 770,000 people who were bankrupted due to medical costs. Around 45,000 people a year die f

Let's back up and make this a statistic instead. In 2016 there were 770,000 people who were bankrupted due to medical costs. Around 45,000 people a year die from a lack of health insurance. In every country that has universal coverage reform has started with a push to ask a basic moral and ethical question: should we consider healthcare a basic human right? In the U.S. we pay 18% of our GDP on healthcare, yet we rank ~ 37th in terms of death due to preventable causes, and 31st in terms of overall life expectancy. If you look at how healthcare works in other countries there are many different systems but what they all have in common is a commitment to provide access to healthcare for all citizens. There are different mixes of private and public, and we have already implemented most of them to some degree: There are 4 main systems 1. Beveridge (public health care providers and insurance rolled into one, like the NHS in UK): The VA and healthcare systems used for native americans use this system 2. National health insurance (private healthcare providers and public insurance funded by the government, like Canada's system): Medicare was copied from the Canadian system (even the name!). 3. Bismarck Model: (private healthcare providers and mostly private insurance, along with an individual mandate and heavy regulation of insurance companies: this is used in Germany and Japan). Obamacare was an incomplete attempt to move more towards this model. 4 Out of pocket model: (fully private: a non-system used by most poor countries in the world). This is what the uninsured fall back on. The main piece that is missing is we haven't committed to scaling either systems 1, 2 or 3 in order to provide universal access to healthcare and so we have an incredibly fragmented and complex system with soaring costs. American for-profit insurance companies are bloated by ~20% administration fees whereas in most countries they are non-profit entities with 5% or less. To back up and sum it all up the fundamental question we need to ask ourselves is: do we want to provide universal access to healthcare?

paulddraper 8y ago
A few comments: First, US insurance companies are often pseudo non-profits, with profit caps. [1] Second, another model is Medicare Advantage where beneficiaries can choose a private entity to administer their Medicare plan. Third, most commercial insurance in the US is not actually underwritten by insurance co's, but by "self-funded" employers. In this case, the insurance company is merely a third-party administrator (TPA) for the employee plans, using XYZ's bank account (and trying to save them money, offer health incentive programs, etc., to secure repeat business). Most companies with more than, say, 500 employees operate this way, though usually you won't even know this is the case. --- Finally, if by > do we want to provide universal access to healthcare? you mean "do we want everyone to have healthcare?", the answer is an easy "yes". We want universal access to housing, healthcare, employment, etc. But if the question is "do we want the government to use taxes to ensure that everyone has healthcare?", the answer is far more divided. There's a lot of interesting examples elsewhere. But as you've mentioned, the US government has already dipped its toe into those waters with the VA, and I don't think it's been perceived as a success. [1] http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/ http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-...
- dontreact 8y ago
  I believe this article is about a provision in the ACA to limit administrative costs to 20%, which is highly unimpressive when you look at the way non profit insurance works in every other developed country.
  - garmaine 8y ago
    That just means you have to increase costs to increase profits. It's NOT a solution, as a century of ballooning cost-plus government contracts have shown.
    - dontreact 8y ago
      I’m not saying that the solution is to close this gap. It’s just another sign of the failure of our system. Seems like there is plenty of evidence around the world that insurance companies can be non profit and work quite well. In fact in the US this was the case until the 80s.
      - garmaine 8y ago
        I'm just pointing out that the specific structure you specified has truly perverse incentives that have historically raised costs in every industry in which they've been applied (which includes not just healthcare and other insurance markets, but also defense spending since WW2).
  - paulddraper 8y ago
    Perhaps. Where are you getting the 5% administrative costs? All numbers I've seen have been far higher than that. * Canada 12% * Britain 16% * Netherlands 20% https://www.commonwealthfund.org/sites/default/files/___media_images_publications_in_the_literature_2014_sep_himmelstein_comparison_hosp_admin_costs_ha_09_2014_itl_exhibit.png https://www.commonwealthfund.org/sites/default/files/___medi...
    - Steko 8y ago
mysterydip 8y ago
I would like to see statistics for these systems as far as number of patients treated vs turned away, and time waiting to be treated. No matter the system chosen, there are only so many resources to go around. It seems mainly to be a choice of who doesn't get the care they need, unfortunately.
- dontreact 8y ago
  It’s true someone always gets squeezed. German and Japanese systems have about the same or sometimes better waiting times but doctors earn not as well as in the US.
  - artwr 8y ago
    On the other end, medical degrees do not amount to ridiculous student loans in those countries either. Tuition is usually on the order of $10k/year.
yourbandsucks 8y ago
The astonishing statistic that results from this is that the US government spends more per-capita on healthcare period than universal healthcare countries, while not even covering everybody. The government is on the hook for the old population and the poor population: the 2 most expensive subsets. Yet private insurance still isn't affordable despite only having to cover the lower-risk chunk of the pop. It's insane.
throw-far-away 8y ago
Jesus H. I ran into a gal with stage iv cancer and a nasal infusion pump who was on her way to a bankruptcy hearing. That's just insane and inhumane how insurance companies and hospitals in the US suck all the money they can out of dying people like proverbial vampires, until patients are fighting to keep a house, a car and the clothes on their back.

paulddraper 8y ago

A few comments: First, US insurance companies are often pseudo non-profits, with profit caps. [1] Second, another model is Medicare Advantage where beneficiaries can choose a private entity to administer their Medicare plan. Third, most commercial insurance in the US is not actually underwritten by insurance co's, but by "self-funded" employers. In this case, the insurance company is merely a third-party administrator (TPA) for the employee plans, using XYZ's bank account (and trying to save them money, offer health incentive programs, etc., to secure repeat business). Most companies with more than, say, 500 employees operate this way, though usually you won't even know this is the case. --- Finally, if by > do we want to provide universal access to healthcare? you mean "do we want everyone to have healthcare?", the answer is an easy "yes". We want universal access to housing, healthcare, employment, etc. But if the question is "do we want the government to use taxes to ensure that everyone has healthcare?", the answer is far more divided. There's a lot of interesting examples elsewhere. But as you've mentioned, the US government has already dipped its toe into those waters with the VA, and I don't think it's been perceived as a success. [1] http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/ http://thehealthcareblog.com/blog/2012/02/04/does-obamacare-...

dontreact 8y ago
I believe this article is about a provision in the ACA to limit administrative costs to 20%, which is highly unimpressive when you look at the way non profit insurance works in every other developed country.
- garmaine 8y ago
  That just means you have to increase costs to increase profits. It's NOT a solution, as a century of ballooning cost-plus government contracts have shown.
  - dontreact 8y ago
    I’m not saying that the solution is to close this gap. It’s just another sign of the failure of our system. Seems like there is plenty of evidence around the world that insurance companies can be non profit and work quite well. In fact in the US this was the case until the 80s.
    - garmaine 8y ago
      I'm just pointing out that the specific structure you specified has truly perverse incentives that have historically raised costs in every industry in which they've been applied (which includes not just healthcare and other insurance markets, but also defense spending since WW2).
- paulddraper 8y ago
  Perhaps. Where are you getting the 5% administrative costs? All numbers I've seen have been far higher than that. * Canada 12% * Britain 16% * Netherlands 20% https://www.commonwealthfund.org/sites/default/files/___media_images_publications_in_the_literature_2014_sep_himmelstein_comparison_hosp_admin_costs_ha_09_2014_itl_exhibit.png https://www.commonwealthfund.org/sites/default/files/___medi...
  - Steko 8y ago

mysterydip 8y ago

I would like to see statistics for these systems as far as number of patients treated vs turned away, and time waiting to be treated. No matter the system chosen, there are only so many resources to go around. It seems mainly to be a choice of who doesn't get the care they need, unfortunately.

dontreact 8y ago
It’s true someone always gets squeezed. German and Japanese systems have about the same or sometimes better waiting times but doctors earn not as well as in the US.
- artwr 8y ago
  On the other end, medical degrees do not amount to ridiculous student loans in those countries either. Tuition is usually on the order of $10k/year.

yourbandsucks 8y ago

The astonishing statistic that results from this is that the US government spends more per-capita on healthcare period than universal healthcare countries, while not even covering everybody. The government is on the hook for the old population and the poor population: the 2 most expensive subsets. Yet private insurance still isn't affordable despite only having to cover the lower-risk chunk of the pop. It's insane.

throw-far-away 8y ago

Jesus H. I ran into a gal with stage iv cancer and a nasal infusion pump who was on her way to a bankruptcy hearing. That's just insane and inhumane how insurance companies and hospitals in the US suck all the money they can out of dying people like proverbial vampires, until patients are fighting to keep a house, a car and the clothes on their back.