8 ms·

So you believe the US healthcare system is better than, say, the United Kingdom?

conanbatt 8y ago
I dont know the UK health intimately to compare confidently. I can tell you what it looks like with Argentina. that has universal care. Normally anyone with a dime goes private. Public is a lower-quality, cheaper service. That system is great for the poor, most expensive to middle class. I can also tell you what I think are reasons why US healthcare is so expensive, and they are not fixed by universal care programs.
- arcticbull 8y ago
  No, they absolutely are fixed by universal healthcare, as they are everywhere else on earth.
  - conanbatt 8y ago
    How is universal care going to reduce the shortage of primary care doctors? How is universal care going to eliminate patents for pharma? How is universal care going to make non-profit hospitals cheaper? How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? How is universal care going to reduce healthcare spending?
    - maxxxxx 8y ago
      Countries with universal care also usually have tight regulations on what can be charged and how. A first step would be to make all prices transparent so people can actually compare. In my view the biggest problem in the US is that the billing aspect of health care is intentionally opaque.
      - conanbatt 8y ago
        Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is. The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans. You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)
        arcticbull 8y ago
        Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.
        conanbatt 8y ago
        Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.
        arcticbull 8y ago
        That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal. When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve. Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?! [1] https://www.cbsnews.com/news/most-americans-cant-afford-a-500-emergency-expense/ https://www.cbsnews.com/news/most-americans-cant-afford-a-50... [2] https://en.wikipedia.org/wiki/Personal_income_in_the_United_States https://en.wikipedia.org/wiki/Personal_income_in_the_United_... [3] https://www.prnewswire.com/news-releases/us-median-rent-hits-a-new-high-at-1-500-a-month-but-rent-growth-slows-heading-into-fall-300720740.html https://www.prnewswire.com/news-releases/us-median-rent-hits...
    - arcticbull 8y ago
      (1) How is universal care going to reduce the shortage of primary care doctors? I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. (2) How is universal care going to eliminate patents for pharma? It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. There's a perception that in Canada "drugs are cheap" -- prescription drugs administered outside of hospitals largely aren't covered by OHIP. Provinces act as bulk buying groups and negotiate prices with pharma companies. You want to partake in the market, great, let's figure something out. It works surprisingly well. Patents are your temporary monopoly on creating an invention in exchange for sharing it with the world. (3) How is universal care going to make non-profit hospitals cheaper? By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated. Oh, and by socializing malpractice insurance. In the US high-cost states OBGYNs pay $85-200K/yr just in medical malpractice insurance. [1] In Ontario it's around $70K CAD. (4) How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier. (5) How is universal care going to reduce healthcare spending? Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2] [1] https://equotemd.com/blog/obgyn-medical-malpractice-insurance/ https://equotemd.com/blog/obgyn-medical-malpractice-insuranc... [2] https://www.washingtonpost.com/news/fact-checker/wp/2017/09/19/medicare-private-insurance-and-administrative-costs-a-democratic-talking-point/?utm_term=.e38da042cc76 https://www.washingtonpost.com/news/fact-checker/wp/2017/09/...
      - arcticbull 8y ago
        Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousands when you're near death? It's yet another reason why universal healthcare is a good, cheaper thing to have.

I dont know the UK health intimately to compare confidently. I can tell you what it looks like with Argentina. that has universal care. Normally anyone with a dime goes private. Public is a lower-quality, cheaper service. That system is great for the poor, most expensive to middle class. I can also tell you what I think are reasons why US healthcare is so expensive, and they are not fixed by universal care programs.

arcticbull 8y ago
No, they absolutely are fixed by universal healthcare, as they are everywhere else on earth.
- conanbatt 8y ago
  How is universal care going to reduce the shortage of primary care doctors? How is universal care going to eliminate patents for pharma? How is universal care going to make non-profit hospitals cheaper? How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? How is universal care going to reduce healthcare spending?
  - maxxxxx 8y ago
    Countries with universal care also usually have tight regulations on what can be charged and how. A first step would be to make all prices transparent so people can actually compare. In my view the biggest problem in the US is that the billing aspect of health care is intentionally opaque.
    - conanbatt 8y ago
      Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is. The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans. You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)
      - arcticbull 8y ago
        Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.
        conanbatt 8y ago
        Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.
        arcticbull 8y ago
        That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal. When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve. Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?! [1] https://www.cbsnews.com/news/most-americans-cant-afford-a-500-emergency-expense/ https://www.cbsnews.com/news/most-americans-cant-afford-a-50... [2] https://en.wikipedia.org/wiki/Personal_income_in_the_United_States https://en.wikipedia.org/wiki/Personal_income_in_the_United_... [3] https://www.prnewswire.com/news-releases/us-median-rent-hits-a-new-high-at-1-500-a-month-but-rent-growth-slows-heading-into-fall-300720740.html https://www.prnewswire.com/news-releases/us-median-rent-hits...
  - arcticbull 8y ago
    (1) How is universal care going to reduce the shortage of primary care doctors? I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. (2) How is universal care going to eliminate patents for pharma? It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. There's a perception that in Canada "drugs are cheap" -- prescription drugs administered outside of hospitals largely aren't covered by OHIP. Provinces act as bulk buying groups and negotiate prices with pharma companies. You want to partake in the market, great, let's figure something out. It works surprisingly well. Patents are your temporary monopoly on creating an invention in exchange for sharing it with the world. (3) How is universal care going to make non-profit hospitals cheaper? By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated. Oh, and by socializing malpractice insurance. In the US high-cost states OBGYNs pay $85-200K/yr just in medical malpractice insurance. [1] In Ontario it's around $70K CAD. (4) How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers? By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier. (5) How is universal care going to reduce healthcare spending? Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2] [1] https://equotemd.com/blog/obgyn-medical-malpractice-insurance/ https://equotemd.com/blog/obgyn-medical-malpractice-insuranc... [2] https://www.washingtonpost.com/news/fact-checker/wp/2017/09/19/medicare-private-insurance-and-administrative-costs-a-democratic-talking-point/?utm_term=.e38da042cc76 https://www.washingtonpost.com/news/fact-checker/wp/2017/09/...
    - arcticbull 8y ago
      Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousands when you're near death? It's yet another reason why universal healthcare is a good, cheaper thing to have.