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Always keep in mind: the US spends more per capita on public healthcare than any other country in the world, except Norway[1] We pay for a single payer system,

Always keep in mind: the US spends more per capita on public healthcare than any other country in the world, except Norway[1] We pay for a single payer system, we just don't get it. [1] - https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

wolco 7y ago
You trade that capital for increased jobs and profit. There is a health admin layer that exists that creates roles strictly to deal with insurance. There are insurance divisions that couldn't exist if insurance wasn't required with each transaction.
- spiralx 7y ago
  Most countries with universal coverage operate on some kind of insurance model, many with private providers, yet don't spend as much as the US does. Insurance companies are a factor in American health care costs but they're not the sole reason.
fooker 7y ago
Spends in paper. Getting billed 5000$ for an x-ray doesn't happen in most other countries.
- Retric 7y ago
  No, the US government is actually #2 in handing money per person to healthcare companies. Though some of this is government employees or retirees. We also subsidize the most expensive people, including the elderly and people with cancer and AIDS. Plus, we directly subsidize hospitals in rural areas etc. It’s a giant flood of money.
  - fooker 7y ago
    You started with 'no', but then wrote nothing to contradict me.
    - Retric 7y ago
      Spends in paper is perhaps more vague than I was assuming. What did you mean? I am saying even if you ignore paperwork costs and crazy bills, it’s still a vast sums of money often sent with minimal overhead. The VA for example is quite expensive though somewhat less so than the rest of US healthcare.
malandrew 7y ago
> the US spends more per capita on public healthcare than any other country in the world, When you're developing most of the world's medical innovations, it should not be a surprise that we are the top spenders. For example, treatments like Car T-Cell therapy aren't cheap to develop or administer. Over time, those innovations will diffuse and they will become more available to less well off Americans and will become available to those outside America once cheap enough.
rayiner 7y ago
There is zero reason to believe a single payer system would cost us what it costs other countries. We have the same basic model as Europe for building infrastructure, and it costs us multiples what it costs Europe. For $6 billion, suburban Maryland is getting a light rail line that isn’t grade separated. For the same money, Copenhagen is getting a fully automatic new circle subway underneath downtown that’s almost twice as long. Why would we expect healthcare to be any different?
- 033803throwaway 7y ago
  I wouldn't. Which is why I view the situation as hopeless, but not serious.
- tzs 7y ago
  Surely it is possible to figure out why Copenhagen can get a better, longer system than Maryland can get the same money, and see if those reasons apply to health care systems?
  - tracker1 7y ago
    Bureaucracy and politics.
    - AstralStorm 7y ago
      Since when is Copenhagen less bureaucratic? Or do you mean that more of that leads to lower costs? And politics, do you mean US lobbying?
      - tracker1 7y ago
        Yes, lobbying is a huge part of politics in the US. Also, don't underestimate US bureaucracy. Just because it's different doesn't mean it's less bad.
  - tptacek 7y ago
    I mean, there's evidence to unearth if you go look for it; for instance, the relative rate of procedures being provided on an outpatient basis in the US vs. Europe, and concomitant overprescription rates here, or the number of vacant hospital beds and general inefficiency of how we provision hospital chains. The provider side of US health care is a mess.
dragonwriter 7y ago
> Always keep in mind: the US spends more per capita on public healthcare than any other country in the world, except Norway Perhaps more important, the US spends a bit more as a share of GDP on public healthcare than most developed countries with a mainly-public universal system. (And on top spends even more on private healthcare, but the combination still isn't a universal system.) Per capita costs are going to be higher just because incomes are higher. But that doesn't explain per GDP costs being so high.
tracker1 7y ago
The problem is that what we do have, we are restricted on negotiation. On the supply side its a bit borked too. I've repeated this a few times, imho what we need are as follows. Non-profit insurance corporation that anyone can buy policies from. Shift existing medical systems over to the new one. Limit extension patents. Require dual-sourcing for FDA approval. Restrict charging more than 20% price difference between clients for the same medication/procedure. Require fiduciary efforts from insurance carriers in terms of negotiation. It's a matter of a few legal shifts and some better policies allowing for more competition.

wolco 7y ago

You trade that capital for increased jobs and profit. There is a health admin layer that exists that creates roles strictly to deal with insurance. There are insurance divisions that couldn't exist if insurance wasn't required with each transaction.

spiralx 7y ago
Most countries with universal coverage operate on some kind of insurance model, many with private providers, yet don't spend as much as the US does. Insurance companies are a factor in American health care costs but they're not the sole reason.

fooker 7y ago

Spends in paper. Getting billed 5000$ for an x-ray doesn't happen in most other countries.

Retric 7y ago
No, the US government is actually #2 in handing money per person to healthcare companies. Though some of this is government employees or retirees. We also subsidize the most expensive people, including the elderly and people with cancer and AIDS. Plus, we directly subsidize hospitals in rural areas etc. It’s a giant flood of money.
- fooker 7y ago
  You started with 'no', but then wrote nothing to contradict me.
  - Retric 7y ago
    Spends in paper is perhaps more vague than I was assuming. What did you mean? I am saying even if you ignore paperwork costs and crazy bills, it’s still a vast sums of money often sent with minimal overhead. The VA for example is quite expensive though somewhat less so than the rest of US healthcare.

malandrew 7y ago

> the US spends more per capita on public healthcare than any other country in the world, When you're developing most of the world's medical innovations, it should not be a surprise that we are the top spenders. For example, treatments like Car T-Cell therapy aren't cheap to develop or administer. Over time, those innovations will diffuse and they will become more available to less well off Americans and will become available to those outside America once cheap enough.

rayiner 7y ago

There is zero reason to believe a single payer system would cost us what it costs other countries. We have the same basic model as Europe for building infrastructure, and it costs us multiples what it costs Europe. For $6 billion, suburban Maryland is getting a light rail line that isn’t grade separated. For the same money, Copenhagen is getting a fully automatic new circle subway underneath downtown that’s almost twice as long. Why would we expect healthcare to be any different?

033803throwaway 7y ago
I wouldn't. Which is why I view the situation as hopeless, but not serious.
tzs 7y ago
Surely it is possible to figure out why Copenhagen can get a better, longer system than Maryland can get the same money, and see if those reasons apply to health care systems?
- tracker1 7y ago
  Bureaucracy and politics.
  - AstralStorm 7y ago
    Since when is Copenhagen less bureaucratic? Or do you mean that more of that leads to lower costs? And politics, do you mean US lobbying?
    - tracker1 7y ago
      Yes, lobbying is a huge part of politics in the US. Also, don't underestimate US bureaucracy. Just because it's different doesn't mean it's less bad.
- tptacek 7y ago
  I mean, there's evidence to unearth if you go look for it; for instance, the relative rate of procedures being provided on an outpatient basis in the US vs. Europe, and concomitant overprescription rates here, or the number of vacant hospital beds and general inefficiency of how we provision hospital chains. The provider side of US health care is a mess.

dragonwriter 7y ago

> Always keep in mind: the US spends more per capita on public healthcare than any other country in the world, except Norway Perhaps more important, the US spends a bit more as a share of GDP on public healthcare than most developed countries with a mainly-public universal system. (And on top spends even more on private healthcare, but the combination still isn't a universal system.) Per capita costs are going to be higher just because incomes are higher. But that doesn't explain per GDP costs being so high.

tracker1 7y ago

The problem is that what we do have, we are restricted on negotiation. On the supply side its a bit borked too. I've repeated this a few times, imho what we need are as follows. Non-profit insurance corporation that anyone can buy policies from. Shift existing medical systems over to the new one. Limit extension patents. Require dual-sourcing for FDA approval. Restrict charging more than 20% price difference between clients for the same medication/procedure. Require fiduciary efforts from insurance carriers in terms of negotiation. It's a matter of a few legal shifts and some better policies allowing for more competition.