9 ms·

> I am worried a massive wealth transfer ... e.g., single payer healthcare Only in America is adequate health provision considered "massive wealth transfer"

rayiner 7y ago
It is a massive wealth transfer. It may be a good idea, too. Currently 2/3 of non-elderly people have insurance through their employers. If we need to extend coverage to those who don’t have it, those 2/3 will have to pay for the other 1/3. If we are proposing a massive income transfer of $3 trillion a year for the good of the country, we have to be honest about it.
- Craighead 7y ago
  You are being dishonest. Please do not speak about being honest.
  - rayiner 7y ago
    Help me understand which point you think is incorrect?
    - deleted 7y ago
      [deleted]
  - habnds 7y ago
    language like that just means someone is arguing, not reasoning
- habnds 7y ago
  There's an additional wealth transfer between the owners of healthcare related stocks and non owners. If the US approached EU type health care costs we could easily give every one health care for free. The cost would come out of healthcare company margins.
  - rayiner 7y ago
    Totally false. Total health industry publicly traded company profits (including drug companies, hospitals, and insurance companies) add up to about $50 billion per quarter, or $200 billion per year worldwide: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Pharmas-Profits https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar.... Total domestic hospital profits (including more than just public companies) is about $74 billion per year: https://www.modernhealthcare.com/article/20180104/NEWS/180109966/hospital-profits-continued-their-rise-in-2016 https://www.modernhealthcare.com/article/20180104/NEWS/18010.... Insurance companies are $25 billion annualized: https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-percent-to-6-billion-dollars.html https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... ($7 billion per quarter for health insurers). The link above shows $100 billion in drug company profits worldwide; about half of revenues are in the US, so let’s say $100 billion in profits domestically. That’s $200 billion for the US healthcare industry, including non-public companies in addition to publicly traded companies. Total US healthcare spending is $3.5 trillion. Profits account for just 6% of that spending. To reduce healthcare spending to the same levels as the rich European countries like Germany or France we’d have to cut spending about $1.25 trillion. Cutting healthcare industry profits to zero (and note that there are for-profit hospitals and drug companies in the EU and they don’t make zero profit!) would reduce healthcare expenditures by just 1/6 of the amount required.
    - AlexandrB 7y ago
      A better estimate for savings from some parts of the industry is revenue not profit. That’s because the work done by, for example, insurance companies is largely useless paper shuffling that doesn’t need to exist under single payer. Edit: oh yeah, and marketing. So much health industry money ends up in marketing. Something almost completely unnecessary under single-payer as well.
      - rayiner 7y ago
        The post I was replying to was talking about wealth transfer from people to shareholders. Profit is the proper measure of that. As to cost savings, you can’t use insurance industry revenue because that includes money spent on services. And a lot of the “paper shuffling” does need to exist under single payer. Most universal healthcare systems aren’t nationalized systems like the UK NHS. Germany for example has mandatory membership in Public health insurance organizations for those making under 60,000 euro. There are 100+ of those. Then 15% of the population has private health insurance. Care providers are mostly private. So there is still medical billing that needs to be done. Most EU countries are similar in that regard, and unlike the UK NHS. As to marketing, now you’re talking about a drop in the bucket. Pharma industry advertising adds up to just $6 billion per year.
- asveikau 7y ago
  > Currently 2/3 of non-elderly people have insurance through their employers. If we need to extend coverage to those who don’t have it, those 2/3 will have to pay for the other 1/3 I thought the uninsured rate was closer to 10%. Some googling suggests 8% or 9%. This is short of 33%. Of course many are insured but under insured, or insured but paying (or in I guess 66% of cases having their employer pay) for massive amounts of waste. There are entire industries like medical billing which don't strictly need to exist.
  - kasey_junk 7y ago
    Insured through their employer is different than insured.
    - asveikau 7y ago
      Yes but he implied that the employer-insured need to pay for both non-employer-insured and uninsured. If his 2/3rd figure is correct we can say it's about 23% in the former and 10% in the latter, but he just says 2/3rd needs to pay for 1/3rd. If the 23% are already paying, why do they need a subsidy from someone else's employer? I guess there is an affordability issue and rising costs ... but this is true for everyone, even those who mask it by going through their employer.
- eveningcoffee 7y ago
  Not necessarily when the medical industry is willing to give up some of its beyond the reason revenues. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Then again perhaps the level US healthcare is considerably higher and it would mean lowering the average quality and availability of novel treatments.
  - deleted 7y ago
    [deleted]
- inimino 7y ago
  Health care is not wealth.
  - ako 7y ago
    Your health is the most valuable thing you have. If, for example, someone has a life threatening illness like cancer, they would gladly sell most of their stuff to pay to get their health back. Your health is more valuable than a garage full of Ferraris. Taking care of that wealth is important. It baffles me how people can smoke sigaretes. It's like cleaning your Ferrari with a scouring pad.
    - journalctl 7y ago
      You’ve never been addicted to a drug, have you.
    - inimino 7y ago
      No amount of wealth (which is a fancy word for lots of money) can buy health. Therefore, health is not wealth. It is, as you say, more valuable than that.
      - Ericson2314 7y ago
        You can view inequality and bad health in the US together as a mutually reinforcing expropriation. On an individual level you cannot buy or sell health, but on an aggregate level they blur. Bad
  - Ericson2314 7y ago
    Eh, just because everyone deserves is doesn't mean it's not wealth. Lack of health care is anti-wealth. Maybe you should consider that everyone deserves some wealth in general.
    - inimino 7y ago
      By definition wealthy, adj. having a great deal of money, resources, or assets; rich most people are not wealthy. Health is not wealth. You deserve access to life-saving health care you can't afford, even if you don't "deserve" to be rich.
- cmiles74 7y ago
  I disagree. The costs of health care are ridiculously high and rising. Out of the people who actually have health insurance, how many can actually afford a serious health issue? That number is getting smaller and smaller and as it shrinks, prices rise to preserve profit. If something isn't done, health insurance will become an empty promise. Even when people have it, it will be to expensive to be truly useful. There are already segments of the population where this is happening. IMHO, that is massive wealth transfer: collecting all the premiums from working people and transferring it to the health care industry.
  - rayiner 7y ago
    You’re talking about a different thing than I am. The CBO estimates Medicare for All will cost $3 trillion per year. That will require a large wealth transfer to pay for. Even if it were half that it would require a large wealth transfer. Paying for healthcare is, by contrast, not a wealth transfer because it’s payment for receipt of goods and services. As I outline in a response to a sibling post, profits account for just 6% of health spending. The rest goes to paying staff, for supplies and equipment, etc. Which is also why cutting healthcare expenditures is a pipe dream. If you look at many places, the local hospital is the biggest employer. Nurses in the US make double or more what they make in the UK. Maybe we do a bunch of unnecessary tests, but we lay for lab techs to do those unnecessary tests. Real reductions in healthcare expenditures will require cutting salaries and cutting jobs, and that’s politically impossible.
    - cmiles74 7y ago
      I think you are oversimplifying. Everything related to health care in the US is more expensive then anywhere else, from personnell to medication and supplies, to equipment. Cost is exaggerated at every step... Unecesary tests and procedures are part of the problem, bet even necessary procedures have costs associated that are inflated. Yes, some costs come down when insurance actually pays. But this still doesn't bring costs down to amounts that we see in Canada. More and more no one can pay for healthcare anymore. Perhaps it will cost $3 trillion the first year but costs will drop as prices standardize and we start to see care become predictable. The alternative is prices that continue to rise with more and more bankruptcies and, eventually, more deaths due to lack of care. Even the insured cannot continue to afford these rising costs. Wealth transfer... from where? The federal budget seems plenty big. $700 billion was transferred to banks staring in 2008, $4.6 trillion was paid out in eight years. I'd prefer a proactive solution, perhaps it will cost less in the end then our current plan to do nothing and fight what little regulation has been put in place.
- scarface74 7y ago
  Those 2/3 are already paying for the other 1/3. A hospital must treat anyone who shows up whether or not they can pay. The difference is made up via increased costs for those who can pay via insurance or tax payer funded hospitals.
- ocschwar 7y ago
  What we're really paying for is the armies of data entry and clerical workers that have to back up every doctor in this country because they are in a constant arms race with the insurers about getting every claim paid. Compare any medical practice to just about any tech firm these days. My company has one office administrator taking care of 30 keyboard commandos. A typical medical practice has more than one clerk per doctor. This is not normal. Go to any medical clinic in Europe, and it's no different from the tech sector. One office admin, lots of doctors and nurses. And it's not cheap either.
  - rayiner 7y ago
    Administrative costs are particularly high in the US, but they're high in lots of places: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1327 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.... (Ex. 3) If we cut hospital administration costs to Dutch levels (as a %-age of GDP) we could save about $140 billion per year. It's not nothing, but it's also only about 4% of total U.S. health expenditures. As noted in my response to a sibling post, all profit in the system amounts to another 6%. So even if you cut out all profit,[1] and reduced administrative costs to Dutch levels, you get a 10% cut. It's not nothing, but it doesn't even get you 30% of the way there to cutting our costs to rich-OECD country levels (as a %-age of GDP). You still need to find another $875 billion or so to cut. [1] Which is of course unrealistic, because drug companies in the EU make significant profits too, and most countries like Germany and the Netherlands have private service providers who make profits.
    - euroclydon 7y ago
      Profit doesn’t take into account inflated salaries which are tallied as expenses.
      - rayiner 7y ago
        Right, but inflated salaries for who? US nurses typically start out at double what nurses in the UK earn. They can top six figures, which a nurse in the UK won’t touch. If you look at smaller US cities, the hospital is typically the largest employer. Cutting down to European levels of healthcare expenditures will require cutting jobs and cutting salaries for upper middle class people, and there is no political will to do that.
- krapp 7y ago
  "wealth transfer" is usually invoked as a dog-whistle for "communism" and "socialist" class warfare. It's literally true, but figuratively, it's a weaker form of "taxation is theft."
- woah 7y ago
  The US spends almost twice the OECD median on healthcare as percentage of GDP (17% vs 9%). Almost all the other countries in the OECD have nationalized health care. Ending our current system and switching to something normal would in fact be ending a massive wealth transfer to the health care industry. In dollar terms, the difference between 17% and 9% of the US’s GDP is $1.7 trillion dollars per year. This is an enormous ongoing wealth transfer to a rather ineffective health care industry, which ranks below many countries that spend much less.
  - deleted 7y ago
    [deleted]
  - CryptoPunk 7y ago
    While potentially true (it's hard to say given US healthcare 1. produces much of the innovation that the rest of the world utilizes at subsidized rates and 2. provides more capital-intensive services per capita, and most healthcare is provided toward the end of life when much of it is futile), all developed nation healthcare systems have performed absolutely terribly over the last 50 years and just because some have performed less poorly doesn't mean that they're the ideal solution. We should look back to a time before national one-size-fits-all healthcare regulations that, based on crude generalizations, regiment a complex industry at great cost to innovation, and monolithic central-government-administered programs with no end user price incentives.
    - stjohnswarts 7y ago
      We are overpaying for everything because healthcare should not be a for profit venture the government needs to step in and set a max profit of say 5%. Also we're paying for a lot of bad habits like overeating and not exercising. Lots of preventable diseases go into that mix, I dare say it's the majority of expenditures. There is virtually no governmental or social efforts being put into stopping those preventable diseases.
      - CryptoPunk 7y ago
        It's much more complicated than that. For one, healthcare gets more expensive with per capita GDP. This is the pattern across the developed world. Healthcare spending in the US is about where you would expect based on this pattern, given US per capita GDP is significantly higher than that of most developed countries. Medicare in the US is similarly much more expensive than comparable programs. For another, there are things the US does better than other countries, like treat heart disease and cancer. Also like I said, other countries get to utilize medical innovation produced in the US at subsidized rates. And yes, for-profit healthcare should be allowed. Healthcare workers aren't all volunteers. They're doing it for money. The same applies to investors. Having laws limiting investment to philanthropy and taxpayers is totally destructive. Healthcare costs are going down in cosmetic surgery, unlike other healthcare fields across the developed world. Cosmetic surgery is driven by price conscious consumers and profit-motivated practitioners. Self-interest is a powerful motivator and ignoring that leads to misguided bans on for-profit healthcare and inefficient, rent-seeking government-run healthcare bureaucracies and government-permissioned private industries shielded from competition by regulatory barriers. >>Also we're paying for a lot of bad habits like overeating and not exercising. Lots of preventable diseases go into that mix, I dare say it's the majority of expenditures. There is virtually no governmental or social efforts being put into stopping those preventable diseases. Agreed. I think health outcomes are mostly a result of non-healthcare factors. Having safer, denser and more pedestrian friendly cities would go a long way in improving health for example.
DrAwdeOccarim 7y ago
I don't mean it as a pejorative at all. I am all for a universal basic health care setup (e.g., Medicare for all) because "we" (the insured and tax payer) are already paying for everyone's healthcare that can't afford it. If you go to the ER instead of PCP, we are paying for it; if you lose out on work because of preventable illness, we are paying for it; if you die early without adding productively to society, we are paying. But we currently don't have this system to pay for this from those who are making money. In other words, everyone is paying for this, but in reality it should be the higher earners that are paying more for this. That is what I see as a wealth transfer. People like you (likely) and me will have higher payroll taxes or income taxes to cover those who cannot afford. Please don't take this the wrong way--I am all for this. But it may entrench this inequality because it removes the "push" from the invisible hand of the market to get people finding ways to improve their lot in life--the whole basis of our current economic system. Again, not saying it is right or wrong, just commenting on how I think things are.
- pjc50 7y ago
  Healthcare is not a market. There's no price transparency, often no real choice (you can't choose your employer's insurer or what drugs you need), no real ability by consumers to assess the quality, and extremely high barriers to entry. US healthcare functions more like a horrific reverse lottery where occasionally someone is sent a bill that bankrupts them for reasons they don't understand and had no control over.
- mnm1 7y ago
  So if people aren't faced with chronic illness and the fear of bankruptcy they won't have a drive to succeed and improve ghetto their lot in life? Are you seriously arguing that? That's absolutely absurd. Why would a sick person me motivated to be productive when they can go on Medicaid or to the er for free? I think you have it backwards.
- NeedMoreTea 7y ago
  The push from the market appears to mainly consist of a) engineering ways of preventing drugs coming out of patent b) absurdly increase margins on basic and necessary items c) insanely increase margins on items with limited competition, e.g. epipens, last but certainly not least, advertising to unbalance healthcare by encouraging the expensive over the appropriate treatment. Pharma prefers to find long term treatments rather than new antibiotics and other treatments that are a week or two then done. Much more money in an ongoing treatment than cure. It's not the market, but far more US liability laws and willingness to sue that brings the US tendency to over investigate, diagnose and treat, is it not? That seems to be the sole advantage of the US approach over others, and even that can be questioned in many areas. All of those market pushes seem to be in the interests of medical CEOs and stockholders, not patients and citizens. I am far happier with a system that tries to remove or limit those for benefit of everyone. That tries (fallibly) to achieve fairness on medical not solely market grounds. I would prefer more openness too, but after the infamous farce of monoclonal antibodies, that's not realistic. Seems more like we need to keep that invisible, and very imperfect hand out of healthcare as much as possible. Then heavily constrain it where we can't keep it out.

rayiner 7y ago

It is a massive wealth transfer. It may be a good idea, too. Currently 2/3 of non-elderly people have insurance through their employers. If we need to extend coverage to those who don’t have it, those 2/3 will have to pay for the other 1/3. If we are proposing a massive income transfer of $3 trillion a year for the good of the country, we have to be honest about it.

Craighead 7y ago
You are being dishonest. Please do not speak about being honest.
- rayiner 7y ago
  Help me understand which point you think is incorrect?
  - deleted 7y ago
    [deleted]
- habnds 7y ago
  language like that just means someone is arguing, not reasoning
habnds 7y ago
There's an additional wealth transfer between the owners of healthcare related stocks and non owners. If the US approached EU type health care costs we could easily give every one health care for free. The cost would come out of healthcare company margins.
- rayiner 7y ago
  Totally false. Total health industry publicly traded company profits (including drug companies, hospitals, and insurance companies) add up to about $50 billion per quarter, or $200 billion per year worldwide: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Pharmas-Profits https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar.... Total domestic hospital profits (including more than just public companies) is about $74 billion per year: https://www.modernhealthcare.com/article/20180104/NEWS/180109966/hospital-profits-continued-their-rise-in-2016 https://www.modernhealthcare.com/article/20180104/NEWS/18010.... Insurance companies are $25 billion annualized: https://www.cnbc.com/2017/08/05/top-health-insurers-profit-surge-29-percent-to-6-billion-dollars.html https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... ($7 billion per quarter for health insurers). The link above shows $100 billion in drug company profits worldwide; about half of revenues are in the US, so let’s say $100 billion in profits domestically. That’s $200 billion for the US healthcare industry, including non-public companies in addition to publicly traded companies. Total US healthcare spending is $3.5 trillion. Profits account for just 6% of that spending. To reduce healthcare spending to the same levels as the rich European countries like Germany or France we’d have to cut spending about $1.25 trillion. Cutting healthcare industry profits to zero (and note that there are for-profit hospitals and drug companies in the EU and they don’t make zero profit!) would reduce healthcare expenditures by just 1/6 of the amount required.
  - AlexandrB 7y ago
    A better estimate for savings from some parts of the industry is revenue not profit. That’s because the work done by, for example, insurance companies is largely useless paper shuffling that doesn’t need to exist under single payer. Edit: oh yeah, and marketing. So much health industry money ends up in marketing. Something almost completely unnecessary under single-payer as well.
    - rayiner 7y ago
      The post I was replying to was talking about wealth transfer from people to shareholders. Profit is the proper measure of that. As to cost savings, you can’t use insurance industry revenue because that includes money spent on services. And a lot of the “paper shuffling” does need to exist under single payer. Most universal healthcare systems aren’t nationalized systems like the UK NHS. Germany for example has mandatory membership in Public health insurance organizations for those making under 60,000 euro. There are 100+ of those. Then 15% of the population has private health insurance. Care providers are mostly private. So there is still medical billing that needs to be done. Most EU countries are similar in that regard, and unlike the UK NHS. As to marketing, now you’re talking about a drop in the bucket. Pharma industry advertising adds up to just $6 billion per year.
asveikau 7y ago
> Currently 2/3 of non-elderly people have insurance through their employers. If we need to extend coverage to those who don’t have it, those 2/3 will have to pay for the other 1/3 I thought the uninsured rate was closer to 10%. Some googling suggests 8% or 9%. This is short of 33%. Of course many are insured but under insured, or insured but paying (or in I guess 66% of cases having their employer pay) for massive amounts of waste. There are entire industries like medical billing which don't strictly need to exist.
- kasey_junk 7y ago
  Insured through their employer is different than insured.
  - asveikau 7y ago
    Yes but he implied that the employer-insured need to pay for both non-employer-insured and uninsured. If his 2/3rd figure is correct we can say it's about 23% in the former and 10% in the latter, but he just says 2/3rd needs to pay for 1/3rd. If the 23% are already paying, why do they need a subsidy from someone else's employer? I guess there is an affordability issue and rising costs ... but this is true for everyone, even those who mask it by going through their employer.
eveningcoffee 7y ago
Not necessarily when the medical industry is willing to give up some of its beyond the reason revenues. https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... Then again perhaps the level US healthcare is considerably higher and it would mean lowering the average quality and availability of novel treatments.
- deleted 7y ago
  [deleted]
inimino 7y ago
Health care is not wealth.
- ako 7y ago
  Your health is the most valuable thing you have. If, for example, someone has a life threatening illness like cancer, they would gladly sell most of their stuff to pay to get their health back. Your health is more valuable than a garage full of Ferraris. Taking care of that wealth is important. It baffles me how people can smoke sigaretes. It's like cleaning your Ferrari with a scouring pad.
  - journalctl 7y ago
    You’ve never been addicted to a drug, have you.
  - inimino 7y ago
    No amount of wealth (which is a fancy word for lots of money) can buy health. Therefore, health is not wealth. It is, as you say, more valuable than that.
    - Ericson2314 7y ago
      You can view inequality and bad health in the US together as a mutually reinforcing expropriation. On an individual level you cannot buy or sell health, but on an aggregate level they blur. Bad
- Ericson2314 7y ago
  Eh, just because everyone deserves is doesn't mean it's not wealth. Lack of health care is anti-wealth. Maybe you should consider that everyone deserves some wealth in general.
  - inimino 7y ago
    By definition wealthy, adj. having a great deal of money, resources, or assets; rich most people are not wealthy. Health is not wealth. You deserve access to life-saving health care you can't afford, even if you don't "deserve" to be rich.
cmiles74 7y ago
I disagree. The costs of health care are ridiculously high and rising. Out of the people who actually have health insurance, how many can actually afford a serious health issue? That number is getting smaller and smaller and as it shrinks, prices rise to preserve profit. If something isn't done, health insurance will become an empty promise. Even when people have it, it will be to expensive to be truly useful. There are already segments of the population where this is happening. IMHO, that is massive wealth transfer: collecting all the premiums from working people and transferring it to the health care industry.
- rayiner 7y ago
  You’re talking about a different thing than I am. The CBO estimates Medicare for All will cost $3 trillion per year. That will require a large wealth transfer to pay for. Even if it were half that it would require a large wealth transfer. Paying for healthcare is, by contrast, not a wealth transfer because it’s payment for receipt of goods and services. As I outline in a response to a sibling post, profits account for just 6% of health spending. The rest goes to paying staff, for supplies and equipment, etc. Which is also why cutting healthcare expenditures is a pipe dream. If you look at many places, the local hospital is the biggest employer. Nurses in the US make double or more what they make in the UK. Maybe we do a bunch of unnecessary tests, but we lay for lab techs to do those unnecessary tests. Real reductions in healthcare expenditures will require cutting salaries and cutting jobs, and that’s politically impossible.
  - cmiles74 7y ago
    I think you are oversimplifying. Everything related to health care in the US is more expensive then anywhere else, from personnell to medication and supplies, to equipment. Cost is exaggerated at every step... Unecesary tests and procedures are part of the problem, bet even necessary procedures have costs associated that are inflated. Yes, some costs come down when insurance actually pays. But this still doesn't bring costs down to amounts that we see in Canada. More and more no one can pay for healthcare anymore. Perhaps it will cost $3 trillion the first year but costs will drop as prices standardize and we start to see care become predictable. The alternative is prices that continue to rise with more and more bankruptcies and, eventually, more deaths due to lack of care. Even the insured cannot continue to afford these rising costs. Wealth transfer... from where? The federal budget seems plenty big. $700 billion was transferred to banks staring in 2008, $4.6 trillion was paid out in eight years. I'd prefer a proactive solution, perhaps it will cost less in the end then our current plan to do nothing and fight what little regulation has been put in place.
scarface74 7y ago
Those 2/3 are already paying for the other 1/3. A hospital must treat anyone who shows up whether or not they can pay. The difference is made up via increased costs for those who can pay via insurance or tax payer funded hospitals.
ocschwar 7y ago
What we're really paying for is the armies of data entry and clerical workers that have to back up every doctor in this country because they are in a constant arms race with the insurers about getting every claim paid. Compare any medical practice to just about any tech firm these days. My company has one office administrator taking care of 30 keyboard commandos. A typical medical practice has more than one clerk per doctor. This is not normal. Go to any medical clinic in Europe, and it's no different from the tech sector. One office admin, lots of doctors and nurses. And it's not cheap either.
- rayiner 7y ago
  Administrative costs are particularly high in the US, but they're high in lots of places: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.1327 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.... (Ex. 3) If we cut hospital administration costs to Dutch levels (as a %-age of GDP) we could save about $140 billion per year. It's not nothing, but it's also only about 4% of total U.S. health expenditures. As noted in my response to a sibling post, all profit in the system amounts to another 6%. So even if you cut out all profit,[1] and reduced administrative costs to Dutch levels, you get a 10% cut. It's not nothing, but it doesn't even get you 30% of the way there to cutting our costs to rich-OECD country levels (as a %-age of GDP). You still need to find another $875 billion or so to cut. [1] Which is of course unrealistic, because drug companies in the EU make significant profits too, and most countries like Germany and the Netherlands have private service providers who make profits.
  - euroclydon 7y ago
    Profit doesn’t take into account inflated salaries which are tallied as expenses.
    - rayiner 7y ago
      Right, but inflated salaries for who? US nurses typically start out at double what nurses in the UK earn. They can top six figures, which a nurse in the UK won’t touch. If you look at smaller US cities, the hospital is typically the largest employer. Cutting down to European levels of healthcare expenditures will require cutting jobs and cutting salaries for upper middle class people, and there is no political will to do that.
krapp 7y ago
"wealth transfer" is usually invoked as a dog-whistle for "communism" and "socialist" class warfare. It's literally true, but figuratively, it's a weaker form of "taxation is theft."
woah 7y ago
The US spends almost twice the OECD median on healthcare as percentage of GDP (17% vs 9%). Almost all the other countries in the OECD have nationalized health care. Ending our current system and switching to something normal would in fact be ending a massive wealth transfer to the health care industry. In dollar terms, the difference between 17% and 9% of the US’s GDP is $1.7 trillion dollars per year. This is an enormous ongoing wealth transfer to a rather ineffective health care industry, which ranks below many countries that spend much less.
- deleted 7y ago
  [deleted]
- CryptoPunk 7y ago
  While potentially true (it's hard to say given US healthcare 1. produces much of the innovation that the rest of the world utilizes at subsidized rates and 2. provides more capital-intensive services per capita, and most healthcare is provided toward the end of life when much of it is futile), all developed nation healthcare systems have performed absolutely terribly over the last 50 years and just because some have performed less poorly doesn't mean that they're the ideal solution. We should look back to a time before national one-size-fits-all healthcare regulations that, based on crude generalizations, regiment a complex industry at great cost to innovation, and monolithic central-government-administered programs with no end user price incentives.
  - stjohnswarts 7y ago
    We are overpaying for everything because healthcare should not be a for profit venture the government needs to step in and set a max profit of say 5%. Also we're paying for a lot of bad habits like overeating and not exercising. Lots of preventable diseases go into that mix, I dare say it's the majority of expenditures. There is virtually no governmental or social efforts being put into stopping those preventable diseases.
    - CryptoPunk 7y ago
      It's much more complicated than that. For one, healthcare gets more expensive with per capita GDP. This is the pattern across the developed world. Healthcare spending in the US is about where you would expect based on this pattern, given US per capita GDP is significantly higher than that of most developed countries. Medicare in the US is similarly much more expensive than comparable programs. For another, there are things the US does better than other countries, like treat heart disease and cancer. Also like I said, other countries get to utilize medical innovation produced in the US at subsidized rates. And yes, for-profit healthcare should be allowed. Healthcare workers aren't all volunteers. They're doing it for money. The same applies to investors. Having laws limiting investment to philanthropy and taxpayers is totally destructive. Healthcare costs are going down in cosmetic surgery, unlike other healthcare fields across the developed world. Cosmetic surgery is driven by price conscious consumers and profit-motivated practitioners. Self-interest is a powerful motivator and ignoring that leads to misguided bans on for-profit healthcare and inefficient, rent-seeking government-run healthcare bureaucracies and government-permissioned private industries shielded from competition by regulatory barriers. >>Also we're paying for a lot of bad habits like overeating and not exercising. Lots of preventable diseases go into that mix, I dare say it's the majority of expenditures. There is virtually no governmental or social efforts being put into stopping those preventable diseases. Agreed. I think health outcomes are mostly a result of non-healthcare factors. Having safer, denser and more pedestrian friendly cities would go a long way in improving health for example.

DrAwdeOccarim 7y ago

I don't mean it as a pejorative at all. I am all for a universal basic health care setup (e.g., Medicare for all) because "we" (the insured and tax payer) are already paying for everyone's healthcare that can't afford it. If you go to the ER instead of PCP, we are paying for it; if you lose out on work because of preventable illness, we are paying for it; if you die early without adding productively to society, we are paying. But we currently don't have this system to pay for this from those who are making money. In other words, everyone is paying for this, but in reality it should be the higher earners that are paying more for this. That is what I see as a wealth transfer. People like you (likely) and me will have higher payroll taxes or income taxes to cover those who cannot afford. Please don't take this the wrong way--I am all for this. But it may entrench this inequality because it removes the "push" from the invisible hand of the market to get people finding ways to improve their lot in life--the whole basis of our current economic system. Again, not saying it is right or wrong, just commenting on how I think things are.

pjc50 7y ago
Healthcare is not a market. There's no price transparency, often no real choice (you can't choose your employer's insurer or what drugs you need), no real ability by consumers to assess the quality, and extremely high barriers to entry. US healthcare functions more like a horrific reverse lottery where occasionally someone is sent a bill that bankrupts them for reasons they don't understand and had no control over.
mnm1 7y ago
So if people aren't faced with chronic illness and the fear of bankruptcy they won't have a drive to succeed and improve ghetto their lot in life? Are you seriously arguing that? That's absolutely absurd. Why would a sick person me motivated to be productive when they can go on Medicaid or to the er for free? I think you have it backwards.
NeedMoreTea 7y ago
The push from the market appears to mainly consist of a) engineering ways of preventing drugs coming out of patent b) absurdly increase margins on basic and necessary items c) insanely increase margins on items with limited competition, e.g. epipens, last but certainly not least, advertising to unbalance healthcare by encouraging the expensive over the appropriate treatment. Pharma prefers to find long term treatments rather than new antibiotics and other treatments that are a week or two then done. Much more money in an ongoing treatment than cure. It's not the market, but far more US liability laws and willingness to sue that brings the US tendency to over investigate, diagnose and treat, is it not? That seems to be the sole advantage of the US approach over others, and even that can be questioned in many areas. All of those market pushes seem to be in the interests of medical CEOs and stockholders, not patients and citizens. I am far happier with a system that tries to remove or limit those for benefit of everyone. That tries (fallibly) to achieve fairness on medical not solely market grounds. I would prefer more openness too, but after the infamous farce of monoclonal antibodies, that's not realistic. Seems more like we need to keep that invisible, and very imperfect hand out of healthcare as much as possible. Then heavily constrain it where we can't keep it out.