6 ms·

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 ea

by 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.
    - mercutio2 7y ago
      I support pretty much any solution that provides guaranteed access to effective acute care (the fact that the ER can’t legally turn you away doesn’t mean it’s effective care). But people who advocate for this position (which, again, I believe in) all too often live in a fantasy world where we can magically switch systems and pay less. If we keep paying US medical personnel their prevailing wages, there is no way we’re going to lower costs. Nurses and doctors are too popular in the US to ever even suggest that we reduce their wages to European levels.
      - tptacek 7y ago
        Acute care, including the ER, is a small fraction of the total cost of health care. If the health care problem was simply ensuring everyone access to a GP's office and an ER for emergencies, we'd have solved it by now.
        mercutio2 7y ago
        Oh, absolutely. Providing effective and low cost chronic care is an unsolved problem everywhere. I can’t say that I support any and all entitlement schemes I’ve ever heard for chronic care, is why I was singling our acute care, where I do, but you’re right that I was mixing up arguments. But of course when you provide low cost acute care, and don’t cover chronic conditions, there’s strong pressure for chronic problems to wait until they’re acute and harder to solve, and for chronic patients to use the acute system very inefficiently. It is indeed a hard problem.
- TuringNYC 7y ago
  >> Total US healthcare spending is $3.5 trillion. Yes, but some of this is funny money. Like when you go to the hospital and get charged $50 for a tablet of aspirin. I can see a coordinated national system to be far more efficient than the system we have now of fake list prices where some parties get a negotiated real price
- noonespecial 7y ago
  That's the big takeaway I wish more people understood. Health is broken not because of fat cats making obscene profits (although there are a few), but because we're fundamentally doing it wrong. Its not one guy digging a ditch and charging too much. Its that for every 6 people digging, 5 are racing behind them filling it back in and all of them are charging us for the "service".
- habnds 7y ago
  so a few things you're missing. First, the location and timing of accounting profits is not the same as economic profits and the return on capital. Second, what do you think the point of single payer negotiation with healthcare providers is? The NHS in britian negotiates prices on behalf of the entire country. This system in the US would massively move producer surplus over to consumer surplus by reducing prices through negotiating power. Lastly, healthcare outcomes in the US are terrible and prices are astronomical compared to Europe, do you think it's a coincidence that their systems are centralized while ours is distributed? The US system massively favors capital returns over service cost and quality.
AdrianB1 7y ago
As an European with family and friends working in health care in several countries, I think the general impression most people in US have about the European health care is idealized and very far from reality. It is not the place for a long discussion here, but we are having serious problems in most countries, from waiting lists longer than the expected patient's life to lack of "free" drugs that you have to buy yourself if you want to live.
- AsyncAwait 7y ago
  As an European...what? Am not saying the system is problem free, but I've had multiple surgeries done for free, whereas in the U.S I'd most likely go bankrupt. Also the point about waiting, not only did I not have to wait, but are you seriously comparing this to a system where I don't have to wait if am wealthy, but can wait until I die if am not?
  - Frondo 7y ago
    There are long waiting times to access American health care too, anyway, even with insurance. I feel like the people who make those sorts of claims must never do more than use the ER or walk-in clinics.
  - rayiner 7y ago
    The medical bankruptcy thing is a misleading narrative: https://thehill.com/blogs/congress-blog/economy-a-budget/263547-the-myth-of-medical-bankruptcy https://thehill.com/blogs/congress-blog/economy-a-budget/263... > A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical. Also the studies that are invoked for that proposition don’t distinguish between bankruptcies due to medical bills and bankruptcies resulting from reduced income due to health issues.
    - NeedMoreTea 7y ago
      Regular people have ended up in debt just to live, and can carry a surprising amount. If we build a society where everyone carries debt, often ongoing, it's hardly surprising just bunging another few thousand or tens of thousands surprise medical debt at them may break them. Even if it turns out to be just a proportion of total. Your link makes no mention of mortgage or home loans. If they are included in the debts at bankruptcy, it's not in the least surprising that medical debt is "only" 12%.
UnpossibleJim 7y ago
"paid by the state" and "free" are not the same thing and shouldn't be used as such. I realize I'm nit picking here, but when people banty about the term "free health care for all" I really do think there is a disconnect somewhere. It's paid for. And while the IRS may be an efficient system, the government certainly is not. Now, while I'm not opposed to medical coverage for all, saying that our government running insurance instead of rolling hospitals into one of it's emergency services, like police and fire, is a different discussion.
- teddyh 7y ago
  > It's paid for. Using this definition, everything is paid for, and nothing is free except sunlight. This is obviously a useless definition. “Paid for by [someone else]” is “free”. There is no other useful definition of the term. Also: https://satwcomic.com/every-time https://satwcomic.com/every-time
  - UnpossibleJim 7y ago
    Well, considering I said maybe we should move health care to emergency services,like the police and fire services, added to that comic, I can only assume you completely missed the point of my statement. And while not everything is paid for except sunlight, everything the government provides IS paid for, yes. There is a ledger to be kept. I'm not some hard core conservative, nor am I some hardcore liberal. Like most Americans, I'm somewhere in the middle and am capable of more nuance and critical thought than I am given credit for.

by habnds 7y ago

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.
  - mercutio2 7y ago
    I support pretty much any solution that provides guaranteed access to effective acute care (the fact that the ER can’t legally turn you away doesn’t mean it’s effective care). But people who advocate for this position (which, again, I believe in) all too often live in a fantasy world where we can magically switch systems and pay less. If we keep paying US medical personnel their prevailing wages, there is no way we’re going to lower costs. Nurses and doctors are too popular in the US to ever even suggest that we reduce their wages to European levels.
    - tptacek 7y ago
      Acute care, including the ER, is a small fraction of the total cost of health care. If the health care problem was simply ensuring everyone access to a GP's office and an ER for emergencies, we'd have solved it by now.
      - mercutio2 7y ago
        Oh, absolutely. Providing effective and low cost chronic care is an unsolved problem everywhere. I can’t say that I support any and all entitlement schemes I’ve ever heard for chronic care, is why I was singling our acute care, where I do, but you’re right that I was mixing up arguments. But of course when you provide low cost acute care, and don’t cover chronic conditions, there’s strong pressure for chronic problems to wait until they’re acute and harder to solve, and for chronic patients to use the acute system very inefficiently. It is indeed a hard problem.
TuringNYC 7y ago
>> Total US healthcare spending is $3.5 trillion. Yes, but some of this is funny money. Like when you go to the hospital and get charged $50 for a tablet of aspirin. I can see a coordinated national system to be far more efficient than the system we have now of fake list prices where some parties get a negotiated real price
noonespecial 7y ago
That's the big takeaway I wish more people understood. Health is broken not because of fat cats making obscene profits (although there are a few), but because we're fundamentally doing it wrong. Its not one guy digging a ditch and charging too much. Its that for every 6 people digging, 5 are racing behind them filling it back in and all of them are charging us for the "service".
habnds 7y ago
so a few things you're missing. First, the location and timing of accounting profits is not the same as economic profits and the return on capital. Second, what do you think the point of single payer negotiation with healthcare providers is? The NHS in britian negotiates prices on behalf of the entire country. This system in the US would massively move producer surplus over to consumer surplus by reducing prices through negotiating power. Lastly, healthcare outcomes in the US are terrible and prices are astronomical compared to Europe, do you think it's a coincidence that their systems are centralized while ours is distributed? The US system massively favors capital returns over service cost and quality.

AdrianB1 7y ago

As an European with family and friends working in health care in several countries, I think the general impression most people in US have about the European health care is idealized and very far from reality. It is not the place for a long discussion here, but we are having serious problems in most countries, from waiting lists longer than the expected patient's life to lack of "free" drugs that you have to buy yourself if you want to live.

AsyncAwait 7y ago
As an European...what? Am not saying the system is problem free, but I've had multiple surgeries done for free, whereas in the U.S I'd most likely go bankrupt. Also the point about waiting, not only did I not have to wait, but are you seriously comparing this to a system where I don't have to wait if am wealthy, but can wait until I die if am not?
- Frondo 7y ago
  There are long waiting times to access American health care too, anyway, even with insurance. I feel like the people who make those sorts of claims must never do more than use the ER or walk-in clinics.
- rayiner 7y ago
  The medical bankruptcy thing is a misleading narrative: https://thehill.com/blogs/congress-blog/economy-a-budget/263547-the-myth-of-medical-bankruptcy https://thehill.com/blogs/congress-blog/economy-a-budget/263... > A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical. Also the studies that are invoked for that proposition don’t distinguish between bankruptcies due to medical bills and bankruptcies resulting from reduced income due to health issues.
  - NeedMoreTea 7y ago
    Regular people have ended up in debt just to live, and can carry a surprising amount. If we build a society where everyone carries debt, often ongoing, it's hardly surprising just bunging another few thousand or tens of thousands surprise medical debt at them may break them. Even if it turns out to be just a proportion of total. Your link makes no mention of mortgage or home loans. If they are included in the debts at bankruptcy, it's not in the least surprising that medical debt is "only" 12%.

UnpossibleJim 7y ago

"paid by the state" and "free" are not the same thing and shouldn't be used as such. I realize I'm nit picking here, but when people banty about the term "free health care for all" I really do think there is a disconnect somewhere. It's paid for. And while the IRS may be an efficient system, the government certainly is not. Now, while I'm not opposed to medical coverage for all, saying that our government running insurance instead of rolling hospitals into one of it's emergency services, like police and fire, is a different discussion.

teddyh 7y ago
> It's paid for. Using this definition, everything is paid for, and nothing is free except sunlight. This is obviously a useless definition. “Paid for by [someone else]” is “free”. There is no other useful definition of the term. Also: https://satwcomic.com/every-time https://satwcomic.com/every-time
- UnpossibleJim 7y ago
  Well, considering I said maybe we should move health care to emergency services,like the police and fire services, added to that comic, I can only assume you completely missed the point of my statement. And while not everything is paid for except sunlight, everything the government provides IS paid for, yes. There is a ledger to be kept. I'm not some hard core conservative, nor am I some hardcore liberal. Like most Americans, I'm somewhere in the middle and am capable of more nuance and critical thought than I am given credit for.