5 ms·

> For profit healthcare in America is devouring its people and economy, full stop. We can either have a society where half a million people go bankrupt from med

by zeveb 7y ago

> For profit healthcare in America is devouring its people and economy, full stop. We can either have a society where half a million people go bankrupt from medical debt each year, thousands die from treatable illnesses or lack of access to medicines, while hospital CEOS and insurance execs walk away with millions, or we can have one that excises their parasitism like the rest of the developed world figured out was necessary decades ago. The majority of the world still has, to my knowledge, for-profit health care: Britain, Germany, France, Switzerland , Sweden and Italy all have at least some form of private health care. The United States definitely have a problem with health care prices. It doesn't appear from where I sit to be an issue with individual bad actors (although of course they do exist) but rather structural. In part, the well-intended federal and state attempts to improve things have backfired — as they tend to do — and made things even more expensive (which reminds me of federal student loans, another instance of well-meaning attempts to help the lesser-off which somehow seem to benefit the upper middle classes most of all; cf. also federally-subsidised mortgages).

ptah 7y ago
> at least some form of private health care. a very tiny proportion of them yes, in the US the whole thing is private
- kube-system 7y ago
  > the whole thing is private The US has several public insurers. About 72 million Americans are enrolled in Medicaid or CHIP. About 60 million are enrolled in Medicare. The MHS covers about 9.5 million people. The IHS covers another 2.2 million people.
  - ptah 7y ago
    insurance is not the same as e.g. UK NHS which is wholly run publically
    - kube-system 7y ago
      The US occupies the large gap between "wholly run publicly" and "the whole thing is private". Besides public-payer insurance, there are government hospitals in the US too. 21% of US hospitals are government owned.
      - ptah 7y ago
        at teh government owned hospitals, do people still use "insurance"? or is it free at the point of use? what criteria applies to treatment there, limitations etc?
        kube-system 7y ago
        It all depends on which program/hospital/patient/government we're talking about. Everything about government in the US is fragmented. Scenarios range from completely free at the point of use, to 100% out of pocket, and everything in between. The 5 programs I mentioned above are just the largest federal programs. States and localities in the US often implement their own programs. There are hundreds of government healthcare programs that someone in the US might take advantage of, depending on where they're at. The problem with healthcare in the US is not that there is no government healthcare initiatives. The problem is that we have too many. Fragmentation is inefficient and expensive. Governments in the US spend $4,854/person/year on healthcare. The NHS spends $4,192/person/year. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet/ https://www.cms.gov/research-statistics-data-and-systems/sta... https://www.nhsconfed.org/resources/key-statistics-on-the-nhs https://www.nhsconfed.org/resources/key-statistics-on-the-nh...
SolaceQuantum 7y ago
IIRC the issue is not that private healthcare exists in first world countries. The major issue is that private healthare is the primary healthcare insurance provider for USA citizens.
bambataa 7y ago
Private health care exists in the UK but the NHS is public, though there are attempts to change this [1] as apparently the US model is considered something to emulate. I definitely wouldn't use the UK as a comparison to the US' private system as the funding models are completely different. From the outside it seems that government attempts to shape the market (by the measures you mention) seem to work out worse and more expensively than measures to make the market (e.g. NHS). We have this in the UK with the government providing subsidies to buy private houses rather than just build enough public houses. I'd be interested in some economic insight into this if anyone has any. [1] https://www.theguardian.com/society/2019/nov/08/private-surgery-nhs-patients-soars-under-tories https://www.theguardian.com/society/2019/nov/08/private-surg...
DiogenesKynikos 7y ago
The countries you listed are all dominated by public health care systems. The NHS in the UK is entirely public (insurance and providers). The other countries have public insurance that covers everyone, and a mix of public and private hospitals. It's a bit complicated in Germany and Switzerland, where there are multiple semi-public insurers, but those insurers are so heavily regulated they're basically public entities (price, coverage and payments to providers are all fixed by government).
marvin 7y ago
The issue has never been whether private healthcare providers should be allowed to exist. The question is whether a good publicly-funded alternative should be available, to allow everyone treatment for the vast majority of conditions and illnesses that are lethal or significantly affect quality of life. Most countries that have the latter, also turn out to have much cheaper healthcare overall. This system doesn't solve or treat every problem, and the US system manages to provide better quality of care in some cases, but there's a serious morality issue here that it does fix. Along with many pragmatic socioeconomic benefits (e.g. healthcare for retirees, early-stage and failing entrepeneurs)
rsynnott 7y ago
> The majority of the world still has, to my knowledge, for-profit health care: Britain, Germany, France, Switzerland , Sweden and Italy all have at least some form of private health care. While private health care exists in all of those countries, and in some of them it's a significant part of the system, a lot of what exists isn't actually _for-profit_. For instance, in Ireland we have a dual public and private system (primary care is private unless you're old, very young, or low income, private hospitals exist as an option), but most of the private system is either outright non-profit (most private hospitals, the statutory VHI health insurer) or is heavily constrained by the existence of the non-profit portion and regulation (private insurers have to compete with the VHI, and are not allowed charge risk-based rates for most customers).
- cookieswumchorr 7y ago
  in Germany, the actual doctors office that treats you may be a for-profit, but they get the cash from your (mandatory) insurance, and the law regulates what kind of treatment is essential and therefore included in the mandatory healthcare plan. You can have a private healthcare plan that gets you extra treatment, or pay yourself for it. But it's really Stuff you can live without. another example, in Russia, you have _theoretically_ the same system, but the level of treatment covered by the mandatory insurance is totally insufficient by any reasonable modern standards, so you have to pay all the way. And it's not about debt, it's often about not getting live-saving treatment before you cash out.

by zeveb 7y ago

ptah 7y ago

> at least some form of private health care. a very tiny proportion of them yes, in the US the whole thing is private

kube-system 7y ago
> the whole thing is private The US has several public insurers. About 72 million Americans are enrolled in Medicaid or CHIP. About 60 million are enrolled in Medicare. The MHS covers about 9.5 million people. The IHS covers another 2.2 million people.
- ptah 7y ago
  insurance is not the same as e.g. UK NHS which is wholly run publically
  - kube-system 7y ago
    The US occupies the large gap between "wholly run publicly" and "the whole thing is private". Besides public-payer insurance, there are government hospitals in the US too. 21% of US hospitals are government owned.
    - ptah 7y ago
      at teh government owned hospitals, do people still use "insurance"? or is it free at the point of use? what criteria applies to treatment there, limitations etc?
      - kube-system 7y ago
        It all depends on which program/hospital/patient/government we're talking about. Everything about government in the US is fragmented. Scenarios range from completely free at the point of use, to 100% out of pocket, and everything in between. The 5 programs I mentioned above are just the largest federal programs. States and localities in the US often implement their own programs. There are hundreds of government healthcare programs that someone in the US might take advantage of, depending on where they're at. The problem with healthcare in the US is not that there is no government healthcare initiatives. The problem is that we have too many. Fragmentation is inefficient and expensive. Governments in the US spend $4,854/person/year on healthcare. The NHS spends $4,192/person/year. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet/ https://www.cms.gov/research-statistics-data-and-systems/sta... https://www.nhsconfed.org/resources/key-statistics-on-the-nhs https://www.nhsconfed.org/resources/key-statistics-on-the-nh...

SolaceQuantum 7y ago

IIRC the issue is not that private healthcare exists in first world countries. The major issue is that private healthare is the primary healthcare insurance provider for USA citizens.

bambataa 7y ago

Private health care exists in the UK but the NHS is public, though there are attempts to change this [1] as apparently the US model is considered something to emulate. I definitely wouldn't use the UK as a comparison to the US' private system as the funding models are completely different. From the outside it seems that government attempts to shape the market (by the measures you mention) seem to work out worse and more expensively than measures to make the market (e.g. NHS). We have this in the UK with the government providing subsidies to buy private houses rather than just build enough public houses. I'd be interested in some economic insight into this if anyone has any. [1] https://www.theguardian.com/society/2019/nov/08/private-surgery-nhs-patients-soars-under-tories https://www.theguardian.com/society/2019/nov/08/private-surg...

DiogenesKynikos 7y ago

The countries you listed are all dominated by public health care systems. The NHS in the UK is entirely public (insurance and providers). The other countries have public insurance that covers everyone, and a mix of public and private hospitals. It's a bit complicated in Germany and Switzerland, where there are multiple semi-public insurers, but those insurers are so heavily regulated they're basically public entities (price, coverage and payments to providers are all fixed by government).

marvin 7y ago

The issue has never been whether private healthcare providers should be allowed to exist. The question is whether a good publicly-funded alternative should be available, to allow everyone treatment for the vast majority of conditions and illnesses that are lethal or significantly affect quality of life. Most countries that have the latter, also turn out to have much cheaper healthcare overall. This system doesn't solve or treat every problem, and the US system manages to provide better quality of care in some cases, but there's a serious morality issue here that it does fix. Along with many pragmatic socioeconomic benefits (e.g. healthcare for retirees, early-stage and failing entrepeneurs)

rsynnott 7y ago

> The majority of the world still has, to my knowledge, for-profit health care: Britain, Germany, France, Switzerland , Sweden and Italy all have at least some form of private health care. While private health care exists in all of those countries, and in some of them it's a significant part of the system, a lot of what exists isn't actually _for-profit_. For instance, in Ireland we have a dual public and private system (primary care is private unless you're old, very young, or low income, private hospitals exist as an option), but most of the private system is either outright non-profit (most private hospitals, the statutory VHI health insurer) or is heavily constrained by the existence of the non-profit portion and regulation (private insurers have to compete with the VHI, and are not allowed charge risk-based rates for most customers).

cookieswumchorr 7y ago
in Germany, the actual doctors office that treats you may be a for-profit, but they get the cash from your (mandatory) insurance, and the law regulates what kind of treatment is essential and therefore included in the mandatory healthcare plan. You can have a private healthcare plan that gets you extra treatment, or pay yourself for it. But it's really Stuff you can live without. another example, in Russia, you have _theoretically_ the same system, but the level of treatment covered by the mandatory insurance is totally insufficient by any reasonable modern standards, so you have to pay all the way. And it's not about debt, it's often about not getting live-saving treatment before you cash out.