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This is useful - as a starting point. I want to be able to make a case for a single payer system in the U.S., but I think to be effective it's a comparison of

This is useful - as a starting point. I want to be able to make a case for a single payer system in the U.S., but I think to be effective it's a comparison of costs and outcomes that needs to be had. In the data linked above, we're told that the 'inpatient and outpatient care' is significantly higher than in 'comparable countries.' I believe it. But isn't 'inpatient and outpatient care' just about .. everything that goes into a health care system aside from the paper pushing and insurance pieces? And are hospitals really breaking that stuff out ? Someone in favor of the U.S. system would say, ah hah, that's because we in the U.S. have access to better care, and more sophisticated technology, than in France or Germany, and also we don't have long waiting lists. I don't know the technology claim, but I've seen the wait list claim and I do think it's true when comparing the U.S. with Canada or the UK (the latter two have long waits for essential surgeries compared to the U.S.) How would one counter this claim?

bhupy 6y ago
You're right that it's a useful starting point, but I think that it's even more complicated than "single payer is better". First of all, it isn't obvious that single payer is the best system, because there are many countries in the world that have exemplary health care systems that are not "single payer". You cited Germany as an example, but Germany doesn't have a single payer system, it has a public-private mix. It's a universal multi-payer system. Netherlands has a purely private universal healthcare system, Switzerland has a purely private universal healthcare system, Australia has a public-private mix (44% choose private), Singapore has universal catastrophic coverage but everything else is driven by savings accounts and private insurance among the upper-middle class, etc etc — Belgium, South Korea (technically "single payer" but only covers 60% of costs, private insurance fills in the gaps), Japan, etc. From where I sit, the most apples-to-apples A/B test of single-public-payer vs private insurance is actually being run in the US, as we speak. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare, also cover Part D prescription drug benefits, and often include supplemental benefits that Original Medicare doesn't already cover. There are some interesting findings so far: - 39% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly, that we expect by 2025, more seniors to be on a private plan than the public one. There's also great variance by State. In Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon, Alabama, Hawaii, and Connecticut — nearly 50% of beneficiaries are on Medicare Advantage. By 2022, we expect more seniors in those States to be on a private plan than a public one. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/ https://www.kff.org/medicare/issue-brief/a-dozen-facts-about... - For most beneficiaries, Medicare Advantage costs about 39% less than Original Medicare. https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-... - Medicare Advantage plans are, on average, of higher quality than the public "Original Medicare" https://healthpayerintelligence.com/news/medicare-advantage-enrollment-quality-continue-upward-trend https://healthpayerintelligence.com/news/medicare-advantage-... - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan. https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2... From this same research, public "Original Medicare" is still cheaper in rural areas, but not by a whole lot. So to make things more complicated, we're not just talking about whether "Medicare For All" is better than the status quo, we also need to litigate if private-insurance driven "Medicare Advantage For All", is even better.
kwhitefoot 6y ago
> (the latter two have long waits for essential surgeries compared to the U.S.) References?
- mancerayder 6y ago
  "Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral. Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America." (https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/?sh=58e2eb1536b8 https://www.forbes.com/sites/sallypipes/2019/04/01/britains-...) Yes, I know Forbes has a bent. And I'm generally in favor of single-payer options and not defending the U.S. However I have seen the Wait Time stat over the years in the context of cancer patients, and this is one data point. Canada is apparently worse.
  - DanBC 6y ago
    > live at least five years after diagnosis, Five year survival rates don't give you much information, because the US engages in massive over testing. You need to know all cause mortality, and the US does worse here than the UK. The US over tests people and over treats cancer; that costs a lot of money and isn't pleasant for people but it doesn't make them live longer. If hypothetical Beth dies age 82 does it matter if she is told she has cancer at age 75 or age 79?
    - mancerayder 6y ago
      I'm always willing to learn more - do we have a one-stop-shop apples to apples comparison of U.S. vs. UK and other countries' healthcare models with stats and explanations, one that is free from strong biases ? I struggled to find a non-political, but still meaningful comparison data site online via Google.
nabilhat 6y ago
Given that inpatient + outpatient = 100% of the category, I have to agree. Lumping the cost of "Medical Care" into a single metric in a breakdown of spending on, well, medical care, doesn't offer much insight. Showing exactly the same data in 4 different graphing methods doesn't add anything but clutter. The lack of effort honestly makes me question this organization's mission. I think the most useful bit is the reference to the OECD data source. For those not already aware, OECD has far more detailed data available to browse [0], and heaps of more informative and competent presentations [1]. [0] https://stats.oecd.org/ https://stats.oecd.org/ [1] http://www.oecd.org/health/health-expenditure.htm http://www.oecd.org/health/health-expenditure.htm

bhupy 6y ago

You're right that it's a useful starting point, but I think that it's even more complicated than "single payer is better". First of all, it isn't obvious that single payer is the best system, because there are many countries in the world that have exemplary health care systems that are not "single payer". You cited Germany as an example, but Germany doesn't have a single payer system, it has a public-private mix. It's a universal multi-payer system. Netherlands has a purely private universal healthcare system, Switzerland has a purely private universal healthcare system, Australia has a public-private mix (44% choose private), Singapore has universal catastrophic coverage but everything else is driven by savings accounts and private insurance among the upper-middle class, etc etc — Belgium, South Korea (technically "single payer" but only covers 60% of costs, private insurance fills in the gaps), Japan, etc. From where I sit, the most apples-to-apples A/B test of single-public-payer vs private insurance is actually being run in the US, as we speak. When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare, also cover Part D prescription drug benefits, and often include supplemental benefits that Original Medicare doesn't already cover. There are some interesting findings so far: - 39% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly, that we expect by 2025, more seniors to be on a private plan than the public one. There's also great variance by State. In Florida, Pennsylvania, Wisconsin, Michigan, Minnesota, Oregon, Alabama, Hawaii, and Connecticut — nearly 50% of beneficiaries are on Medicare Advantage. By 2022, we expect more seniors in those States to be on a private plan than a public one. https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/ https://www.kff.org/medicare/issue-brief/a-dozen-facts-about... - For most beneficiaries, Medicare Advantage costs about 39% less than Original Medicare. https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare https://healthpayerintelligence.com/news/medicare-advantage-... - Medicare Advantage plans are, on average, of higher quality than the public "Original Medicare" https://healthpayerintelligence.com/news/medicare-advantage-enrollment-quality-continue-upward-trend https://healthpayerintelligence.com/news/medicare-advantage-... - In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan. https://www.commonwealthfund.org/publications/issue-briefs/2016/jan/does-medicare-advantage-cost-less-traditional-medicare https://www.commonwealthfund.org/publications/issue-briefs/2... From this same research, public "Original Medicare" is still cheaper in rural areas, but not by a whole lot. So to make things more complicated, we're not just talking about whether "Medicare For All" is better than the status quo, we also need to litigate if private-insurance driven "Medicare Advantage For All", is even better.

kwhitefoot 6y ago

> (the latter two have long waits for essential surgeries compared to the U.S.) References?

mancerayder 6y ago
"Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009. And keep in mind that "on time" for the NHS is already 62 days after referral. Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America." (https://www.forbes.com/sites/sallypipes/2019/04/01/britains-version-of-medicare-for-all-is-collapsing/?sh=58e2eb1536b8 https://www.forbes.com/sites/sallypipes/2019/04/01/britains-...) Yes, I know Forbes has a bent. And I'm generally in favor of single-payer options and not defending the U.S. However I have seen the Wait Time stat over the years in the context of cancer patients, and this is one data point. Canada is apparently worse.
- DanBC 6y ago
  > live at least five years after diagnosis, Five year survival rates don't give you much information, because the US engages in massive over testing. You need to know all cause mortality, and the US does worse here than the UK. The US over tests people and over treats cancer; that costs a lot of money and isn't pleasant for people but it doesn't make them live longer. If hypothetical Beth dies age 82 does it matter if she is told she has cancer at age 75 or age 79?
  - mancerayder 6y ago
    I'm always willing to learn more - do we have a one-stop-shop apples to apples comparison of U.S. vs. UK and other countries' healthcare models with stats and explanations, one that is free from strong biases ? I struggled to find a non-political, but still meaningful comparison data site online via Google.

nabilhat 6y ago

Given that inpatient + outpatient = 100% of the category, I have to agree. Lumping the cost of "Medical Care" into a single metric in a breakdown of spending on, well, medical care, doesn't offer much insight. Showing exactly the same data in 4 different graphing methods doesn't add anything but clutter. The lack of effort honestly makes me question this organization's mission. I think the most useful bit is the reference to the OECD data source. For those not already aware, OECD has far more detailed data available to browse [0], and heaps of more informative and competent presentations [1]. [0] https://stats.oecd.org/ https://stats.oecd.org/ [1] http://www.oecd.org/health/health-expenditure.htm http://www.oecd.org/health/health-expenditure.htm