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I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. Also FWIW

I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. Also FWIW France and Switzerland both have universal healthcare, under different systems where France splits payments 3 ways and covers more with the govt[1], and Switzerland seems to have a system like the ACA in the US where it's compulsory, but they also set caps on the deductibles and maximum price. [1]: https://en.wikipedia.org/wiki/Health_care_in_France https://en.wikipedia.org/wiki/Health_care_in_France [2]: https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

JumpCrisscross 4y ago
> France and Switzerland both have universal healthcare You said private healthcare/insurance were to blame. Switzerland has private health insurance. Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)
- PaulDavisThe1st 4y ago
  What aspect of America's immigration model do you think intersects with this? > You said private healthcare/insurance were to blame. Switzerland has private health insurance. Private business in all western countries operates within the regulations and laws that cover them. The health insurance industry in Switzerland operates under a very different set of regulations and laws than the same industry in the USA. If you want to blame the OP for not being more explicit - "private healthcare/insurance and the regulatory framework are to blame" - then fine, but ... this is actually the crux of the issue.
  - JumpCrisscross 4y ago
    > but ... this is actually the crux of the issue I'm not sure it is. Universal healthcare is orthogonal to private health insurance. That's the lesson of Switzerland's example. I don't believe this is commonly known or accepted in American politics. Instead, any attempt at reform is pitched and vilified as an attempt to end private health insurance and healthcare.
    - bhupy 4y ago
      Not sure why you're getting downvoted, but this is exactly correct. Universal healthcare != public healthcare.
    - PaulDavisThe1st 4y ago
      It may not be commonly known in the USA. However, I'm a european immigrant of 33 years, and it's well known to me. However, "private health insurance" is not, in and of itself, really "a thing". Only "private health insurance plus a regulatory structure for it". It is in this department that the US falls over so badly, while, for example, Switzerland gets it (mostly) right.
- ggrrhh_ta 4y ago
  Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere.
  - bhupy 4y ago
    > Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance So does the US: https://www.healthcare.gov/glossary/minimum-essential-coverage/ https://www.healthcare.gov/glossary/minimum-essential-covera... > there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. > Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere. You're mistaken, Switzerland has no centralized social insurance — it is fully privatized (for real medicine as well as alternative medicine), and is decentralized among its Cantons. It's just that the private Swiss insurers tend to be non-profits (same holds true for the US, e.g. Blue Cross, Kaiser, etc) and the for-profit insurers' profits are heavily capped/regulated (same holds true for the US).
    - notsrg 4y ago
      TIL Blue Cross is a "non-profit"
- e_i_pi_2 4y ago
  Ah good catch I was moving the goalposts there - I think in my head public and universal and basically interchangeable - if everyone has it is it a public good regardless of if it's provided by a collection of "private" companies
bhupy 4y ago
It's not just Switzerland and France; the Netherlands also has a private-only health insurance system. It's also very difficult to draw decisive conclusions since, across countries, there are hundreds of confounding variables — it's not just public vs private, but it's also which regulations exist in each country, whether it's employer-sponsored vs individual, general willingness to pay, etc. You're correct that Switzerland has a system like the ACA in the US, but the biggest difference is that it's not common for the Swiss to get their private insurance from their employers; it's all on the individual market. The US is actually unique in that regard, and is probably the most significant difference — the vast majority of working age adults in the US get their insurance from their employers, and as a result the ACA's individual market has been in a dire state since the program's inception. Also "socialization" is very different from "nationalization". The general trend you're talking about is more to do with the fact that having society subsidize healthcare for the poor can lead to better outcomes. As it relates to who actually does the insuring, underwriting, and payment (public vs private), one isn't necessarily better than the other; each has its trade-offs. It's just that the US (in particular) has chosen the worst of both worlds. I work in this industry, and from where I sit, the closest thing we have to a clean A/B test that controls for all of those confounding variables is actually being run in the US right now, with Medicare. 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. - 48% 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 the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ https://www.kff.org/medicare/issue-brief/medicare-advantage-...) - For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare 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...) So no, you cannot look the cost difference between the US and other countries and simply conclude that it's because of private insurance, because the actual data tells a different story. And "universal healthcare" is not the same as "public" healthcare. It might help to think about it this way: universal access to food can be achieved without nationalizing the food industry, or the food payment industry.
jaarse 4y ago
As a Canadian I have only know completely socialized healthcare. One of our largest problems right now is that our system is failing and can’t keep up. The solutions being rolled out by the provinces to fix the huge backlog of people waiting for care is to privatize more of the service delivery (while keeping single payer).
BurningFrog 4y ago
> I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. You also haven't given even a hint of proof for this alleged trend. Maybe there is a trend, but let's look at some serious data before we just assume it's an obvious fact.
- specialist 4y ago
  Google healthcare cost per capita vs life expectancy. Last time I checked, Canada, for example, spent 1/3rd less than the USA and Canadians lived a few years longer. IIRC, of the "universal coverage" systems, Switzerland's ACA-like system had the highest per capita, but still less than USA's system. Much has changed these last few years. eg Our life expectancy in the USA has fallen.
  - BurningFrog 4y ago
    I know this is really counterintuitive, but last I heard, health care isn't a major contributor to average life span. A much bigger factor is GDP per person. I think of it as: The more material wealth you have, the better your life is, and you get less risk of bad health.
  - refurb 4y ago
    Life expectancy is a terrible measure for quality of healthcare. It ignore so many other factors. The only way it could be a suitable measure if you assumed every human in every country was the same except for the healthcare they receive. It's pretty clear they aren't - lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. You’re far better to look at things like “survival after cancer diagnosis” where the US has some of the world’s best outcomes. https://www.healio.com/news/hematology-oncology/20180131/us-cancer-survival-rates-remain-among-highest-in-world https://www.healio.com/news/hematology-oncology/20180131/us-...
    - specialist 4y ago
      > Life expectancy is a terrible measure for quality of healthcare. ...lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. Only if we assume public health is unrelated to individual health.

JumpCrisscross 4y ago

> France and Switzerland both have universal healthcare You said private healthcare/insurance were to blame. Switzerland has private health insurance. Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)

PaulDavisThe1st 4y ago
What aspect of America's immigration model do you think intersects with this? > You said private healthcare/insurance were to blame. Switzerland has private health insurance. Private business in all western countries operates within the regulations and laws that cover them. The health insurance industry in Switzerland operates under a very different set of regulations and laws than the same industry in the USA. If you want to blame the OP for not being more explicit - "private healthcare/insurance and the regulatory framework are to blame" - then fine, but ... this is actually the crux of the issue.
- JumpCrisscross 4y ago
  > but ... this is actually the crux of the issue I'm not sure it is. Universal healthcare is orthogonal to private health insurance. That's the lesson of Switzerland's example. I don't believe this is commonly known or accepted in American politics. Instead, any attempt at reform is pitched and vilified as an attempt to end private health insurance and healthcare.
  - bhupy 4y ago
    Not sure why you're getting downvoted, but this is exactly correct. Universal healthcare != public healthcare.
  - PaulDavisThe1st 4y ago
    It may not be commonly known in the USA. However, I'm a european immigrant of 33 years, and it's well known to me. However, "private health insurance" is not, in and of itself, really "a thing". Only "private health insurance plus a regulatory structure for it". It is in this department that the US falls over so badly, while, for example, Switzerland gets it (mostly) right.
ggrrhh_ta 4y ago
Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere.
- bhupy 4y ago
  > Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance So does the US: https://www.healthcare.gov/glossary/minimum-essential-coverage/ https://www.healthcare.gov/glossary/minimum-essential-covera... > there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. > Switzerland's compulsory private health insurance is nothing comparable to other countries' private insurance. There is "additional private insurance" in Switzerland (covering alternative medicine treatments, access to single bed rooms in hospitals, etc.) which do operate as private insurances elsewhere. You're mistaken, Switzerland has no centralized social insurance — it is fully privatized (for real medicine as well as alternative medicine), and is decentralized among its Cantons. It's just that the private Swiss insurers tend to be non-profits (same holds true for the US, e.g. Blue Cross, Kaiser, etc) and the for-profit insurers' profits are heavily capped/regulated (same holds true for the US).
  - notsrg 4y ago
    TIL Blue Cross is a "non-profit"
e_i_pi_2 4y ago
Ah good catch I was moving the goalposts there - I think in my head public and universal and basically interchangeable - if everyone has it is it a public good regardless of if it's provided by a collection of "private" companies

bhupy 4y ago

It's not just Switzerland and France; the Netherlands also has a private-only health insurance system. It's also very difficult to draw decisive conclusions since, across countries, there are hundreds of confounding variables — it's not just public vs private, but it's also which regulations exist in each country, whether it's employer-sponsored vs individual, general willingness to pay, etc. You're correct that Switzerland has a system like the ACA in the US, but the biggest difference is that it's not common for the Swiss to get their private insurance from their employers; it's all on the individual market. The US is actually unique in that regard, and is probably the most significant difference — the vast majority of working age adults in the US get their insurance from their employers, and as a result the ACA's individual market has been in a dire state since the program's inception. Also "socialization" is very different from "nationalization". The general trend you're talking about is more to do with the fact that having society subsidize healthcare for the poor can lead to better outcomes. As it relates to who actually does the insuring, underwriting, and payment (public vs private), one isn't necessarily better than the other; each has its trade-offs. It's just that the US (in particular) has chosen the worst of both worlds. I work in this industry, and from where I sit, the closest thing we have to a clean A/B test that controls for all of those confounding variables is actually being run in the US right now, with Medicare. 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. - 48% 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 the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ https://www.kff.org/medicare/issue-brief/medicare-advantage-...) - For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-costs-40-less-than-fee-for-service-medicare 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...) So no, you cannot look the cost difference between the US and other countries and simply conclude that it's because of private insurance, because the actual data tells a different story. And "universal healthcare" is not the same as "public" healthcare. It might help to think about it this way: universal access to food can be achieved without nationalizing the food industry, or the food payment industry.

jaarse 4y ago

As a Canadian I have only know completely socialized healthcare. One of our largest problems right now is that our system is failing and can’t keep up. The solutions being rolled out by the provinces to fix the huge backlog of people waiting for care is to privatize more of the service delivery (while keeping single payer).

BurningFrog 4y ago

> I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. You also haven't given even a hint of proof for this alleged trend. Maybe there is a trend, but let's look at some serious data before we just assume it's an obvious fact.

specialist 4y ago
Google healthcare cost per capita vs life expectancy. Last time I checked, Canada, for example, spent 1/3rd less than the USA and Canadians lived a few years longer. IIRC, of the "universal coverage" systems, Switzerland's ACA-like system had the highest per capita, but still less than USA's system. Much has changed these last few years. eg Our life expectancy in the USA has fallen.
- BurningFrog 4y ago
  I know this is really counterintuitive, but last I heard, health care isn't a major contributor to average life span. A much bigger factor is GDP per person. I think of it as: The more material wealth you have, the better your life is, and you get less risk of bad health.
- refurb 4y ago
  Life expectancy is a terrible measure for quality of healthcare. It ignore so many other factors. The only way it could be a suitable measure if you assumed every human in every country was the same except for the healthcare they receive. It's pretty clear they aren't - lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. You’re far better to look at things like “survival after cancer diagnosis” where the US has some of the world’s best outcomes. https://www.healio.com/news/hematology-oncology/20180131/us-cancer-survival-rates-remain-among-highest-in-world https://www.healio.com/news/hematology-oncology/20180131/us-...
  - specialist 4y ago
    > Life expectancy is a terrible measure for quality of healthcare. ...lifestyle, smoking rates, alcohol and drug abuse, accidents, suicides, genetics. Only if we assume public health is unrelated to individual health.