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It's complicated. Health insurance is expensive because healthcare is expensive. Different countries have approached this differently. In the UK the doctor will

It's complicated. Health insurance is expensive because healthcare is expensive. Different countries have approached this differently. In the UK the doctor will see you in 5 years, in China the government sponsors snake oil ( traditional Chinese medicine), and in Canada they introduced MAID (the 'just kill yourself now' health plan).

jademohnahan 2y ago
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kerpopulous 2y ago
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- throwaway48476 2y ago
  I think drugs should be manufactured by state run non profits.
linsomniac 2y ago
But it seems obvious that inserting a group of middlemen into an already expensive system is going to make it more expensive. The complexity of dealing with all the insurance companies is literally overwhelming. It is so confusing to me that "socialized healthcare" is such a dirty word, when the whole purpose of insurance is, a it's core, introducing socialism into healthcare. If you are anti-socialism, cancel your healthcare and just private pay for your healthcare. :-) Sadly, we in the US seem to be sliding in that direction with the noises being made about "healthcare pools".
- vondur 2y ago
  Most working people in the US are on private healthcare. What you are saying makes no sense. Most everyone agrees our current system isn’t working and needs fixing.
- Ajedi32 2y ago
  Yes, insurance is effectively a form of voluntary socialism implemented on top of the free market. That's why it sucks so much in the first place. (Which isn't to say a purely market based system would be better; people buy insurance for a reason.) As I see it, health insurance is uniquely bad for a few additional reasons: 1. People don't treat it as insurance against catastrophic events so much as a subscription for ongoing care, which greatly expands the scope of what costs are socialized. 2. It's often paid for through employers, which reduces consumer choice in deciding what plans to purchase. 3. Demand for healthcare services is relatively inelastic and with modern medicine there's often almost no limit to how much it can cost. If you wreck your car, at most your car insurance company is on the hook for the cost of the vehicle (and perhaps some additional costs up to a fixed limit). But if you're suffering from some disease with no known cure, you could easily spend tens of millions trying hundreds of different procedures trying to find something that will work to mitigate the effects of the disease, and that's an ongoing cost that goes on forever until you're either cured or dead. Somebody has to decide which procedures are worth it or not, and if you're not paying for it yourself that "somebody" isn't going to be you, which creates lots of inefficiencies and is heartbreaking for everyone involved. This is also why we end up with systems such as "in network" and "out of network" providers, and government regulations intended to make things more fair at the cost of even more layers of inefficient bureaucracy. A few other thoughts: > If you are anti-socialism, cancel your healthcare and just private pay for your healthcare. Even for those who might be inclined to do so, this often isn't viable because of #2; they'd be leaving a bunch of free money on the table. I've also heard stories of some healthcare providers charging private individuals many times what they'd charge an insurance company for the same thing, though I'm not sure how common that still is today. > inserting a group of middlemen into an already expensive system is going to make it more expensive This is true, though note that government healthcare just replaces one set of middlemen with another.
  - dragonwriter 2y ago
    > Yes, insurance is effectively a form of voluntary socialism implemented on top of the free market. No, its not. Socialism is when the working class exercises control of the (non-financial) means of production. Insurance is neither about workers qua workers or control of the non-financial means of production. Using disproportionate control of financial resources to sell risk-leveling as a service and therebu increase your disproportionate control of financial resources isn’t socialism.
- TheGRS 2y ago
  Simplifying the system should be the goal for lawmakers IMO. But that would never really get much traction. Getting care to people who need it has an obvious priority, so we layer more and more complexity over the current system.
- User23 2y ago
  Capitalism with transfer payments (the Nordic model) and socialism (Union of Soviet Socialist Republics model) are two very different things. Regardless of how we might wish it to be, it's an observable fact that the latter sense is how the word socialized is understood in the USA. And yeah, people rightly object to totalitarian control over their health care, whether it's by a government or a for profit cartel that has managed to achieve a stranglehold on medical payments.
sneed_chucker 2y ago
It's not that complicated. Healthcare is expensive, sure. It's made more expensive by allowing the private healthcare industry to operate in such a parasitic way. Americans and their employers pay an obscene amount of money to insurance companies every year for "health insurance". In turn, those companies use that money to employ people full time to find ways to deny people the coverage that they pay for based on technicalities. They do this so that they can pay people like Brian Thompson more money. It's a disgusting and immoral system that should not be allowed to exist.
- lamontcg 2y ago
  It is worse than that now, though, because they own doctors as well through Optum under the united health group umbrella corporation.
tim333 2y ago
>In the UK the doctor will see you in 5 years I get your point but for reality's sake the last time I saw a doctor, on the NHS in the UK it took one day. The service is a bit ropey but in strange ways.
nunez 2y ago
Yeah but many people wait months to see specialists in the US that will only give them 10 minutes of their time...
Latty 2y ago
The NHS is crumbling under a decade and a half of underfunding and intentional mismanagement to designed to prove it doesn't work by the Tories, and even then, it isn't as bad as you make out. There are 100% unacceptable wait times for some things and some procedures, but I'd take having an annoyingly long wait to see my GP over people I care about not having healthcare at all, and realistically it isn't as bad as you are making out. In 2022, the British government spent £3.5k ($4.4k) per person per year on healthcare. The US spent $13k per person per year in 2022, of which $6.2k was government (national+state+local)[2]. The UK government spends less per person than the US government on healthcare, even before the amount paid privately. Even if you think the UK's healthcare is worse than the US (which I fundamentally disagree with), you have an extra $2k to play with and do better than the UK before it costs more than the current system to the government, and then another $6k of extra tax before people would be more out of pocket than with private healthcare. Healthcare is complicated, all systems have flaws and all are vulnerable to being manipulated. None of that changes that the US has the worst system, run in the worst way, with the least efficiency. And that's without even getting to the obvious point that a country where people are healthier is worth paying for: my friends and family, colleagues, people I interact with being well, living longer, and not having diseases is very worth paying for and I want to be taxed to achieve that. [1]: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2022and2023 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan... [2]: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo...
- nickff 2y ago
  >"In 2022, the British government spent £3.5k ($4.4k) per person per year on healthcare. The US spent $13k per person per year in 2022, of which $6.2k was government (national+state+local)[2]. The UK government spends less per person than the US government on healthcare, even before the amount paid privately." The difference in medical spending is largely due to wage costs being much higher in the USA than the UK; healthcare insurance companies are not as profitable as it may seem (they're about as profitable as other insurance businesses). Pharmaceutical prices don't explain much of the difference either, because they’re only a single-digit percentage of healthcare spending (in the USA).
throwaway48476 2y ago
I'd add that the point of insurance is to pool risk for rare but costly incidents. Somehow we have a system where it also pays for foreseeable and very likely events. Of course supply and demand market competition breaks down in a non linear S/D case where there is no elasticity of demand. Ideally routine care would never be covered by insurance with full proce transparency like plastic surgery. Further separating health insurance from employment would drastically reduce the number of unique plans offered making it more efficient. It would also require public non profit manufacturing of drugs to reduce the cost.
- nradov 2y ago
  If routine and preventive care isn't covered by some form of insurance than low-income people won't be able to afford it at all. Some of those costs are inevitably going to be pooled. Generic drug manufacturers have very low profit margins. Switching manufacturing of generics to non-profit organizations would have very little impact on total healthcare system costs. If you're suggesting handing over ownership of patent protected drugs to non-profit organizations, well that would lower costs in the short term. It would also ensure the pipeline of new drug development is slowed to a trickle.
  - throwaway48476 2y ago
    New drug development is largely funded by the government already. There are basically 0 new compounds on the market in the last 20 years. Most of the cost for drug development that is pricately funded is just dealing with regulation, not doing R&D. It is always economically more efficient to develop drugs instead of cures.
    - nradov 2y ago
      The vast majority of drug development costs are are in phase-3 human clinical trials. That's not just regulation, it's essential to prove safety and efficiency. The government provides very little funding for those trials. Stop making things up.
plugger 2y ago
No offense, but I find this comment ignorant at best and purposefully misleading at worst. I've visited emergency multiple times over the 20+ years I've been living in Australia. The first time I left with crutches, a casted ankle, and a whole slew of scans indicating it was just a serious sprain, not a bone break or tissue tear. I was almost out of emergency before I turned around and uncomfortably announced that I was leaving and yet hadn't paid for anything. A doctor came directly over, pressed the button for the automatic doors, and said "It's ok, this isn't America. You're free to leave, and you don't owe us any payment. Your taxes cover this." I have severe spinal stenosis. On Tuesday I had an EOS scan. $0. Last year I had both an MRI and CT scan. Both cost me nothing and were covered by the public health system. If I had these 3 scans done in the US without private health care I'd be out of pocket $10k or more.
- marcus_holmes 2y ago
  I've lived in a few countries and the Aussie system is by far the best I've used. I've also had that "so I've just come out of the doc's, how much do I owe?" at reception, only to be told "nope, you're good, see you in 3 months for your next checkup" shock.
bigfatkitten 2y ago
The U.S. spends much more money on health care per capita than any country on the planet, with far less to show for it. This is a uniquely American problem. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-...

jademohnahan 2y ago

[flagged]

kerpopulous 2y ago

[flagged]

throwaway48476 2y ago
I think drugs should be manufactured by state run non profits.

linsomniac 2y ago

But it seems obvious that inserting a group of middlemen into an already expensive system is going to make it more expensive. The complexity of dealing with all the insurance companies is literally overwhelming. It is so confusing to me that "socialized healthcare" is such a dirty word, when the whole purpose of insurance is, a it's core, introducing socialism into healthcare. If you are anti-socialism, cancel your healthcare and just private pay for your healthcare. :-) Sadly, we in the US seem to be sliding in that direction with the noises being made about "healthcare pools".

vondur 2y ago
Most working people in the US are on private healthcare. What you are saying makes no sense. Most everyone agrees our current system isn’t working and needs fixing.
Ajedi32 2y ago
Yes, insurance is effectively a form of voluntary socialism implemented on top of the free market. That's why it sucks so much in the first place. (Which isn't to say a purely market based system would be better; people buy insurance for a reason.) As I see it, health insurance is uniquely bad for a few additional reasons: 1. People don't treat it as insurance against catastrophic events so much as a subscription for ongoing care, which greatly expands the scope of what costs are socialized. 2. It's often paid for through employers, which reduces consumer choice in deciding what plans to purchase. 3. Demand for healthcare services is relatively inelastic and with modern medicine there's often almost no limit to how much it can cost. If you wreck your car, at most your car insurance company is on the hook for the cost of the vehicle (and perhaps some additional costs up to a fixed limit). But if you're suffering from some disease with no known cure, you could easily spend tens of millions trying hundreds of different procedures trying to find something that will work to mitigate the effects of the disease, and that's an ongoing cost that goes on forever until you're either cured or dead. Somebody has to decide which procedures are worth it or not, and if you're not paying for it yourself that "somebody" isn't going to be you, which creates lots of inefficiencies and is heartbreaking for everyone involved. This is also why we end up with systems such as "in network" and "out of network" providers, and government regulations intended to make things more fair at the cost of even more layers of inefficient bureaucracy. A few other thoughts: > If you are anti-socialism, cancel your healthcare and just private pay for your healthcare. Even for those who might be inclined to do so, this often isn't viable because of #2; they'd be leaving a bunch of free money on the table. I've also heard stories of some healthcare providers charging private individuals many times what they'd charge an insurance company for the same thing, though I'm not sure how common that still is today. > inserting a group of middlemen into an already expensive system is going to make it more expensive This is true, though note that government healthcare just replaces one set of middlemen with another.
- dragonwriter 2y ago
  > Yes, insurance is effectively a form of voluntary socialism implemented on top of the free market. No, its not. Socialism is when the working class exercises control of the (non-financial) means of production. Insurance is neither about workers qua workers or control of the non-financial means of production. Using disproportionate control of financial resources to sell risk-leveling as a service and therebu increase your disproportionate control of financial resources isn’t socialism.
TheGRS 2y ago
Simplifying the system should be the goal for lawmakers IMO. But that would never really get much traction. Getting care to people who need it has an obvious priority, so we layer more and more complexity over the current system.
User23 2y ago
Capitalism with transfer payments (the Nordic model) and socialism (Union of Soviet Socialist Republics model) are two very different things. Regardless of how we might wish it to be, it's an observable fact that the latter sense is how the word socialized is understood in the USA. And yeah, people rightly object to totalitarian control over their health care, whether it's by a government or a for profit cartel that has managed to achieve a stranglehold on medical payments.

sneed_chucker 2y ago

It's not that complicated. Healthcare is expensive, sure. It's made more expensive by allowing the private healthcare industry to operate in such a parasitic way. Americans and their employers pay an obscene amount of money to insurance companies every year for "health insurance". In turn, those companies use that money to employ people full time to find ways to deny people the coverage that they pay for based on technicalities. They do this so that they can pay people like Brian Thompson more money. It's a disgusting and immoral system that should not be allowed to exist.

lamontcg 2y ago
It is worse than that now, though, because they own doctors as well through Optum under the united health group umbrella corporation.

tim333 2y ago

>In the UK the doctor will see you in 5 years I get your point but for reality's sake the last time I saw a doctor, on the NHS in the UK it took one day. The service is a bit ropey but in strange ways.

nunez 2y ago

Yeah but many people wait months to see specialists in the US that will only give them 10 minutes of their time...

Latty 2y ago

The NHS is crumbling under a decade and a half of underfunding and intentional mismanagement to designed to prove it doesn't work by the Tories, and even then, it isn't as bad as you make out. There are 100% unacceptable wait times for some things and some procedures, but I'd take having an annoyingly long wait to see my GP over people I care about not having healthcare at all, and realistically it isn't as bad as you are making out. In 2022, the British government spent £3.5k ($4.4k) per person per year on healthcare. The US spent $13k per person per year in 2022, of which $6.2k was government (national+state+local)[2]. The UK government spends less per person than the US government on healthcare, even before the amount paid privately. Even if you think the UK's healthcare is worse than the US (which I fundamentally disagree with), you have an extra $2k to play with and do better than the UK before it costs more than the current system to the government, and then another $6k of extra tax before people would be more out of pocket than with private healthcare. Healthcare is complicated, all systems have flaws and all are vulnerable to being manipulated. None of that changes that the US has the worst system, run in the worst way, with the least efficiency. And that's without even getting to the obvious point that a country where people are healthier is worth paying for: my friends and family, colleagues, people I interact with being well, living longer, and not having diseases is very worth paying for and I want to be taxed to achieve that. [1]: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2022and2023 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan... [2]: https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet https://www.cms.gov/data-research/statistics-trends-and-repo...

nickff 2y ago
>"In 2022, the British government spent £3.5k ($4.4k) per person per year on healthcare. The US spent $13k per person per year in 2022, of which $6.2k was government (national+state+local)[2]. The UK government spends less per person than the US government on healthcare, even before the amount paid privately." The difference in medical spending is largely due to wage costs being much higher in the USA than the UK; healthcare insurance companies are not as profitable as it may seem (they're about as profitable as other insurance businesses). Pharmaceutical prices don't explain much of the difference either, because they’re only a single-digit percentage of healthcare spending (in the USA).

throwaway48476 2y ago

I'd add that the point of insurance is to pool risk for rare but costly incidents. Somehow we have a system where it also pays for foreseeable and very likely events. Of course supply and demand market competition breaks down in a non linear S/D case where there is no elasticity of demand. Ideally routine care would never be covered by insurance with full proce transparency like plastic surgery. Further separating health insurance from employment would drastically reduce the number of unique plans offered making it more efficient. It would also require public non profit manufacturing of drugs to reduce the cost.

nradov 2y ago
If routine and preventive care isn't covered by some form of insurance than low-income people won't be able to afford it at all. Some of those costs are inevitably going to be pooled. Generic drug manufacturers have very low profit margins. Switching manufacturing of generics to non-profit organizations would have very little impact on total healthcare system costs. If you're suggesting handing over ownership of patent protected drugs to non-profit organizations, well that would lower costs in the short term. It would also ensure the pipeline of new drug development is slowed to a trickle.
- throwaway48476 2y ago
  New drug development is largely funded by the government already. There are basically 0 new compounds on the market in the last 20 years. Most of the cost for drug development that is pricately funded is just dealing with regulation, not doing R&D. It is always economically more efficient to develop drugs instead of cures.
  - nradov 2y ago
    The vast majority of drug development costs are are in phase-3 human clinical trials. That's not just regulation, it's essential to prove safety and efficiency. The government provides very little funding for those trials. Stop making things up.

plugger 2y ago

No offense, but I find this comment ignorant at best and purposefully misleading at worst. I've visited emergency multiple times over the 20+ years I've been living in Australia. The first time I left with crutches, a casted ankle, and a whole slew of scans indicating it was just a serious sprain, not a bone break or tissue tear. I was almost out of emergency before I turned around and uncomfortably announced that I was leaving and yet hadn't paid for anything. A doctor came directly over, pressed the button for the automatic doors, and said "It's ok, this isn't America. You're free to leave, and you don't owe us any payment. Your taxes cover this." I have severe spinal stenosis. On Tuesday I had an EOS scan. $0. Last year I had both an MRI and CT scan. Both cost me nothing and were covered by the public health system. If I had these 3 scans done in the US without private health care I'd be out of pocket $10k or more.

marcus_holmes 2y ago
I've lived in a few countries and the Aussie system is by far the best I've used. I've also had that "so I've just come out of the doc's, how much do I owe?" at reception, only to be told "nope, you're good, see you in 3 months for your next checkup" shock.

bigfatkitten 2y ago

The U.S. spends much more money on health care per capita than any country on the planet, with far less to show for it. This is a uniquely American problem. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-...