At this point the fact that the whole friggin' rest of the OECD states have managed to come up with something less-broken and less expensive than what we do, and that AFAIK even the most "free market" and incomparable to ours demographically and geographically (e.g. Singapore) have done this with price controls and a "public option" or similar, is such easy-to-come-by and oft-repeated info that "gee I just don't know how this could work in the US" or "more government intervention can't possibly fix anything" can't be charitably interpreted. It's concern trolling or gross ignorance. Period. We've been talking about this for decades. The data are there. They're not hidden. It's not theoretical. Pick a demonstrated-to-work system and do it.
Singapore's system is not even single payer. Why is the only choice single payer or nothing? Also, if Americans could import drugs from abroad, that would greatly lower health care costs as the overseas drugs are made by the same manufacturer and are sold at 1/10th the price in India and elsewhere.
Yeah, there are plenty of non-single-payer ones that work. Probably it'd be safer to pick a system that works for a country more similar to ours (Canada, Australia, even France or Germany) but a Swiss or maybe Singaporean system would likely still be better than what we're doing. Singapore's odd and can do to-us-crazy (that is, restrictive) stuff to improve public health if they need to to keep costs down, so I'd hesitate to advance that as the best choice, but our system is so very bad that it'd probably still be better than sticking with what we're doing.
Price controls, public option, everyone must get insurance. Maybe outlaw for-profit health insurance. Those seem to be the basic, minimum common factors that make these suck less than ours, if you don't want to go single-payer or nationalized.
I'm in one of the other OECD states and I'd pick American healthcare over mine most of the time. You guys have so many more treatment options available.
Ours is the one where you end up with one hundred bills from a twenty different providers, fighting insurance & hospital billing departments for a hundred plus hours on the phone, and five-figures of out of pocket expenses for a completely normal pregnancy & birth of a child, if you've got decent insurance. It holds back entrepreneurship, and it threatens to take all the money you've saved up, at any time. Inheritance? The hospitals will get it before you do. Your savings for retirement? You're just holding on to it before the hospitals eventually get it. Maybe your kid gets seriously sick and then you just don't retire ever. Freedom! Choice!
It's a huge source of risk and anxiety even if you have insurance. The extreme budgeting uncertainty and stress are hard to put in dollar terms, but they're expensive, on top of what's already the most expensive system around, and getting more expensive at something like double the inflation rate. It's inhumane and unsustainable. If it blew every other system out of the water it might, might be worth all that, but it doesn't, so it isn't, at all.
Presumably you’d only pick it if you had insurance and income to pay for those services. Not if you’re one of 30 or so million without insurance, and I’m not sure how many million more who are underinsured and can’t afford the deductibles. So you can avoid ending up being one of the 40,000 or so Americans that die each year from lack of healthcare access.
Well, you still have to pay a bit out of pocket here. I've been unable to get asthma medication in the past due to cost. I've also had no insurance at all, because it's not actually universal. In fact, right now I've been without an inhaler for a while and won't have one for a long time to come. But I guess this would be no different in the American healthcare system.
I agree though that the American system makes people feel insecure, but on the other hand, you guys can get treated for things like ADHD much more easily if you can afford it.
All I'm trying to say is that it's not sunshine and rainbows in every other OECD country. It might be in others, but not mine.
I'm in one of the other OECD states and I'd pick American healthcare over mine most of the time.
I'm in one of the other OECD states and I'd prefer my health system to America's, any time.
A&E might be a pain the arse, sure, but an agonising life of medical debt - that I can't hope to pay-off any time in the near future - is a worse fate, I feel.
I don't think anybody is arguing that the US healthcare system is in a good way. It's preposterously overpriced. But people are peddling nonsense like "just extend Medicare to everyone" as if 90% of the excessive costs have anything to do with that.
We need to solve the actual problems, which is going to eliminate a lot of wasteful healthcare-related jobs, which makes it hard to do. But we still need to do that instead of proposing things that sound like they wouldn't do that but in practice would either do it anyway because it's not "Medicare for all" but "Medicare for all plus seven other things" and it's the seven other things doing all the work, or wouldn't do that and correspondingly wouldn't actually work.
"just extend Medicare to everyone" as if 90% of the excessive costs have anything to do with that.
> We need to solve the actual problems, which is going to eliminate a lot of wasteful healthcare-related jobs
Medicare for All virtually eliminates the private insurers, a significant part of waste in providing healtcare.
Private insurers are not a significant part of the waste in providing healthcare.
Their total profits are around 5% of premiums, which isn't even a dent in the problem even if you attribute no part of them to legitimate value such as taking the risk that actual claims will closely match actuarial expectations even when there may be unexpected events such as regulatory changes.
And their other costs are things that would either still be present with Medicare or provide legitimate value. One of the major costs is that they make consumers price insensitive, encouraging everyone to do unnecessary tests etc., which Medicare only makes worse. They also require doctors to do more paperwork, but the purpose of the paperwork is to reduce the incidence of those unnecessary tests and procedures and to defend against fraud. Medicare can eliminate those administrative costs by increasing the incidence of unnecessary test and undetected fraud, but that does not result in an overall reduction in costs.
Comments
At this point the fact that the whole friggin' rest of the OECD states have managed to come up with something less-broken and less expensive than what we do, and that AFAIK even the most "free market" and incomparable to ours demographically and geographically (e.g. Singapore) have done this with price controls and a "public option" or similar, is such easy-to-come-by and oft-repeated info that "gee I just don't know how this could work in the US" or "more government intervention can't possibly fix anything" can't be charitably interpreted. It's concern trolling or gross ignorance. Period. We've been talking about this for decades. The data are there. They're not hidden. It's not theoretical. Pick a demonstrated-to-work system and do it.
Singapore's system is not even single payer. Why is the only choice single payer or nothing? Also, if Americans could import drugs from abroad, that would greatly lower health care costs as the overseas drugs are made by the same manufacturer and are sold at 1/10th the price in India and elsewhere.
Yeah, there are plenty of non-single-payer ones that work. Probably it'd be safer to pick a system that works for a country more similar to ours (Canada, Australia, even France or Germany) but a Swiss or maybe Singaporean system would likely still be better than what we're doing. Singapore's odd and can do to-us-crazy (that is, restrictive) stuff to improve public health if they need to to keep costs down, so I'd hesitate to advance that as the best choice, but our system is so very bad that it'd probably still be better than sticking with what we're doing.
Price controls, public option, everyone must get insurance. Maybe outlaw for-profit health insurance. Those seem to be the basic, minimum common factors that make these suck less than ours, if you don't want to go single-payer or nationalized.
Free trade for me, not for thee.
I'm in one of the other OECD states and I'd pick American healthcare over mine most of the time. You guys have so many more treatment options available.
Ours is the one where you end up with one hundred bills from a twenty different providers, fighting insurance & hospital billing departments for a hundred plus hours on the phone, and five-figures of out of pocket expenses for a completely normal pregnancy & birth of a child, if you've got decent insurance. It holds back entrepreneurship, and it threatens to take all the money you've saved up, at any time. Inheritance? The hospitals will get it before you do. Your savings for retirement? You're just holding on to it before the hospitals eventually get it. Maybe your kid gets seriously sick and then you just don't retire ever. Freedom! Choice!
It's a huge source of risk and anxiety even if you have insurance. The extreme budgeting uncertainty and stress are hard to put in dollar terms, but they're expensive, on top of what's already the most expensive system around, and getting more expensive at something like double the inflation rate. It's inhumane and unsustainable. If it blew every other system out of the water it might, might be worth all that, but it doesn't, so it isn't, at all.
And yet the U S has a higher birth rate and more entrepreneurs than Europe. Can't be that bad.
What the hell do those have to do with health care?
Presumably you’d only pick it if you had insurance and income to pay for those services. Not if you’re one of 30 or so million without insurance, and I’m not sure how many million more who are underinsured and can’t afford the deductibles. So you can avoid ending up being one of the 40,000 or so Americans that die each year from lack of healthcare access.
Well, you still have to pay a bit out of pocket here. I've been unable to get asthma medication in the past due to cost. I've also had no insurance at all, because it's not actually universal. In fact, right now I've been without an inhaler for a while and won't have one for a long time to come. But I guess this would be no different in the American healthcare system.
I agree though that the American system makes people feel insecure, but on the other hand, you guys can get treated for things like ADHD much more easily if you can afford it.
All I'm trying to say is that it's not sunshine and rainbows in every other OECD country. It might be in others, but not mine.
I'm in one of the other OECD states and I'd prefer my health system to America's, any time.
A&E might be a pain the arse, sure, but an agonising life of medical debt - that I can't hope to pay-off any time in the near future - is a worse fate, I feel.
Sure, but the comment I'm replying to argued that all the other OECD countries are better at it than the US.
I don't think anybody is arguing that the US healthcare system is in a good way. It's preposterously overpriced. But people are peddling nonsense like "just extend Medicare to everyone" as if 90% of the excessive costs have anything to do with that.
We need to solve the actual problems, which is going to eliminate a lot of wasteful healthcare-related jobs, which makes it hard to do. But we still need to do that instead of proposing things that sound like they wouldn't do that but in practice would either do it anyway because it's not "Medicare for all" but "Medicare for all plus seven other things" and it's the seven other things doing all the work, or wouldn't do that and correspondingly wouldn't actually work.
Medicare for All virtually eliminates the private insurers, a significant part of waste in providing healtcare.
Private insurers are not a significant part of the waste in providing healthcare.
Their total profits are around 5% of premiums, which isn't even a dent in the problem even if you attribute no part of them to legitimate value such as taking the risk that actual claims will closely match actuarial expectations even when there may be unexpected events such as regulatory changes.
And their other costs are things that would either still be present with Medicare or provide legitimate value. One of the major costs is that they make consumers price insensitive, encouraging everyone to do unnecessary tests etc., which Medicare only makes worse. They also require doctors to do more paperwork, but the purpose of the paperwork is to reduce the incidence of those unnecessary tests and procedures and to defend against fraud. Medicare can eliminate those administrative costs by increasing the incidence of unnecessary test and undetected fraud, but that does not result in an overall reduction in costs.