Drlee wrote:It is quite clear why it is so expensive. Not difficult at all. Start another thread and I will explain it. (I am not being sarcastic.)
Feel free to PM me, but from what I recall the US spends like 2.5% of its GDP on admin costs... Which is a lot, actually, but then again its overall human healthcare spending is 17.7% of GDP, which is absolutely insane (easily the highest one globally... The second place stands at like 10% so that doesn't account for much of the difference).
XogGyux wrote:This is simply not true. Universal healthcare, for instance, is one of those things that Republicans like to use for fearmongering.
You wan't to know the dirty little secret... we have already "universal healthcare" of sorts, in fact we have had it for decades. If you have no insurance, you get into an accident and end up in the ICU... doctors don't throw you away from the hospital, you get treated even if your care cost 3m. Who pays for that? You'll get a bill alright, but chances are that if you were not carrying health insurance you won't be paying 3M USD. You might get thrown to courts and you might end up in bankrupsy paying a tiny percentage of the whole bill while you are bankrupt but who pays for the rest? Well, that is more complicated but the answer is a combination of government and a portion might end up being paid by private health insurance (when hospital charges $3000 for an MRI that really cost a couple hundred).
The problem with this system is that you lose on a lot, and I mean A LOT, of preventative medicine that you could address early on and not only improve quality of life for those patients but you could save real $$, money that could easily fund most if not all of the universal care.
I put this example on another thread. A patient with ESRD almost always end up getting medicare/medicaid and disability regardless of age. Just the dialysis for this patient would cost 50-70k per year that they are alive, but dialysis is not the only cost, to that add disability benefits? another 20-30k? to that add hospitalizations due to complications (these patients are sick, they get their fistulas infected/clotted, they get bloodstream infections, pneumonias, bleeding, electrolyte abnormalities) So add a few thousand dollars per hospitalizations as well. Surgical procedures? (e.i fistula creation, insertion of tunneled dialysis catheters, amputation of extremities, and many more). By the time you compile the expenses you end up with a number that is in the multiple of hundreds of thousands of dollars and in a few instances you could very well be talking about millions of dollars in costs per year. What are the 2 most common cases of ESRD? Well almost 2/3rd of cases occur due to Diabetes and Hypertension. Hypertension is super cheap to control, the vast majority of BP medication cost less than 100USD/year. Diabetes could be very cheap but it could also be a bit more expensive if the patient requires more sophisticated medications and/or insulin because their diabetes is hard to control, but in any case it is not going to be more than a few thousand dollars per year AT MOST, simpler cases could be similar to high blood pressure and cost hundreds and not thousands.
On average, the goverment could easily cover this cost for hundreds if not thousands of patients and just preventing one of those to progress to ESRD would pay for the whole program cohort, including medical consults.
This is just one simple example, you could do the same analysis for heart disease (the leading cause of death) and stroke.
Furthermore, it is not like there are not examples of countries to show this working. We see it working in most other civilized countries to various degrees of success and this idea that "we cannot afford it" is nonsense.
Insurance companies won't like it. Probably doctors won't be a fan either. The docs would likely need the same sort of liability protection that other countries offer and/or loan student aid given that in this country a doc might end up with half a million dollars in student loans while in many of the other countries their education is subsidized and/or free. The quality of life of a doc that makes less $$ but has no student debt, doesn't have to pay expensive liability insurance, is not crazy overworked with 20+ daily patient panels, etc has been shown to be similar between countries. As for the insurance companies... well they can go suck a dick, they have been leeching on people for decades.
Well, one question one may also ask is if the cost of these procedures is the same globally. One theory I've heard for why the hell is American healthcare so expensive is that Americans will tend to use the newest treatments available, and being the first adopter of anything is pricey - and new treatments appear all the time.
Other countries may use other older treatments with similar or very, very slightly lower effectiveness yet pay a LOT less. As such, their aggregate healthcare outcomes don't really worsen compared to the counter-factual in which they adopt the new treatment first, but the treatment itself is already way cheaper from the get go.
To the above, you can also add that the US has a de facto protectionist regime for pharmacological manufacturing through insanely stringent FDA regulations that essentially ban the imports of several medicines, even from countries with good regulations on the matter like Canada. That undoubtedly makes these more expensive as well.
Could these two institutional features help explain the issue?
XogGyux wrote:Anyhow, the US is in no imminent danger of getting "medicare for all" anytime soon. Most likely even if a "woke" president such as Bernie were elected, he/she might start with this plan of "medicare for all" in negotiations, and with any luck we get something like "medicare for more" or some Obamacare-like expansion or something like that.
Right, but that will happen because there may be many taxpayers who would not find tax hikes palatable. I'd be surprised (tbh) if it turned out no tax hikes were necessary to get an European-style healthcare system, particularly since the American tax burden is lower than in most European countries.
The real question, then, is if the "woke" wing of the Democrats would be able to accept it, or if it would try to force Biden and the party's hand. I think they'll do the latter, which will lead to an implosion within the party. And I think so because if they were nuanced, if they were moderate, I doubt they would have rioted (mostly) against Democratic mayors in the midst of this election, and I also don't think there would be any further riots that make Trump's election ads for him. If Trump wins, it will be their fault.
XogGyux wrote:Health insurance is tied to your work is ridiculous. When I left residency, since my contract did not start for a month I lost health insurance for 1 month. I looked into paying it myself... good lord it was $700 USD.... and the plan was crappy to begin with (since I am young I had a high deductible crappy insurance) I ended up just going that month without insurance, which is obviously a risk for me (not much because I am young and other than a bit fat nothing else, but a risk nonetheless, I could have gotten in a car accident or something). The problem is... if young people like me don't pay for the insurance to help subsidize the rest of the "sicker patients" that do use the insurance more... then you end up with companies that keep increasing their premium (or in previous times flat out declining to insure "sick people" AKA pre-existing conditions) that is why the "Obamacare mandate" as to encourage young people like me to buy into the insurance and prevent the crazy runaway effect of more and more "healthy" people not buying insurance. It is a crude solution but a necessary one.
That's weird because I come from a country (Chile) where private and public insurance systems coexist. There, you must choose one but you can opt to just take a public one (which isn't all that great) or have access to a very basic "just keep you barely alive" one that is also public (which is geared towards homeless people).
There, employers (often) don't offer insurance, it's your own responsibility to arrange that for yourself. That may sound nice, but if that happens employees may actually get a worse deal than if the company pooled everyone in and negotiated plans with insurers - although they'll still need to find an (expensive) alternative if fired.
XogGyux wrote:As for Green New Deal. People like to play the armaggedon "we gonna go bankrupt" kind of shit but this is also nonsense. What is green? Let's see, electric cars maybe? Tesla model S has a profit margin of 25% as compared to the traditional luxury (gasoline/diesel) companies like mercedez/bmw whose profit margin look more like 10%... or what about solar panels/winds/hydroelectric that in many cases end up being cheaper than oil with the added benefit that we don't pollute our lakes/rivers/beaches that could wreak havoc on our tourism/food industries. The fact is the rest of the world is embracing this... even china has built CO2 capturing plants and devices/plants that clean other pollutants (smog) from the air. Forget about having a pretty healthy earth, if you want our products to compete in a market that is embracing those "clean technologies" you need our country to start shifting our production.
I am a pragmatic even if a Tesla were to generate the exact same amount of CO2 over its lifetime as the BMW... if hippies in Sweeden perceive that they generate less and prefer to buy the tesla... I sure hope it is an American company rather than a german one that gets the sale.
Same thing with solar panels... if the germans are willing to pay for American solar panels/technology even if coal is cheaper who am I to opose ... Now, if we are not competitive because we have a government that constantly talking nonsense and fighting amongst themselves meanwhile the rest of the world's governments are quitely subsidizing and promoting their "green companies" we will lose any sort of competitive advantage.
Green energy is an opportunity to create new technologies that we hold patents and sell. Green energy is an opportunity to create high paying jobs. The environmental perks are just that, bonus
Here, a good taxation and/or cap and trade systems would probably be the best options.