A while back I had a sinus operation and reproduced the bill, which ultimately came to about $40,000, on these pages. Readers, especially those in countries with subsidized or government medical care, were astounded at the fees. Here’s another case like that.
A while back I had a 6-week-long gastric infection of unknown provenance. It lasted so long, and was so resistant to antibiotics, that I had to have three stool samples analyzed (pardon my indelicacy). I was dumbfounded when I got the list of costs for the first one, which was over $1200. Although I have medical insurance, I had to pay more than a quarter of that because of the “deductible” (an upfront fee you pay the first time you get medical care in a given year).
I have now received the bill for the second sample (the details of the analysis may interest those doctors among the readers). The bottom line is that my insurance company was billed $1357.00, though, as you see, I had to pay just $138.93 of that. The rest is paid by my insurance carrier.
The upshot is that these costs seem unconscionably high. The total bill for all three samples will come in at $3600 or more! Let me note that my doctor is superb, and did his best to diagnose what affected me (it was never found, but was probably a virus), and that my university has a good medical plan for faculty. But still. . . .
This is symptomatic of the spiraling medical-care costs in the U.S. I don’t mind paying my share to subsidize those who can’t afford proper medical care, but something seems badly amiss in the U.S. if it costs $3600 to search for a bacteria or protozoan.
This is especially apposite given the current fight in Congress, where Republicans are opposing “Obamacare.” And many Americans agree with them that it’s “socialized medicine.” Well, we already have socialized medicine for older people—it’s called “Medicare.” And we have socialized retirement, which is called “social security.”
It’s time America got over this stupid fear of “socialized anything.” We’re one of the few First World countries that is resistant to government-sponsored health care for non-retirees, and it’s embarrassing. Socialized medicine does not equal Communism.
Now have a gander at this:
I could genome-sequence your parasites for that money.
I was about to say. For $1218.07, you could Illumina-sequence the bejeezus out of that stool sample, including bacteria, viruses, and a good portion of the host genome (=JC).
The host genome could probably be auctioned off for a decent profit. I wonder who would bid for that genome, and why.
A MiSeq run is still a lot less than the culture or pcr-based methods that are typically used to diagnose, or fail to diagnose in this case, the cause of the infection. That doctor bill is a good example of a case of missing accountability.
Analogous that faith is a character flaw instead of a virtue, socialized medicine is a good thing instead of a bad policy. Boehner and Cantor are lying through their teeth ( which our taxes pay for 100% for THEIR healthcare).
Phrased correctly, no one is really against “Obamacare.” Just ask them: “Should YOU be able to get insurance even though you have a pre-exisisting condition? Should insurance companies be able to set a cap on how much is spent on YOUR condition?”
Oddly enough, there seems to be a third of the country willing to deny… well, almost anything (abortion, marriage, the right to be an atheist and run for office, whatever) but still think EVERYTHING should be available to THEM. Due to their special circumstances.
Indeed, abortions are the same. See “The only moral abortion is my abortion.” at the link. Too many people think they must stop others having what they have.
http://mypage.direct.ca/w/writer/anti-tales.html
Very true. My ex-wife was anti abortion when we were married but has since had two according to my daughter. I was thinking about this subject recently and realised that two of my girlfriends had had abortions (previous to my relationships with them), one of their mothers, and I suspect my own mother.
The book “Freakonomics” includes an analysis of abortion whys and wherefores. The author concludes that women have abortions because they feel that they will not be able to give the child the upbringing it deserves, for one reason or another. He points particularly to certain crime rates that declined in sync with the legalization of abortion in various states.
PS: Not that I’m a great fan of “Freakonomics”. It came across almost as a kind of personality cult focused on the author, and it confined itself mostly to specific analyses, not general principles. Interesting, but no guide to improving one’s own thinking.
The real question is how much did your insurance company pay. They do not pay the list price – typically they pay about half. But if you do not have insurance, the hospital will come after you for the full list price. What a country!!
The explanation of benefits letter you get from your insurance should state what amount insurance forked over. What the hospital gives as its list price for that procedure is indeed even more capricious, and someone without insurance would typically get shamelessly ripped off.
Both Time magazine and New York Times have done stories that even insurance companies are complacent about what they get billed by hospitals. It’s easier to just pass on the costs to the companies/patients they contract with. So why doesn’t anyone cry foul? Well, because there is a deliberate and calculated obscurity about what you get billed for and what it’s true market value is.
There is an exception to this: Medicare. They are the only entity that rolls its sleeves up and trawls all the medical complexities to determine what is fair reimbursement for a procedure. And even that up to a point because the bulk of procedures performed are superfluous. Indeed a macroanalysis of medicare billing shows the higher the relative costs of a health provider for a given condition, the worse a patient outcome!
Is this a new revelation? Not at all. The esteemed economist Kenneth Arrow had decades ago demonstrated that a purely capitalist approach to healthcare is futile. For one, consumers would need to fully understand the nuances of each medical step and practice to determine its fair market value. Hardly the best premise for the function of a country’s most critical social obligation to its citizenry. National defense is one area exempt from unbridled capitalism. Everyone from left to right accedes that much. It’s just a plain fact of life that healthcare is even more deserving of such an exemption. When it comes to health, socialism is just what the doctor ordered. And Obamacare, my friends, is only a nominal regulation of an out-of-control capitalist market. We need a complete overhaul in the form of a single payor system – at the very least. We need Medicare-For-All.
I have now received 135 email posts about “The absurd cost of American Health Care” alone, which have caused me to want/need to Unsubscribe from WEIT please.
I’ve tried repeatedly to “Modify my Subscription” but to no avail.
Can the moderators please remove my name/email address from your system?
Fraternally and sororally yours,
Stafford Gordon.
I have no ability to unsubscribe somebody who’s subscribed. Perhaps other readers can give advice.
Another admin matter: what address does one use to start a new thread, or submit a cat picture, etc.? Is there a basic WEIT address?
Click on “Research Interests” at the top right of the page and you will go to a page with Jerry’s email address.
Got it ( under Ceiling Cat). Thanks, Jesper:)
Anytime. 🙂
Is it Jesper or Gesper or Yesper ( yum pin’ Yimenee!)?
Soft j so it’s yesper, but I answer to all varieties including the Spanish hesper.
Oh, yeah, I forgot the Hesper version. I get a kick out of my Colombian friend who writes JA JA for ha ha ( not sure why my iPad chose to capitalize the JA…)
A Mexican colleague used to say “jello” for “yellow”.
I have heard that yellow for jello. Wonder how they’d say yellow jello?
Hehe… I worked in Spain a few years back and it took me a couple of days before I realized they were pronouncing my name when they said hesper. I’m sure some of them must’ve thought I was a bit thick.
You mean je je:-). ( the French would think you were full of yourself: me me)
🙂
At the bottom of one of the emails should be a link that reads, “Want less email? Modify your Subscription Options” with “Subscription Options” as the link. Click that & it will take you into a Web page that allows you to remove subscriptions by hovering over the various linked subscription on the left and getting the “Delete” option in red.
Reblogged this on Critical Thinking – A World View.
In my plan, co-payments don’t count toward the deductible. It makes no sense at all. In July I got $340 worth of prescriptions and insurance only paid about $40 of it. And I’m on the “low-deductible” plan! Prescription payments don’t count toward the deductible for medical, only for prescriptions. And the vision “plan” only pays for single vision lenses. So only young people are happy with that one!
Services are over-charged precisely *because* insurance companies are picking up the bill, so they know there will be no downward pressure on costs from end-users (i.e. patients). Insurance companies in turn known that their insurees have no choice but to be insured, so don’t mind. So you end up with a system that costs twice the GDP percentage that it does in countries with government-run health systems, but you cover a smaller percentage of the population (i.e. less than 100%). Where does all that extra money go? Into the pockets of the insurance industry, the inflated profits of medical service industries, and the extraordinary salaries of the elite class of medical professionals. The costs are out of control, but opposition to change has been so fierce because the system has created powerful vested interests with deep pockets.
If Americans don’t mind me saying so (and I say this as an Americophile Brit), there are three topics on which Americans simply cannot think sensibly, namely guns, abortion and health care.
Even Biblical literal creationism is relatively sane by comparison!
(Readers of WEIT are of course exceptions to the above rule.)
If Americans don’t mind me saying so (and I say this as an Americophile Brit), there are three topics on which Americans simply cannot think sensibly, namely guns, abortion and health care.
I don’t mind you saying so, but I think you’re very, very wrong.
I suspect you have a highly inaccurate understanding of what Americans think about these issues, anyway. On abortion, for example, there is overwhelming evidence that most Americans support a broad right to abortion. You really think that means Americans “cannot think sensibly” about the topic?
Overwhelming evidence that most ‘murkans support a broad right to abortion? Really?
I’d like to know just one shred of that evidence. I’d also like to know why many states are left with only 1 location that provides abortion services in the entire state… and those places are the most inaccessible to most of the state’s population.
Abortion services are under severe threat just about every state. Planned Parenthood has also been “de-funded” in many states because the right-wing goons and their god-fearin’ supporters believe that abortion is all that PP provides.
What evidence do you have for this claim?
Most ‘murkans cannot think sensibly about the topic. This I’m 99.9% confident.
When I was in grade school, we were told we’d be learning the metric system. (Because it was sensible and the rest of the world had it.) We were in fear of *that.* (And never recovered.)
I’d like to know just one shred of that evidence.
40 years of polling data and election results and law. Abortion law in the U.S. is among the most permissive in the developed world. Roe v. Wade effectively guarantees the legal right to abortion on demand through the end of the second trimester of pregnancy.
Abortion is being systematically being hounded out of existence by laws and restrictions and protests, and yes, murder. We live in a climate where it’s *perfectly acceptable* to boast that your state killed the previous “baby-killer” and it shouldn’t be that hard to get rid of the one remaining…
I’d also like to know why many states are left with only 1 location that provides abortion services in the entire state
I think you need to check your facts. As far as I’m aware, only one state (North Dakota) has only one location that provides abortion services. And the main reason for that is that ND’s population is too small to support more than one location. There are only 700,000 people in the entire state. About 0.2% of the U.S. population.
According to this article, there are 4 states (North Dakota, South Dakota, Arkansas, Mississippi) with only 1 abortion clinic.
http://usnews.nbcnews.com/_news/2013/01/21/16624980-40-years-after-roe-v-wade-more-states-restricting-abortion?lite
Mississipi has a population of 2,984,926 according to the US census. Here’s a story about that clinic.
http://abcnews.go.com/US/inside-mississippis-abortion-clinic/story?id=19136825
@ Gary W: Coel talked/wrote of three topics on which Americans cannot think sensibly. In your answer you only mentioned one, abortion. I am Canadian and I agree with Coel. Can you address the other two,guns and health-care, please ?
@John Perkins: Funnily enough, if you read some more of his posts, you’ll find that Gary serves as an unintentional example of exactly the point made by Coel.
Services are over-charged precisely *because* insurance companies are picking up the bill, so they know there will be no downward pressure on costs from end-users (i.e. patients).
Health insurance is a market. Health insurers compete to provide coverage to customers. A health insurer who provides a given level of coverage at a lower price than his competitors has an advantage in the market. That exerts a downward pressure on costs, same as for any other type of insurance.
Where does all that extra money go? Into the pockets of the insurance industry, the inflated profits of medical service industries, and the extraordinary salaries of the elite class of medical professionals.
Do you have any evidence that the health insurance industry and “medical service industries” make wildly disproportionate profits compared to other industries? Have you looked at the profit margins in, say, the tech industry? Apple and Google, for example, are enormously profitable. If you find big profits so objectionable, why aren’t you complaining about that?
Because if I can’t afford a new iPad, it doesn’t mean I will die from the lack, or be financially ruined if I am forced to buy one. An iPad is a luxury item, and health care is, according to the rest of the civilized worlD, a basic human right.
http://www.advisory.com/Daily-Briefing/2013/06/06/Pay-for-health-care-CEOs-exceeds-all-other-industries
http://www.fiercehealthfinance.com/story/highest-paid-exec-healthcare-earns-145m/2011-12-16
http://www.huffingtonpost.com/2012/12/11/ceo-worker-pay-ratio_n_2259233.html
Ginger, I’m sorry…I’m a doctor, and you DON’T have a right to my abilities, anymore than I have a right to come into your house and raid your refrigerator because I’m hungry, or sleep in your bed because I need shelter. I’ve given lots of free medical care to people, and have never been wealthy. You certainly have a right not to have someone willfully or willingly IMPAIR your health, but I don’t see how you have a right to have anyone care for your health at their expense (or at that of any other unwilling individual). I’ve saved quite a number of people’s lives, and I don’t think that <> have a RIGHT to have health care. You’re saying that, precisely because what the medical profession provides is SO important, that they should be rewarded LESS than those who provide luxury items. I don’t quite follow the logic. I’m betting that if you claimed a right to your plumber’s services or your auto mechanic’s services, because you desperately needed the services they provided, they’d happily laugh in your face.
Now, the medical professions’ willing (and greedy) abuse of systems like Medicare, especially when it first came on line, have contributed inestimably to the overgrowth of the costs of healthcare. So have the abuses by the insurance industry…and both industries have powerful lobbies, there’s no doubt about that, and they have contributed to inappropriate inequities in the system and hidden costs/charges. There’s so much baggage in our healthcare system that sometimes I think we should scrap ALL of the programs and start over at the beginning…I don’t know what the best answer is, but a person cannot have a right to have their health care provided by others at someone else’s expense anymore than a person can have a right to have their religious (non)sensibilities given special precedence despite the fact that it interferes with the rights of those who do not share the religion.
It may be more PRACTICAL to have government- subsidized medical care; it may be better overall for society, and lead to greater health and prosperity for everyone–it may not, but there’s reason to suspect that it IS a good way to do things, just as it’s more practical to have government in charge of setting up interstate highways, and police forces, and so on. Likewise, I think that, if government does cover those services for anyone, it’s probably only ethical that it make them available for everyone–there’s no restriction on who can use highways, whether you’re rich or poor. But just as police officers and highway construction workers and so on all deserve appropriate compensation, so do healthcare providers. If the services provided by healthcare providers require more training, are more sophisticated, more scientifically advanced, and address more difficult to understand and address problems–like prolonged idiopathic gastroenteridites, the likes of which could easily have killed Professor Ceiling Cat in the pre-modern-medical era–then it makes sense that they be paid well.
I don’t think there’s any easy answer. America has a complicated history, and the problems and inequities are many…and personally I think that ANYONE who makes a profit greater than they could honestly have made by misleading purchasers, by coercing them (through political, social, or employment pressures, or straight trickery, including overbilling insurance companies, or ordering unnecessary tests, etc.) should be considered and treated as thieves (since that IS what they are, not businesspeople, nor professionals) and subject to the same treatment we give muggers, bank robbers and car thieves. Just as more rarefied and crucial services deserve better compensation, so those who commit crime at HIGHER levels and with greater costs than lesser should be treated MORE harshly, yet our culture treats them barely as criminals, if at all. Changing THAT attitude might change a great many things for the better. Yeah, I know…good luck with that.
Okay, well…that just went on and on, didn’t it? Sorry.
okay…accidental italic use…my mistake
(or perhaps I should say malpractice?)
Eugene.
You certainly do deserve to get paid for your efforts but I hope you understand that in the US you get paid more than in other countries.
http://www.worldsalaries.org/generalphysician.shtml
That being said Doctor salaries are certainly NOT the main disparity nor would I suggest they are.
Doctors in Canada and the US don’t get paid drastically different. Yet for some reason the American system is 2x as expensive.
Also I don’t think it’s a matter having the government subsidize. The government in reality needs to control costs. Set reasonable values.
Afterall what price would you pay for a life saving surgery? Most people would pay everything they own and several often do. But they shouldn’t have to and other countries they don’t have to.
People should be expected to pay a reasonable price based upon the expenses and time spent.
Not based upon how much they value there life, there leg or there health. there shouldn’t be a price on these things.
I remember one of my flatmates (errrr, apartment sharers? I’m not sure what the American is, if the idea exists there), when I was in my finals year had the explicit aim of completing his medical education (paid for by the government, with a government-funded living allowance, and with all tuition fees paid by the government) and then immediately decamping to go and set up in practice in America in order to make lots and lots of money. Which I thought was absolutely despicable theft from the tax-payers of the UK, and the sign of a thoroughly immoral person. Probably not the best attitude to be taking into the caring professions.
We generally call them roommates even if not actually sharing a room. Also housemates.
Yeah, I’d always been a bit suspicious of that “roommates” word with it’s horrible privacy implications. But the alternative “housemates,” in EN_GB, has an implication that you’re both, or all, contributing to a joint mortgage.
But neither language is particularly stable on the question. Because social mores are changing pretty rapidly.
“I’m sorry…I’m a doctor, and you DON’T have a right to my abilities,”
I find that an incredible statement. In this country (NZ), we tend to think *everybody* has a right to a reasonable standard of healthcare. And if you (as an individual doctor) don’t want to provide it we’ll just find doctors who do.
This doesn’t mean we think doctors should be underpaid. But it does mean we believe in a functioning public health system. (And of course there are debates about how well it works).
“And if you (as an individual doctor) don’t want to provide it we’ll just find doctors who do.”
On second thoughts that sounds unduly harsh and is probably reading too much into your comment, particularly in the light of the rest of your post. Please ignore that sentence.
I meant to post this here.
I have to consume health care. I don’t have to buy and IPhone. Get it. There is a huge difference.
You don’t “have” to consume a particular health care product or service any more than you have to buy an iPhone. And why is this a “huge” difference with respect to the issue of profits?
No one has provided any evidence that health care-related companies are making wildly disproportionate profits, anyway.
You do not choose to be sick.
You can choose not to buy an Iphone.
Get the difference?
You don’t seem to have read my question. Here it is again: Why is this a “huge” difference with respect to the issue of profits?
Because people get sick and need treatment regardless of potential economical profit scenarios.
Speaking of profits, how big an income should a good healthcare system make in a year in your opinion?
Because people get sick and need treatment regardless of potential economical profit scenarios.
So what? People need housing and clothing and food and jobs and lots of other things too. Are you proposing to eliminate profits from those products and services too?
And your comment doesn’t make sense even when limited to the health care industry. Even if we eliminated all for-profit health insurance, the rest of the health care industry — drug companies, hospital builders, medical equipment suppliers, etc. — would still be making profits anyway.
If you seriously believe that making profits from the provision of health care is a bad thing and should be eliminated, then the legal and economic changes you would need to make go far beyond eliminating profits from health insurance.
You didn’t answer my question, and I’d ask you to read my comment again. I’m not suggesting that a healthcare system( the providers of medical treatment ) aren’t allowed to make a profit.
I’m suggesting that profit is not necessarily compatible with the treatment of diseases.
Gary.
There is a simple argument about this.
In the case of Healthcare the DEMAND is always in excess of the supply. People will pay anything for there health.
Even John Adams said that medical services should be regulated.
America has the HIGHEST healthcare costs on earth. With some of the lowest results in the G20.
The amount the American government pays per capita is more than the government and private portions that individuals pay in Canada.
People make profits in other countries as well.
the only difference is the people profit as well.
No but you do have to consume health care of some sort unless you are extraordinarily lucky to never get sick. The same is not true of Coca Cola.
But they are making unnecessary profits. If medicare were available for all, the cost of health care would shrink immediately by the fact that medicare premiums are less than for insurance companies. Why does everything have to be reduced to a commodity. It’s like some sort of bad Ayn Rand novel. What is so precious about preserving the existence of private insurance companies. Is it in the constitution?
My prescription medicines are $15 a day for two generics and one brand name drug – that’s the copayment on a high-deductible insurance plan’s “negotiated rate”; it’s substantially less than the out-of-pocket cost that I’d pay if I was uninsured.
I’ve had a severe disabling lung disease for 30 years and don’t consider these medications “optional” in the way that an iPhone is.
And for a maintenance drug that costs $10 per day, SOMEBODY is making a handsome profit.
No but you do have to consume health care of some sort unless you are extraordinarily lucky to never get sick.
Except in rare circumstances, you don’t “have” to consume either health care in general or any specific kind of health care product or service. People are routinely denied lots of health care services because they can’t afford them or because their insurer or government refuses to pay for them. For example, it appears that the UK’s National Health Service refuses to provide the most commonly requested cancer drugs. But if you live in Britain and can afford to pay for the drugs yourself, you can get them.
But they are making unnecessary profits. If medicare were available for all, the cost of health care would shrink immediately by the fact that medicare premiums are less than for insurance companies.
I have no idea what “unnecessary profits” is supposed to mean. How are you distinguishing “necessary” profits from “unnecessary ones?” Virtually all health care products and services involve someone making (or trying to make) a profit, even in countries with “socialized medicine” like Britain and Canada. Drug companies make profits, medical equipment suppliers make profits, hospital construction companies make profits, health care staffing agencies make profits, and so on. Unless you propose nationalizing the entire health care industry (do you?), someone is going to be making a profit from the provision of health care.
I’m still waiting for someone to show that ANY part of the health care industry involves wildly disproportionate profits in comparison to other industries.
Health care is evidently not a market, at least not like laptops. Laptops consistently go down year by year and perform better, while health care consistently gets more expensive without proportional increases in results. Something is clearly wrong here. Why is the invisible hand not working properly here, if our free market health care system is so great.
The answer, naked unregulated greed all the way down from doctor fees to insurance fees. One simple solution is negotiated uniform rates for all services like they do in Japan. That could please libertarians while solve the cost problem at the same time. Of course it’s too sensible so it ain’t gonna happen ever. It works in Japan, and it ain’t socialism.
The profits aren’t wildly disproportionate to at least two other industries – Banking and Oil Companies, which are also driven by unregulated greed. So I’ll grant you that one.
Here’s a quick link to show an example of naked unnecesary greed. Japan mandates MRI cost so a neck MRI costs $98 versus $1500 in the US due to negotiated rate controls in Japan. If you can explain to me how this isn’t pure naked unnecessary greed, I’d like to hear it. It would be interesting to compare some of the costs for Jerry’s treatments he describes with similar costs in Japan. Bet we’d find the exact thing going on.
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778_pf.html
Oh, nonsense!
Medical care often deals with life-or-death matters. Are you saying that even though that cancer you have will kill you, you don’t have to get treatment?
Very concise.
Vested interests are killing Americans, or at least forcing a system where they die.
This is what I call “industrialized medicine.” and it became the reality with the formation of HBOs. Today in Des Moines there is “the medical mile,” as I call it, where all manner of specialized doctors and staffs work from new, very expensive buildings with very expensive equipment. Referrals are the standard way of keeping these specialists busy. So first one sees a general practitioner who, when a simple pill won’t do the trick, refers one to the appropriate clinic. Allergies have a clinic, OB/GYN has a clinic. X-rays have a clinic, minor surgery has a clinic and on and on. All must be fed a steady diet of referrals. My former GP seemed to know just about everything necessary to take care of everything but surgery (and he carved out skin cancers in his office)
As an academic I had good insurance until I retired and then I slipped effortlessly into Medicare. Medicare has its flaws – overwhelming paperwork being one that I (thank goodness) don’t have to deal with. My wife is not even close to 65 so she has been going without insurance and paying with a credit card (for which she usually gets a reduced charge there being no endless paperwork involved). We can only hope that socialized medicine is soon up and running. The lack of a “single payer” system is a gaping flaw that may have to be fixed if a plague iradicates Tea Party nihilists. My niece now lives in Denmark – cradle to grave socialized medicine for all. No complaints from her.
And yes, you and I know what it takes to plate out bacteria. Would that I had over a thousand dollars for each Petri dish I have worked with (and perhaps that would cure part of my grumpiness).
Mike
The lack of a “single payer” system is a gaping flaw that may have to be fixed if a plague iradicates Tea Party nihilists.
Single-payer health care systems tend to suffer from shortages and rationing. The British National Health Service is probably the clearest example. In general, markets are a better way of matching supply with demand for goods and services than central government planning.
Japan has an interesting system that is completely private. It works because they have a book which mandates how much health providers can charge for a given service. Results- MRI’s, hospital room charges are drastically less that the US -look it up. And no – MRI manufacturers and hospitals are not going out of business. Private systems can work, but they must be regulated. Our largely unregulated system even under Obamacare is a disaster and a prime reason for the high costs. Also note that medicare overhead is drastically lower than a typical insurance company overhead.
The difference between health care and Apple profit. I have to consume/use heath care – I don’t have to buy an IPhone. A distinction with a huge difference.
Japan also has an indecently large number of hospitals. In the process of pursuing other interests, I’ve spent a lot of time the last six months peering at Google maps of various Japanese cities. They are liberally sprinkled with little red crosses in shields denoting hospitals.
Doesn’t Japan also mandate that everyone subscribe to private medical insurance?
According to the Wikipedia page on US healthcare, the WHO stated that the USA spent more per capita on healthcare than any other nation. A Bloomberg study in 2013 ranked the USA 46 out of 48 nations on efficiency. A market system might be best, but your market system sucks.
Furthermore, the British NHS has its faults, but everybody is entitled to healthcare and nobody gets bankrupted by getting sick.
The fact that the U.S. spends more per capita than other countries certainly does not mean that government planning would do a better job at matching supply and demand. Rationing and shortages in countries with single-payer health care systems suggest that such systems do poorly at matching supply with demand.
In general, richer countries tend to spend a higher fraction of their GDP on health care than poorer ones. And as countries get richer, the share of GDP they devote to health care tends to increase. Once people reach a certain level of material wealth, the relative value of good health and longer life increases, so they’re willing to devote a larger share of their wealth to those goals.
Gary the fact that American’s pay more than 2x than anyone else indicates that the government could probably do better. They can also negotiate massively reduced rates and costs for medicines.
And FYI. EVERY OTHER single payer, or joint system besides Britain indicates that it is better.
In short comparing yourself to one of the lower ranked systems with some of the larger problems is a DISHONEST argument.
Most people who want to make an HONEST argument would try to compare themselves to the higher ranked systems instead of relying on peoples ignorance of different countries to make an argument.
sub
That was evident when the royal baby was born in England recently. The birth (in a chic private hospital) cost less than half an AVERAGE birth in the US.
http://www.huffingtonpost.com/2013/07/25/birth-costs-_n_3653256.html
My housemate has been travelling recently in the US and had to have an ultrasound. The cost for this, absurdly, came to $5000. Being British and entirely unused to this he flat out refused to pay and negotiated a %40 reduction. The notion that you can negotiate for something as crucial as healthcare is abhorrent to me.
Incidentally he wasn’t quoted any costs up front and so couldn’t compare prices. So the system is rigged and unfair in pretty much every respect.
The lack of pricing up front is what really gives the lie to the claim that the US has “free market” health care system. What kind of market can operate without known prices? What other things do you purchase where you do not even learn the price *range* until long after you’ve purchased the service? And whatever other limitations there are of markets, and there many, the one thing you should at least be able count on a functioning market for is lower costs. These may often come at the expense of other important externalities but, by god, you get low costs. But we don’t even get that out of our supposed “free market”. We have some monstrous chimera of a system that is ill adapted to anything except gobbling up more and more of the economy.
“…So the system is rigged and unfair in pretty much every respect”
Just the way the Republicans want it – give corporations everything and screw the consumer.
Unfortunately, many Americans fall for their lies and bullshit.
Oh dear, always take out travel insurance when traveling esp to the US.
Yes, I remember having to fork that out when I went to a friend’s wedding there. The medical insurance was something like a quarter of the total cost of the trip. Fortunately I don’t forsee any reason to return there, as the aforementioned friend has escaped to the Netherlands and more recently back to the UK.
In the UK we have the original National Health Service; the operative words being: National, Health, Service.
And albeit it’s initiator Aneurin Bevan had to, aprospos of the Doctors, “Stuff their mouths with gold”, it has hugely benefitted our nation.
You “Yanks” need to wake up to the fact that there’s more to life than “a lousy buck” : coutesy of Budd Schulberg.
Your National Health Service seems to be doing a rather poor job, as illustrated by, for example, Britain’s very low international ranking in cancer survival rates.
There is always rationing. There is either rationing by the ability to pay (our system) or rationing due to a collective decision to regulate both health care costs and mechanisms for deciding how to treat people (most of the rest of the world). I contend the latter is preferable. Besides if you can afford it, in either system you can still buy better treatment, but the latter as a whole is a far superior way to go. It depends ultimately if you think access to at least adequate medical care is a right or just another market commodity like Coke or IPhones.
There is always rationing. There is either rationing by the ability to pay (our system) or rationing due to a collective decision to regulate both health care costs and mechanisms for deciding how to treat people (most of the rest of the world). I contend the latter is preferable.
You may prefer it, but most Americans don’t seem to. And as you acknowledge, rich people in both Canada and the U.S. (and all other countries too, in fact) have access to better health care than poor people. Even within Canada’s Medicare system, there are large disparities in access, depending on where people live and how much money they have.
I disagree. I think the majority of Americans would prefer a single payer system to Obamacare. What is lacking is political will. Note that a significant minority of people opposed to Obamacare, like me are people who think it doesn’t go nearly far enough, not that many parts aren’t good, or health care should be scrapped entirely. Health care costs were something like 2% of GDP in 1960. Now they are ~17%, compared to ~8% for most industrialized “socialized” systems. Going back to pre-Obamacare, if it happens will prove to be unsustainable, and will be rejected one way or another by the public. I predict we will eventually move toward some sort of single payer system eventually, or we’ll retreat and the high costs of medicine will simply bankrupt us, and then we’ll adopt some sort of socialized medicine. In either case, the former is better, but one way or another we’re not going backwards because we can’t – it’s unsustainable.
@ Gary W:This is absolute nonsense about Canada. I live in an isolated village of 1400. It has a hospital and I have had a stroke and a congestive heart incident. My health care has not cost me one red cent – I have been transported to a cardiac facility 200 kms away twice by ambulance in the last 10 years – once by road and once by air completely free. You really should acquaint yourself with a few facts before posting!
Yup! I agree. My dad who lives on government retirement now so he certainly is not rich, just had cancer surgery with a very skilled thoracic surgeon, spent 3 weeks in hospital recovering and had a nurse visit him post surgery (because he had a feeding tube into his stomach). He also had follow up visits to his surgeon and his other doctors (including one for blood). He also received immediate attention so this rumour that you wait forever and die in Canada is a load of crap (in case someone is going to bring that one up) and I think he had his tests, MRI and surgery within weeks of being diagnosed. He paid nothing for all this.
My mom also had a seizure a couple of years ago and was taken in and saw a neurologist within hours. She had follow up appointments within a week for treatment.
My dad was transported by air ambulance from his small town to the nearest major hospital by the ‘system’ for no fee. He wasn’t put on a waiting list for the MRI or the operating room when he arrived.
The lies and propaganda about Alberta’s health care spread about by some people in the US are shocking.
I had an MRI and a few other scans when I had daily migraines. My neurologist scheduled them and I waited only a few weeks for totally non life threatening scans (though I really wanted them because of my pain). I agree, there is crazy propaganda. My dad is always dispelling it to his friend (a conservative and ex-military guy – but a total teddy bear) from Arizona.
Yep, I’m a Canadian who lives in a very small town. I have no problems with access to treatment. I think our health care system is amazing.
You’re another one who thinks that a personal anecdote somehow establishes a general pattern. You’re simply wrong. Numerous reports by the Canadian government have acknowledged that there are large disparities in access to health care depending on where in Canada someone lives and how much money they have. Rural areas have fewer doctors and nurses per capita and more primitive medical facilities. Rich Canadians are more likely to live in wealthy urban areas with the best facilities, are better able to travel to receive health care services, and are more likely to be able to afford to buy health care services outside the government system (including by traveling to the United States).
See, for example, this report for more details.
Your a person who thinks that strongly worded statements based on a complete lack of facts and information constitutes an argument.
I hate to tell but I think Canadians know more about there system than you do.
especially since there/my system ranks higher than your in almost every category and we pay almost 50% of what you do on average.
and FYI poor American’s often STEAL from the Canadian system because they can’t afford healthcare in Canada.
So continue with your one off stories and cherry picked stats all you want.
The rest of us who are part of the SKEPTICAL movement will use the all the facts.
…so this rumour that you wait forever and die in Canada is a load of crap…
You really ought to try doing some research before making this kind of dogmatic assertion.
Longer surgery wait times lead to higher death rates
Gary – I’m a Canadian who lives with a bunch of other Canadians. I have more than one story. I’m also familiar with what crap gets propagandized in the US as fear tactics because I have American friends and family. I’m not wrong and my experiences are more than anecdotal. I’m not going to engage with you on this because you are too frustrating a person to argue with and the back and forth goes on far too long.
There’s no sense in arguing with Gary. You won’t get anywhere because he’ll never concede a point and will never change his mind.
my god what a pathetic article.
It uses a hip replacement stat. (Is a broken hip life threatening???????)
Than says that people who wait too long die. (well DUH), this is none statement.
WHY DIDN’T THE ARTICLE COMPARE SOMETHING DEADLY AND SAY THAT.
The report contained information on all sorts of things. WHY DID THEY IGNORE all the life threatening problems? Why did they focus on something only affecting seniors?
In short because they couldn’t find anything life threatening that would support there view point and senior caste a lot of votes.
Gary you need thin THINK about what you read.
“Your National Health Service seems to be doing a rather poor job, as illustrated by, for example, Britain’s very low international ranking in cancer survival rates.”
Cheery pick much? All health care systems have weaknesses. Picking on one particular area doesn’t negate all other areas. For example:
http://www.telegraph.co.uk/health/healthnews/8877412/NHS-among-best-health-care-systems-in-the-world.html
And even the weaknesses are being addressed:
http://www.commonwealthfund.org/Newsletters/International-Health-News-Briefing/2010/November-2010/United-Kingdom/New-Commitment-to-Cancer-Care-in-the-NHS.aspx
Yes, the NHS has areas in which it needs to improve. But the weakest areas don’t make all other strengths irrelevant.
Considering that cancer is the leading or second-leading cause of premature death, I don’t consider pointing to the UK’s poor performance on cancer survival rates to be “cherry-picking.” It seems to me a very important indicator of health care system quality.
If anyone’s cherry-picking, it seems to be the author of that Daily Telegraph article you cite. Perhaps you think that fast access to GPs is more important than avoiding premature death, but I doubt many people would share your priorities.
Most health care systems have strengths and weaknesses. The main strength of the UK system is that it’s cheap. I don’t think it does very well in broad international comparisons of the quality and quantity of health care services (especially in comparison to the US).
“The main strength of the UK system is that it’s cheap. I don’t think it does very well in broad international comparisons of the quality and quantity of health care services (especially in comparison to the US)”
Well, the WHO ranks the UK system as 18th in the world. It ranks the US system as 37th (just better than Slovenia, but not quite as good as Costa Rica)
http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/
If you’re a poor person in the USA who can’t afford health insurance, I bet the NHS would look pretty good.
Life expectancy in the UK is actually slightly higher than in the USA.
Well, if you die young of a preventable infection, your chances of dying of cancer are not exactly high.
Well, the WHO ranks the UK system as 18th in the world. It ranks the US system as 37th
The WHO rankings do not compare the quality and quantity of health care services. It’s a political evaluation, not a medical one.
It must be a bad evaluation since is does not agree with yours.
Is there any state you would accept Gary?
How about Amenable Mortality. Aka medically preventable death. The stat regularly used in order measure the quality of a health care system.
http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Sep/Variations-in-Amenable-Mortality.aspx
Correction: Courtesy.
Even though many people see the insurance industry as the big problem, their profit margins are not that high.
Time recently did a study of the profit margins of hospitals which are astronomical (Exxon doesn’t come close). And the sad thing is that people with no insurance wound up paying the full undiscounted prices.
The obscenely fat profits existed in both profit based and non profit institutions and the salaries of hospital directors (again both profit and non profit, including university based) far outstrip most corporate executives.
Unfortunately Obamacare does nothing to deal with that problem, in fact by limiting deductables the way it does, it removes incentive for people to consider the relative pricing of different institutions.
What strikes me in both this and JC’s previous post about his $40k sinus operation is that he was able to produce a bill at all. When I had surgery the charges were spread over so many different entities that the separate bills would easily overstuff a legal binder. I don’t recall the details but I feel certain that payments were made to at least a dozen separate entities, at least half of which I had never heard of before I got a bill in the mail from them. Fortunately I had pretty good insurance through my medical school employer but still I paid thousands of dollars out of pocket. If I had wanted to keep the costs down there would have been no way in advance to even identify all the entities I’d have to negotiate with, not that any of them would have told me in advance the probable costs anyway. Dealing with medicine feels a bit like dealing with the mob… the deal seems pretty bad, but then you’re just thankful that they didn’t take it all.
ditto
My experience as regards multi-bills was similar (though I hasten to add that the total cost of my heart op was NZ$42K, exactly what I was quoted beforehand). I got bills from the surgeon, the anaesthetist, the perfusionist (?) (I think that’s the guy who runs the blood machine), and the hospital. The one from the hospital runs into pages and goes as far as itemising rolls of surgical tape – but that’s okay, obviously their system tracks each item used and if they didn’t go individually on the bill they’d just go down as increased overheads, but it did cause me some amusement.
Just got into a heated argument with my Christian conservative coworker about “Obamacare”. I’m no political, economic, or social science student – I can’t throw any figures around to back up my stance which is this: We have enough money to take care of our people. We have enough money to feed them, educate them, and keep them in health. The problem is not “The People”. The problem is corporate profit. And again, I am NOT anti-corporate. There has GOT to be standardized medical billing for items and procedures. There has GOT to be transparency and swift penalties for insurance fraud, not fraud committed by patients but fraud committed by medical supply companies and the like. There is enough money to take care of our people and allow reasonable profits for the providers of medical supplies and services.
My failed induction, c-section, and subsequent surgery due to an incisional hernia received during the c-section cost nearly $250,000. I am grateful to have had the coverage – my child and I would have died (he was 9lbs 12oz a week before my due date – if allowed to go past that due date, he could have easily topped 11 lbs and he was no where near ready – hence the 2 days of torture they called the “induction”.
Conservatives blame the people, always the people. Always the people luxuriating on food stamps and welfare checks. Fuck them. The wealthy continue gain wealth as never seen before – pay almost no taxes – business or personal – and then dare complain that the minimum wage might go up or that we might be able to provide affordable health care for all? What they are doing is, in essence, creating a slave class – we have to accept that the cost of living is rising while salaries remain the same, at best if we are lucking enough to be employed. We have to beg and scrabble for “crumbs” such as retirement and health care. I haven’t had a raise in 6 years and am making less than I did when I was single. Yet, I am lucky that I do have health care. My husband does not. My child will not very soon as we will no longer qualify for California’s Healthy Family program since my husband was hired part time as a porter at a dealership making $9/hr. And day care is $150 a week. It’s almost not worth him having a job as we will now be in worse shape having to pay $350/mo for my child’s healthcare. This state, this country is totally motherfucking ass backwards. I want to see these lawmakers live one month on my salary – not minimum wage, we keep food on the table and pay rent, but we will never have a new car, or trips to Disneyland, or a savings account. We should be proud to take care of our people, we should be ashamed that so many are drowning in poverty. Fuck the conservatives, and fuck the liberals – all of them are corporate puppets anyhow.
“I’m no political, economic, or social science student…”
I disagree, Jeanine. Your study of the problem strikes me as insightful, experienced, and astute.
Oh dear, sorry to hear about the 2 day induced torture. My friend had to have an emergency C-section after 17 hours of induced hell and I can’t believe they made her wait that long!
I’m just astounded over and over that so many of my Christian friends have such strong political views (mostly conservative, but there are exceptions). Their whole raison d’etre seems to be that this world isn’t worth trifling with, that it’s all about the fate of your eternal soul. Yet they seem very obsessed with how things are run in the here and now on an earth they are sure will be burnt up and thrown on god’s rubbish bin any day now. What if a few layabouts do get government handouts, what’s it to them? According to them it’s all gonna burn anyway. It’s kind of bizarre.
obama”care” is way insufficient but if it’s nose under the tent, maybe someday it can get turned in to medicare for all. Not optimistic – unless we can elect a courageous, progressive president and congress – also an unlikely prospect.
and oust Boner Boehner!!
For a country that pulled off that spectacular Mars landing a year ago you are some fucked up, as coel pointed out above.Our Canadian socialized health care is not perfect, but the bill for two of us is in the area of $120.00 monthly. for that we don’t have to wait more than a day to see a family physician, if a referral is urgent a specialist can usually be seen within 10 days or so. The only negative is the visit to a specialist for a non emergency can take months, but that is being worked on.
And I bet you are from British Columbia. Most of the other provinces do not have any monthly fee at all.
Which brings up the fact that the Canadian system is not one system, but 15 different ones with differing degrees of cost sharing. Each province controls the system in their domain. There are also systems for the territories, veterans, inmates and the native populations.
Yes, health care is administered at the provincial level and there are transfer payments from the Feds. I don’t pay a fee in Ontario either.
I live in the US. I pay a lot more than $120/month and for that I also can wait a long time (months in one case) to see a specialist for a non emergency. That’s not being worked on here.
As soon as “insurance” gets involved insurance companies are the only ones making a mint. More than half the costs of “medical care” go on administration. And at least double that on legal bills in a world gone crazy where doctors barely dare help people for fear of being sued.
Well to be fair, my Social security tax is payed by my employer 7% and by me 7% for a total of 14%. So I wouldn’t call that socialized.
And if I die before I can retire and collect any SS, I lost those funds.
I would rather take that 7% I contribute and the 7% my employer pays and invest that in some kind of personal retirement fund, that would be passed on to my family if I should die before retirement.
Same can be said for medicare as I contribute into that as well.
The socialism comes in when people that contribute nothing but get a share of my contributions.
And what does contribute nothing mean?
Many people have never worked and get SS and Medicade.
Do those “many people” include stay-at-home mothers raising future taxpayers, consumers, and human “resources/”capital”?
Obamacare (ACA) should be a half way house toward some sort of single payer system. We pay 2X the rates of most western democracies who by and large get better care according to WHO statistics. We could have a private system that works if it were heavily regulated like Japan. So it is not strictly a public/private argument. It is not just greed from insurance companies, but greed all the way through from doctors, hospitals, HMOs, manufacturers, all the way down. It’s really a question of whether we want to tolerate rampant greed all the way through for no apparent reason. But as long as Americans remain by and large ignorant morons who fall for slogans rather than look at facts for solutions which are not influenced by corporate greed we will continue have fights to shut down the government to keep even this meager inadequate experiment called ACA going.
We pay 2X the rates of most western democracies who by and large get better care according to WHO statistics.
WHO doesn’t publish statistics comparing quality of health care services between western democracies. And defining and applying objective measures of the overall quality of health care services is problematic, anyway.
This study found that for the leading causes of premature death (cancer and heart disease), the quality of health care in the U.S. compares favorably to that of peer countries.
So what. Cancer and heart disease and just two of many health conditions to consider. And how do we know that this is a product of our health care system and not the fact that we have better medical training and research in the US in these areas. In other words these facts may be decoupled from our medical system. It’s not clear that going to a British or Japanese system would in any way impact these treatments in the US. I doubt it would.
So what. Cancer and heart disease and just two of many health conditions to consider.
As I said, cancer and heart disease are the two leading causes of premature death. That would seem to make them rather more important than less severe health problems. But I think the U.S. probably does better than most peer countries on health care in general, not just with respect to the leading causes of death.
And how do we know that this is a product of our health care system and not the fact that we have better medical training and research in the US in these areas.
Huh? The quality and quantity of training and research is part of the cost of the health care system. One reason health care is so expensive is that modern medicine is a highly skilled and knowledge-intensive profession. Doctors require many years of expensive education and training to become proficient, and have to keep on learning throughout their careers to stay current on advances in medical science and technology. Even less-skilled medical workers, like nurses and pharmacists, have to go through extensive and on-going education and training.
Yeah yeah, health care training is expensive. It is expensive everywhere. I don’t see doctors in Europe and Japan starving. They seem to make a pretty good living.
You may be right that they are coupled in a perverse way. The high non-subsidized costs of medical education might be a driver for the need to charge more for medicine as a doctor to compensate for this training. So it may be a factor in the high cost of medicine. But it is a factor for all the wrong reasons.
My claim still stands, if we had a socialized system of some sort (even if largely private like Japan) it is not clear in any way that cancer research, etc. would be impacted in any significant way.
Unless you are prepared to argue that in exchange for highly trained cancer specialized, we need to have a system where every other person goes bankrupt in seeking the said treatment, so we create a society that resembles Breaking Bad to make your payments. Reminds me of a twisted horror story out of Borges.
Yeah yeah, health care training is expensive. It is expensive everywhere. I don’t see doctors in Europe and Japan starving. They seem to make a pretty good living.
Yes, but not as good as they do in the U.S. Incomes are higher in the U.S. in general, the labor market for highly-skilled workers may be more competitive than it is in other countries, and educational and training requirements for health care workers may also be higher. All of these things would contribute to higher labor costs.
Perhaps one hope for a future reduction in labor costs is growing computerization.
You may be right that they are coupled in a perverse way. The high non-subsidized costs of medical education might be a driver for the need to charge more for medicine as a doctor to compensate for this training. So it may be a factor in the high cost of medicine. But it is a factor for all the wrong reasons.
What “wrong reasons?” If Americans demand and are willing to pay for more highly-skilled doctors and other health care workers than people in other countries, I don’t know why you think that’s a bad thing.
My claim still stands, if we had a socialized system of some sort (even if largely private like Japan) it is not clear in any way that cancer research, etc. would be impacted in any significant way.
If we had a socialized system then overall funding would likely be reduced, and so would funding for R&D on basic medical science, new drugs, new equipment, new surgeries, and so on.
Unless you are prepared to argue that in exchange for highly trained cancer specialized, we need to have a system where every other person goes bankrupt in seeking the said treatment,
I’m not arguing that and I don’t have to argue it to maintain that despite its flaws the U.S. system may be better overall than those of other countries. You seem to have a vastly inflated view of the rate of medical bankruptcy.
Haha. We’re willing to pay for all of this? What choice do we have? If I break my leg, should I spend my time calling around to see where I can get the best deal for fixing my arm. Should the doctor pull out a menu and ask are you willing to pay for a $40,000 surgery or do you want to live with a broken arm the rest of your life, or maybe we can cook you a bargain and put your arm in a sling that might work. Are you willing to pay $300 for drug X for your illness, or would you rather stay sick. You may be willing to pay for this, but I’m not. It’s just that currently I have no choice but to pay, or maybe not if I loose my insurance. Why this irrational vapid defense of are clearly dysfunctional and irrational system even from an economic standpoint. I don’t get it. Are you an insurance agent?
Haha. We’re willing to pay for all of this? What choice do we have?
The choice of paying less and getting less, either as consumers or voters. Neither major party has proposed replacing our current health care system a single-payer health system, because they know it’s a complete fantasy. Americans do not want to give control of something as important as health care funding to the federal government. That’s why Obamacare leaves the existing funding structure largely intact.
In the 1990s, health insurers experimented with providing less service for lower cost using the HMO model. And for a few years, the rate of increase in health care spending did decline. But then consumers rebelled, and insurers went back to more traditional insurance plans with fewer limits on access to doctors and health care services. The clear lesson was that Americans are simply not willing to accept the kind of limits on access that would need to be imposed in order to dramatically reduce spending.
All right Gary, you always seem to be getting into one-on-one fights on this website, and although contrary points of view are appreciated, it’s time for you to bow out of this thread, as you are making everyone respond to your comments, which verges on trolling. No more posts, here, please: you’ve taken up 20% of the thread.
Also bankruptcies from medical debt is no big deal huh. Exaggerated. I guess 2 million people affected by this last year is no big deal.
http://www.cnbc.com/id/100840148
There is my vastly inflated view of medical bankruptcies for yah!
I am an American Citizen that has lived in the UK since 2003. I grew up with the American health system which meant that since my single mother couldn’t afford health insurance it was hit and miss whether I would be able to see a doctor. My mother (an agnostic) always “prayed” that my brother and myself never broke a bone or anything else.
Now I live in the UK with the NHS. When I worked I paid taxes and those taxes helped to provide health care for everyone. I was a bit annoyed at the higher taxes but I felt that healthcare shouldn’t be withheld from anyone. Then I lost my job and I ended up going back to university to get a BSc Computer Science, at the same time my wife worked on a BSc Psychology. In our first year in university my mother in law was diagnosed with stage 4 ovarian cancer and was given 6 months to live. A month later my eldest daughter went into liver failure and was diagnosed with auto-immune hepatitis. At the time I had next to no income as I was living off of student loans, but the NHS provided care for my daughter and mother in law. Later my wife had to have some surgeries as well. My mother in law passed away 2 years later having lived 18 months past her 6 month prognosis. I needed mental health assistance and the kids would keep getting the cold and the flu. The NHS provided all of this for my family. It provided a way for me to improve our prospects by getting an education while not having to worry about getting my family to a doctor.
I am convinced that if we had been in the states we would have been bankrupt, my mother in law would have passed away quickly, my daughter probably would have died of the hepatitis, and my wife may have passed from the conditions that affected her as there is no way we could have afforded the care. In addition to that without the mental health care I received I probably would have committed suicide or destroyed my family through my actions.
Now I am studying for my doctorate with the knowledge that no matter what happens my family will be able to see a doctor and that, to me, has become a foundational block in the idea of freedom. You cannot be truly free if you cannot access healthcare.
I wish all my fellow Americans had the freedom that I have living in the UK, I think the USA needs an NHS as an upgrade to Obamacare.
I agree totally. For every scary story about the evils of the Canadian or British heath care system, I bet there are a thousand stories about bankrupt families in the US due to health care costs. There may be tradeoffs, but the tradeoffs are completely one sided in terms of their actual impacts to people as a whole. Like the banking system, the only explanation for the shenanigans, is that we tolerate pointless greed for no apparent reason.
And tons of stories about insurance companies pulling coverage as soon as you get sick.
Glad to hear you were able to continue with your studies and it seemed everyone got the care they needed! I’m a socialist pinko but I think the government’s job is to help with the health of its people and healthcare should be provided. I have grown up with universal healthcare (it came into existence in the late 60s/early 70s).
I feel sorry for you Americans. A while back I had a surgical procedure. I had to make a few trips to a larger centre two hours away to have it done. My Canadian provincial government gave me a couple of hundred bucks each time to cover travel costs. The surgery cost me nothing and I didn’t have to wait long to get it. I think it’s unethical to make healthcare a for profit business. I really do not understand the American resistance to universal healthcare.
Personal anecdotes are not a reliable way of evaluating the quality of a nation’s health care system.
Here’s an overview of health care in Canada. Like most systems, it’s strong in some areas and weak in others. One of the weak areas of Canada’s health care system is wait times. Quote:
It is interesting that the largely conservative Canadian government has no plans for dismantling their health care system for all its supposed inadequacies. Same for the conservative British government. These damn socialists are taking over the world.
Yes, the government that tried that would not find themselves elected again. Canadians are happy with their healthcare system and many of us are old enough to remember what it was like before universal health care as it has only been in existence since the 60s/70s. Indeed, because they couldn’t afford to take their child for heart surgery, my dad’s cousin died when he was 9 of a totally fixable ailment. The family was saving up to go to Toronto and have the surgery done but he died before they could get the money together.
I agree, and I only intended to share my personal experience. However, according to the World Health Organization Canada here compares quite favourably with the United States here.
Hmmm. First time trying links. Obviously need much more practice! Would appreciate instruction.
One more try with the links: Canada here and the United States here
As usual Gary is playing fast and lose with the stats.
Canadian’s had to wait longer to see non-urgent specialists, diagnostics, and to have ELECTIVE care.
http://getbetterhealth.com/wait-times-for-medical-care-how-the-us-actually-measures-up/2010.02.02
This was I find so annoying about the healthcare debate. Anyone who has bothered to check what they heard can quickly find out what utter BS the Anti-healthcare crowd has been spouting.
I’m Canuckistanian, and I’ve had to wait “longer” for things I thought were pretty important. But that’s a systemic problem – a problem with how the system is set up. Such problems are much harder to solve; throwing money at the problem or going “US style” won’t do jack because the system here is poorly designed.
I once had to wait 10 hrs in Emerg for a scrip that I should have been able to get within 48 hrs. However, because of the systemic design flaws would have to wait 2 months for, by which time it would have become a true emergency.
10 hrs may seem like a long time, but it wasn’t. Not when I saw the various truly emergency cases go past me in queue.
So, yeah, Canuckistanians wait longer. But that’s cuz people can’t “see in systems” enough yet to understand that a few non-obvious, and not-especially-expensive organizational changes, would fix everything.
Till then, I’ll still take a longer wait time to what I see going on in the US.
In the UK care is free for all – including the unemployed and destitute – not just those who can afford insurance.
You could pick out any one aspect – cancer survival for example – and show relatively poor performance – but the truth is far more complex.
The National Health Service is proactive in preventative medicine for everybody – look at the Olympic Games opening ceremony if you want to see how much we value it here. It’s a symbol of our caring and humane democracy.
Technically, it’s not free and we all pay insurance to the government if we are employed. It’s just that it looks like a tax.
Jerry is fortunate to live in a city where the type of health care that he needed was available. I doubt that most parts of the U.S. (except a few educated urban enclaves) would have a medical facility and/or personnel that were capable of ordering, running, and interpreting the tests that are shown on his bill.
Anyway, Jerry, I hope whatever-it-was is gone for good and you don’t have to go through all that again…ugh. Maybe the Polish cherry pies cured it!
So what if it *does* equal Communism?
Do certain political concepts induce such knee-jerk reactions that it is not possible, even for intelligent rationalists, to even mention them without getting angry?
Here in NZ we have a de facto mixed system i.e. a free national health service (free for NZ nationals only; foreigners will be treated in a public hospital just like any other urgent case but they will get a bill afterwards); plus a well-established private medical insurance / private hospital sector. If it wasn’t for the private component, the national health service would be overloaded (obviously it would then have to be greatly enlarged); but the availability of free treatment under NHS seems to help to keep private costs reasonable.
When I had heart valve repair surgery it cost almost $43000 NZ all-up ($35000 US, though more like $30K then, our exchange rate is way up atm) – about $1000 more than the estimate I was given beforehand. I could have waited about six months (it was non-urgent, though essential) and had it in Auckland Hospital for free; since I had private insurance which covered $35000 for any one op I chose to ‘go private’ and pay the extra $8000 myself. If I lived anywhere else in NZ the $35000 would have covered the whole operation, Auckland is the most expensive city. By going private, I got to choose the surgeon (the best one in Auckland, according to my GP) and the date of my op – I chose midwinter so I’d be fully recovered in time for summer. And I freed up a place on the public waiting list. So my $8K was worth it to me.
Probably also a factor here – we have a no-fault Accident Compensation scheme which levies all income earners and businesses and pays out to all victims of accidents/injuries. It’s always being criticised for being (a) too costly and (b) too stingy which is probably inevitable. But the significant thing is, our law also removes the right to sue for personal injury. (That’s right, it makes no difference if your car was hit by Bill Gates or a no-hoper car thief or an inconvenient bit of scenery, you can’t sue and your hospital care will be paid for by ACC. You can sue for damage to the car, though). This means that medics of all sorts are vastly less likely to face million-dollar lawsuits so their insurance costs are way lower, which must be a factor in their fees. It also means lawyers have a thin time of it, which is more than enough justification for ACC already 🙂
NZ used to pay for foreigners if they got sick! Poor NZ with such a small population could’t foot that bill. I think they will still pay if you get in an accident.
I’m British and I don’t really understand the US healthcare system. What does it actually mean when they say x million people don’t have insurance?
For instance, if I’m uninsured and I get wheeled into A & E with a gunshot wound, the doctors aren’t going to just sit around and watch me die, are they?
What happens if I have a cancer that can be treated but I’m either not insured or I can’t afford it? Does everybody just sit around and watch me die? For that matter, am I entitled to any of the screening programmes available in other countries that catch such cancers?
That’s a good question: You can find examples where people get taken somewhere else or otherwise not treated, but there are usually laws to prevent that for life-threatening situations. For non-urgent care, they’ll just send you away so you can suffer elsewhere.
In your example, most hospitals will provide the immediate care to stop you from dying. The hospital will try to get you (or your relatives) to sign some sort of financial responsibility form, usually while you are in pain, or too drugged, or upset, to realize what you are doing. Often they’ll mix this with saying they can’t treat you until you consent – by signing the form. Later, in return for the emergency treatment, you’ll get a bill for tens of thousands of dollars, lose your house, possessions and any retirement savings. If you don’t have any resources, then the bill gets passed on the rest of us anyway.
This also happens to people who just don’t happen to have good insurance. The problem is that they don’t realize their insurance is no good until it’s too late.
No, you’ll get treated, then sent the bill. Which will bankrupt you.
If you are shot, you can always try to sue the shooter to get the money back.
Good luck with that.
Yes. Or your family remortgages their house, takes out loans, maxes credit cards, and manages to pay for the first three months of treatment, then there’s no more money, and they watch you die, then go bankrupt with the debt they took on while you were alive.
Fun, eh?
Nearly two thirds of all US bankruptcies are caused by medical bills. That’s almost 2 million Americans per year.
And the other pisser… of those 2/3 of bankruptcies, (I had to check again – apparently I had it right), 3/4 of them HAD INSURANCE.
Count me as one of the disgruntled that KNOWS (not “thinks” or “believes”) that Obamacare does not go far enough. It is essentially a huge subsidy for the insurance industry that does little to nothing to remedy the insurance situation. By and large, you can play by the rules, fold tons of money into your insurance plans for you and your family for your whole life… and get wiped out anyway. (usually by the one kind of thing not opted for)
Was it Alzheimer’s or merely advanced dementia? The former is covered, but the latter counts under your program as “getting old”. You bought long-term care insurance, in addition to your catastrophic and [fill in the blank] plan(s), didn’t you? Oh. Why not? Oh… couldn’t afford it. Too bad.
Thanks Andy and Ian for your replies.
I was hoping that the impression I had got was just the usual anti-American nonsense and it wasn’t really that bad. I really can’t understand American thinking on this. To me it’s obvious that access to healthcare should be a human right.
The costs of health care in America are beyond ridiculous and they are obviously a result of the system, as no other country has similar costs. The solution is for the government to provide heath insurance. In Australia our drugs cost less than in the states, because the government negotiates prices with the drug companies. It is the only institution large enough to negotiate successfully with multi-national drug companies. The government also announces what it will pay doctors and hospitals for services, and any provider who charges more has to explain to patients how much they will be out of pocket. This is always done up front. When “socialized medicine” was introduced in the 70s, the doctors carried on no end, they knew is would limit their ability to charge patients and it did, to the benefit of everyone except doctors, who are still doing just fine.
This post inspired me to something on Facebook, I’d thought I’d reproduce it here. An argument from someone closer to the Penn Jilette side of the New Atheists political spectrum.
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little bit of an essay on acceptable socialism, by someone who is more libertarian in thought. Perhaps it’ll help convincing other people.
Health care is generally seen to be a far left wing thing in America. Accept, of course, with all the people I hang out with, who are constantly comparing us to Europe to show how much we suck.
But overall, I’m more and more seeing health care as a necessity. There are two big points. First, lets start with a subtler one, that seems pretty important, but I never hear anyone address. High health costs are problems for startup businesses. It crushes entrepreneurs, who may have a great idea, but can’t abandon the health care at their current job. I had to turn down an offer that was pretty sweet, and probably would have lead to a better job in Boston. But, I’d be without health care for an indefinite stretch of time. And I need my seizure medicine just to be able to get safely out of bed. Currently, my medicine costs so much money that if I were to pay for it out of pocket, my monthly expenditures would double. So I have to play it safe.
Now, the second point is the more popular one, but phrased in a way I’ve not heard before. It’s the one that got me. You see, we have ‘socialized law enforcement’. The cops (or firemen, or whatever) work to protect you from threats that the victim has no responsibility for encountering, that can destroy or gravely harm a person and productive member of society. A dead man can no longer build, think, or even just push boxes around. From a purely practical perspective, murder victims are bad for the economy. I have no need to explain out the human side of this problem, but it’s why even the grossest capitalist isn’t against paying for law-enforcement for all.
But the exact same argument applies to medicine. What is different about medicine available for all from police available for all? People are defended from threats that they are largely blameless for coming across. Succumbing to these threats reduces societal productivity, and of course, hurts the people involved. That hurt, and the fear of encountering that hurt, has a negative impact on society that is not felt nearly as much when it comes to robbery and murder. The same can be done for medicine.
Sure, some people will game the system. People who rely on government health care to cover for their downright self-destructive activities. But then, police protect gang members from being shot by other gang members, if they can. It’s part of the package deal.
I don’t much trust government, but it’s not like we’re relying on our *ahem* esteemed congress to come up with plans from scratch, thanks to Europe giving us a smörgåsbord of health care plans put into action to observe and learn from.
So, yah. I don’t like the government sticking it’s fingers into things. Especially something as important as my health. But in the end, it’s better than the alternative. And in the end, it’s not just good for Americas standard of life, it’s good for our wallets. The same way the cops are. And if you can’t convince someone to take a course of action to help others for the joy of helping others, convincing their pocketbook will probably manage it.
Your government, it *does* need to be pointed out, has its fingers stuck egregiously into all *sorts* of things which would make you blench in outrage. The one thing that they *should* be “sticking a finger in” is the one thing which screams of horror are heard at.
I had a similar stomach test a few years ago (I had C-difficile — and I went to work every day, what a dumb ass). I didn’t pay anything for the tests.
This time when I got my stomach ailment I just waited it out. It took all summer but seemed to fix itself. It sucked but it wasn’t as bad as C-diff which was crippling!
I’m glad you at least had health insurance. My relatives in California pay a small fortune each month for insurance because they are self employed. America has advanced medical facilities and a large population. It wouldn’t take much in your taxes to have a system for all. In Canada, we had huge resistance to universal healthcare; doctors even walked off the job. The government then allowed for a choice of private or public & people realized how good the public option was. It then caught on to other provinces.
Even in Australia where things are not cheap, laboratory tests don’t get anywhere near that expensive; on top of that, citizens and permanent residents often don’t pay at all for the lab tests because the government is billed for it. My dad used to complain about the US medical system even back in the 1960s – he said that there were numerous problems including (1) insurance companies were buying out and running the hospitals, (2) hospitals were run by people more interested in money than health, (3) hospitals were taking bribes from pharmaceutical companies (you prescribe at least $$$ worth of X each year and we’ll make sure you’re rewarded for it) and so on.
The fact that the health insurance industry in the United States spent ONE MILLION dollars per day lobbying against the ACA as it wended its way through legislation tells you something about the profits at stake.
People from the USA are going to Thailand, Costa Rica, and Argentina for treatment on medical vacations. Whenever you see indications of “black market” type activities, you know that “open, free enterprise” is not the prevailing condition.
I too do not like “anecdotal evidence” as it is the worst kind of argument. But it is instructive. My old college buddy (forty years ago) lives in rural Thailand. All foreigners get treated before native Thais. This friend suffered a heart attack while in Bangkok on business. The hotel management sent for an ambulance, which arrived with a physician and nurse. Trip to the hospital in an ambulance, stent put in the artery, three days in recovery, at the hospital.
Total bill: $400
Yes, four hundred dollars.
My sister, here in California, got thrown from her horse, riding in a pasture not far from UC Berkeley. Since the wheels of the gurney would not roll in a pasture (and the attendants unwilling to lift her in a litter) she was Medi-Vac’ed to a hospital four miles away.
Total charge: $25,000 for the helicopter ride.
Health care is rationed in the USA. Do NOT let anyone tell you different. Ask to see a dermatologist, for something other than cosmetic work (they all prefer that!!) and see how long you wait for a simple visual exam of your skin for possible carcenomas. Three months? Six months?…..but, no rationing!!
Actually, it’s not clear to me that those costs are terribly high compared to other countries.
I’m pretty sure US health care insurance unnecessarily increases those costs compared to
In Canada, where pretty much everything is “paid for” (i.e., we still pay for it, but through taxes rather than insurance), I’d be surprised if the costs were much lower.
But – and this is a big problem from my POV – we Canuckistanians have no idea how much these things cost. We get no accounting of what we spend.
I’m very happy with the Canadian system EXCEPT I wish we got the invoices that let us see how the money is spent – specifically, who gets what, and how much. I think that would be a great lesson for us, especially when we get all bitchy about how much doctors “make.”
OECD Figured on health care spending:
Per person spending on health care, 2009 (or nearest year):
United States: $7960
Canada: $4363
Germany: $4218
France: $3978
United Kingdom: $3487
Australia: $3445
OECD average: $3233
Italy: $3137
Spain: $3067
Japan: $2878
Especially when you factor in health care outcomes and life expectancy, it looks like something is quite wrong here.
Thanks of the info. Yeah, I would have guessed somewhere around 2x more in the US than Canada. But some argue the difference is even greater (I’ve heard some people suggest it’s 10x, which is pretty absurd). 2x sounds pretty much right based on my experience.
Fil
It might depend on the item or test. I’ve heard many people who had to live or temporary work in the US being charged excessive amounts for simple tests.
A friend of mine needed a certain type of blood test and the American hospital wanted to charge him $2000 for it.
In Canada this test would cost $200 (unsubsidized)
However, overall thesytemoftheworlds stats are a pretty accurate average.
There’s no question that there are “outlier” cases, like this one, where it’s more like “Healthcare Gone Wild” than anything else. Fortunately, they are quite rare. Still, it would be nice if “universal” actually meant “universal.”
It depends. The drug cartel in the USA has a stranglehold, so some drugs available without subsidy in Canada can be 1/5 of the cost in the USA. It was already very bad when I was a young ‘un, but for over 20 years it’s simply been criminal.
Interesting to note that Richard Nixon, while in his first term (1968-1972), proposed a single-payer national health.
But, for political reasons, it went nowhere. It was blocked by Senator Ted Kennedy, who wanted universal healthcare as part of his platform in a possible presidential election.
I’m bewildered by health costs in the US, and despite hearing many anecdotes and proposed solutions I have no idea how to fix the problem. When I was last in the US I took the best travellers insurance I could get and kept my fingers crossed.
I suggested we do something similar to what the Japanese do. Have a government or private entity (like the Federal Reserve or other private regulatory agencies) so it doesn’t have to be the government per se, set in place which regularly convenes to set price guidelines for various procedures such as MRIs and hospital stays, which could be adjustable based on regional/state factors and set annually. The group could be a mix of private and public people in the medical profession. Reviews would allow the costs to be shifted up or down based on whether they are reasonable. I think it is doable and would go along way towards reducing costs. But of course, since this is a rational approach, it ain’t gonna happen. But is it really different from any other agencies we accept like the FCC, FDA, etc., which if funded properly work pretty efficiently.
Did a checkup a year ago, blood samples, stool samples, and some more… cost me about 30$.
Also did an MRI on my back not to long ago, cost me nothing.
Wow these responses go on forever. I had a mammogram and needed another one and a ultra sound i’m fine no cancer,but when I got the bill about 1000.00 that I have to pay.My thought was i’d rather have the cancer I can afford it but barely. My husband had a blood test we don’t care what they find we want to know how much will it cost.Yes we have insurance grrrr.
If you want your socks blown off sometime, get Kaiser Permanente insurance. It just amazes me that this business model can even be legal. The doctors work for the insurance company. At least when your doctor is independent, you can argue with your insurance over what procedures are necessary if they deny coverage (and you’ve got your doctor supporting YOU). With KP, the doctors’ bosses tell them what they can provide.
Another problem is (and I just found this out yesterday), that your doctor/lab/whatever charges fees based on your plan. Patient A pays $200 for a procedure, patient B pays $300 for the same procedure, patient C pays $400 (then your plan covers 80% or whatever of that charge). So the worse your plan is, the more they charge you, i.e. the poor pay more for the same service. It’s outrageous…and profitable.
Also, my son has various issues and is on psychiatric meds. His former Psychiatrist charges about $300 for an initial visit (about an hour). This guy is Harvard Med/Johns Hopkins top notch guy. We switched to Kaiser and they “needed to see him for evaluation” before they could refill his meds. Okay, no big deal. HA! He saw a psychologist and then a physician’s assistant (not an MD). Total cost? $1572.00, out-of-pocket: $950! The 20 minutes with some doofus physician’s assistant (who didn’t know what the f she was talking about) cost $600. Compare that to Harvard/JH guy (MD) at $300 for a full hour. She also had the balls to tell me that the 4 previous psychiatrists he saw were wrong and she was right (about prescribed meds). How this is legal is beyond me.
U.S. Healthcare is atrocious. There are a few bright spots. Non-profits such as Kaiser Permanente and Harvard Pilgrim have relatively high patient satisfaction scores, better overall health outcomes, and low rates of cost escalation. Of course, there are instances where Kaiser and HP get handily outperformed – always by Veterans Administration and Medicare, both forms of socialized medicine. I don’t deny your frustration. And I admit things could be better. But there is something about that streamlined and consolidated management model that makes it outperform U.S. healthcare on average.
When we first joined Kaiser, I thought: Great business model. I could see where streamling could be beneficial for all. Little did I know that they have ways (e.g. overcharging for doctor visits) to gouge their patients. My son could have walked into almost any psychiatrist’s office and paid full price for an evaluation and saved a couple of hundred bucks. Plus, having a physician’s assistant changing medications prescribed by four separate psychiatrists (over a period of 10 years…meaning they all agreed) is dangerous and IMO illegal/unethical. And yes, I asked: Are you supervised by a real psychiatrist? Yes. Is he here? No. Did you call him before making this change? No. BTW, she never id’d herself as a PA, I had to ask.
BTW, I’m also concerned about how much “woo” is pushed by Kaiser. I get bombarded with email links from them about how alternative medicine can improve my health (as opposed to costly real medicine).
Unfortunately as far as “non-profit” medical companies in the USA goes, it’s nothing but a tax evasion and advertising scheme. They have complex arrangements to funnel all profits elsewhere and people mistakenly believe that “non-profit” means the corporation somehow has noble aims.
In Australia you can get two total hip replacements for $40,000 which includes the treatment of any complications (the cost of complications is evened out over all patients)
Yes, your health system sucks.
Well, I suppose that one can be thankful that no capitalist can charge us (so far) for the air we breathe, and the sunshine not captured by some solar collector.
And, who do those bloody plants think they are, using that solar energy and not paying some human or corporation for the privilege?
I agree with yiu that many procedures are excessively over priced. As a dentist, Practicing in Puerto Rico, the difference in medical costs is outstanding. (People come here for “medical and dental tourism”).
On the other hand, there are many new materials, procedures, and techniques dor treatment. The bioengineers, chemists, IT TECHNICIANS and other people that develop them expect a decent pay. For example: a nurse anesthesist can earn over $150k in the US. They earn les than $60k here.
Still, something should be done… My take is that government should provide for ALL types of preventive care. We pay for supplementary insurance.
Pardon my misspellings. Stupid iPhone.
Aside from the issue that what hospitals charge insurance companies (and the uninsured) is exorbitant, there’s fairly good evidence that the true cause of the out-of-control healthcare costs in America are being driven by overuse and innovation. Higher costs from innovation we have to live with. But overuse? Doctors AND patients are guilty together. MORE medicine is not BETTER medicine.
Analysis here: http://bit.ly/1gOynj3
Here’s an interesting video trying to explain the why’s of expensive health-care in the US. The conclusion: there is no single why, but moving towards more common systems is highly likely to decrease costs tremendously.
Sorry to all for the video not linked, didn’t know it would show up this way!
I’m glad to see somebody beat me to linking to John Green.
The money article to read and digest is “Bitter Pill” that appeared several months ago.
Now behind a paywall it seems…
http://content.time.com/time/magazine/article/0,9171,2136864,00.html
But here in PDF
http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf
Your article is like reading a creationist talk about biology. I don’t understand why so many scientific minded people are so woefully ignorant of good economics. The destruction that socialization causes doesn’t happen overnight, and the US is far down that path already. The correct solution is to remove all governmental intrusion into the industry, no price controls, no tax incentives, nothing.
Yes, as a Canuckistanian who has had to endure the agony of universal health care his entire life, I can tell you….
…wait – we’ve got it great here, ever since the system started getting implemented in ’46, 15 yrs before I was even born.
The “destruction of socialization” hasn’t really happened yet in any country where universal health care has been implemented. So I’m curious what evidence you have for your claim.