It always makes me think, perhaps due to the ignorance of Trump, he will be more receptive towards progressive lobbying too. Most of us know so little about Trump's actual policies that maybe anything is possible after all.
But only if it's called socialism. If it can be called something else, then it will be accepted. In my experience, US citizens (not all, obviously; I'm massively generalising) have been conditioned to be against things labelled socialism, but the level of economic and political knowledge amongst the general public is such that if you don't call something socialism, it is judged on its own merits without people realising.
Opponents will hang that label on it, and then it doesn't matter whether or not the general populace would recognise it.
It's interesting that my comment is somehow controversial, because it's been down to -2, is now back to -1. I wonder whether they are objecting to my calling "universal healthcare funded by taxes on the general populace" socialism, or whether they are objecting to the claim that the USA populace would ever accept a socialist policy.
Indeed, while I've been editing this comment it's gone back down to -2. Interesting to watch, and I really do wonder what it is that's provoking people into downvoting it.
It's not socialism, it's the normal way to do healthcare in a first world democratic society. Most first world countries are not socialist, but have a proper health system like this.
It'll be a long time until the entire USA implements socialised healthcare (if it happens at all...) but are there any individual states which have something resembling a single-payer system, or is this an issue where they all have roughly the same system?
Well, Medicare (health insurance for people 65+) is not that different, and is essentially a federal single pay program. (Though they don't pay salaries, but on care provided like regular insurance).
Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered)
All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like
https://en.wikipedia.org/wiki/Massachusetts_health_care_refo...
and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance).
My impression (as a European) of the US system is that in practice what we have with individual states here in Europe + EU isn't possible in the US, since the federal government taxes are proportionally so high, compared to what individual EU members contribute to the EU.
Thus while individual states could implement their own health care system, it would have to be on top of everything that's federally mandated, which they're already paying for. The tax burden would be outrageous, so it just doesn't happen.
It's also odd to see other Europeans dismiss the argument many Americans have for a smaller federal government, while in practice that's pretty much what we have over here in the EU. Could you imagine a EU-wide single-payer health care system? It would be a complete disaster.
So in that sense I wonder if the better solution for the EU would be to roll back all federal health entitlements (Medicare etc.) and just implement this completely on the state levels, then states like California and the like could have European-like single-payer health care systems, while perhaps other states would opt for different systems.
Maybe he has some kind of private health insurance. Here it's very common when you have kids or you don't want to wait for your turn for non critical medical assistance.
He says he used wifi, TV, telephone, and asked for a better room. If he didn't ask for this, I think he wouldn't have pay anything.
The French hospitals offer a lot of paid bonuses. I think it's a good thing, it allows to make the basic needs free.
It's probably tiered, like in many other EU countries. In UK for example you don't pay any tax on the first 10k earned, then 20% on anything between 10k and 40k, and then 40% on anything above 40k. I think there's a tier above it as well, but I'm not 100% sure. I know France has more tiers and they are more aggressive(80% being the highest I think?)
In France you pay 0 % taxes for the first 9.700 € of income, then 14 % for everything up to 26.791 €, then 30 % for everything up to 71.826 €, then 41 % for everything up to 152.108 € and 45 % for everything beyond that [1]. Hence 23 % effective tax rate sounds reasonable for an average income of around 50.000 €. The tax system in many European countries is similar btw, as is the health system.
And btw there is a very good reason for those tiered systems. Imagine people making 26k and paying 14%. They end up with 22,360. If they get a 5k pay rise they make 31k, pay 30% and end up with 21,700. Would they want that raise? No thanks, but a system preventing some pay raises would be insane.
I understood perfectly how it works: it works how you explained.
My example was for a system that doesn't work in that way but switches from 14% to 30% for all the income, and not only for the amount above the threshold.
Maybe I should have worded it better but I take the downvotes I got as a demonstration of my point, that it would be insane.
That's a ridiculous statement, many people do. I personally wouldn't, sure, it's an expensive city to live in (I have lived there), but €50k is I think a little above the median salary there. You could easily survive on half that if you needed to, I know many people who do. Not everyone lives in the privileged world of tech salaries, think through all the jobs people do in Paris and think if they're all being paid 50k or more..
Actually, you do, and rather comfortably. (Sources: me, 22k/year after taxes. Or my parents who raised two children in a big flat in paris, both 35k/year)
(Germany) well all taxes together, I'm not sure the social part is probably not a tax, but over the years it feels more like a tax, since you actually get less and less per year, but you need to pay more. I mean just looking at my rents or healthcare...
The system is broken by design, since actually people that earn better could actually use a privat healthcare/rent. Well some could argue that people who earn more would abuse the system anyway or would leave the country, however at the moment it is worse since if everybody would pay, all people would need to pay less and actually letting people have a private healthcare/rent makes the system anti social especially if you get better services while inside a private system.
The same with our taxes, they are too progressive, which means that if you are like me you are inside the worst part of the curve which is a little bit unfair.
Different countries have wildly different tax strategies. Sales tax, property tax, corporate tax are some avenues that may make up the difference here. Belgium in particular IIRC draws a large portion of its tax revenue from income taxes
Income tax, however, doesn't cover social security. That's covered by the taxes an employer pays, and those are larger than 23% (but also contain other taxes). It's all detailed on pay slips. https://fr.wikipedia.org/wiki/Bulletin_de_salaire
It's covered by some of the taxes you and your employer pay (though it's transparent for you) that are roughly proportional to your salary. For most people :
Health cotisation : ~14%
CSG (on all types of revenue, not only salaries) : ~8%
Some other taxes go to fund the medical system (e.g. Forfait social, Taxe sur les salaires, TVA on drugs), but as far as I know those two are the main ones.
Because income tax isn't the whole story. The French also pay social charges: ~8% on salary (and, unlike income tax, no relief on the first €9.700); ~15% on capital income (e.g. a house sale, investments etc.). Employer's also have to contribute to employee's social security (~13%). So, total tax revenue is closer to ~45% of gross salary (excluding TVA tax levied on purchases made with your net income). See: http://www.cleiss.fr/docs/regimes/regime_france/an_a2.html
Long story short: the level of care is fantastic but it costs the country a fortune and there's huge waste within the system (seen it first hand). Note too: most French also pay for private health insurance to augment the default level of state care (for things like dentistry work, optician etc.).
So it ain't cheap but if I had a serious condition there's no place in Europe I'd rather be to have it treated.
Most of the difference between US and other OECD countries in infant mortality is that the US has a much lower standard for what's considered a viable birth. Basically, lots of what in France are classified as still births would be infant deaths in the US.
Combining the two for a birthed (Still or not) and didn't make it to 5 rate:
USA: 8.8
France: 8.2
UK: 7.9
Germany: 6.1
Obviously the studies aren't matched, but it does suggest that the variance isn't as great as either statistic shows, and there likely is a very strong ranking.
He's literally asking us to disregard the health outcomes for a particularly vulnerable section of society. That strongly implies that these people aren't worth factoring in to our evaluation of a healthcare system, that their health simply doesn't matter.
On a purely statistical level, it makes very little sense. Does he believe that poverty and drug addiction are uniquely American phenomena? Does he believe that the healthcare system has no impact on the number of people with drug addictions or chronic poverty-related diseases?
I'm pointing out that you are comparing apples to oranges.
France is closer in composition to New Hampshire than the US as a whole.
So comparing health outcomes of the US as a whole to France is wrong.
Compare health outcomes of say New Hampshire or Vermont to France....
This is the same mistake the news and popular politicians use to exploit the groupthink. "Look how bad the US is at X compared to this homogenous European country". Be it prison rate or poverty level or what have you.
It is not a huge difference, but it's there. I wouldn't consider religion the top factor to pivot on, I would consider things like native language a better model.
Here is data that suggests infant mortality ranges from 9.6 in Mississippi to 4.2 in MA. So by this metric, infant mortality is in fact LOWER for many people than in France (or many parts of Europe).
Why would one take a subset of healthy people in a comparison?
If anything, healthcare systems ought to be ranked on the life expectancies of the bottom percentile. Making a great health care system for the not-poor, not-addicted and those without preexisting conditions isn't a hard problem.
Part of the difference in mindset might be that addiction or poverty is partly seen as self inflicted in the US whereas I would always classify both as being mostly beyond the control of the individual. Even with our socialized medicine rich people eat bettter, excercise more, stress less and thus live longer. I'm glad our healthcare system offsets the life expectancy difference down to 5-10 years between me and a poor person, and I'm happy to pay for it.
Because you are now selecting for that which is untreatable, assuming access to finance and an education of the parents are the primary factors in treatable deaths.
If that is the case the interesting comparison would be the rate for the populace excluding those people.
Here is data that suggests infant mortality ranges from 9.6 in Mississippi to 4.2 in MA. So by this metric, infant mortality is in fact LOWER for many people than in France (or many parts of Europe).
> The US spends more per capita on health care than other OECD countries, even ones with universal public health care:
Sure, but the French social security system (la secu) is completely bankrupt and survives only because France continues growing its national debt. NO matter how you look at it, all these health systems are not sustainable anywhere on Earth.
The fundamental problem to solve, though, is getting money back out of medicine. American doctors get paid ridiculous amounts more than doctors in other developed nations. If you want affordable medicine, then medical salaries are going to have to take a hit, so you can afford more staff overall.
An example of how much money is in the system: I was talking to a nurse in the US whose adult son had a series of mental illnesses. She was going to see a specialist neurologist about one of them. "Why not ask him about all of them?", asks I. Turns out that in the US, it's quite common for specialists to specialise into a single syndrome, and will happily reject similar things in their field that aren't their specialty. I was horrified - here are people that take a decade and a half of training, all to become a glorified lookup table. I used to work in a neuro lab myself, and while I could see a motor neuron specialist perhaps referring on a brain problem to someone more suitable, the idea that any of the doctors would only take patients with a single, prediagnosed syndrome... was just alien.
But in the US you can do that, and get ridiculous amounts of money for it.
The costs involved are higher (though or course of the same magnitude), but money seems ever present e.g the concept of malpractice insurance.
Foreign doctors can certainly help lower salaries for doctors but they need to be a large fraction, if they are a small fraction they'll just enjoy the high salaries of their US educated peers.
And that hits the point that the US is very different in a lot of ways, and changing one of those things without changing the others is difficult.
Its harder to make health care cheaper because of the salaries, drug cost, hospital costs, etc.
A lot of those things are expensive because of education costs, housing cost, etc. And don't forget the lawyer happy culture that raises costs too.
Then once you fix that, you have to take into account the added cost of the current poor demographic, illegal immigration, etc.
Then when you fix that...etc etc etc.
Its a very complicated net of problems. Its not as simple as "LOL wave a wand and make it free".
It's made worse in that you have to kick down some people a few notches to have similar taxes (upper middle class would get taxed way more) combined with how a lot of people moved to the US because they did better $$ money with low taxes, and you'll have a lot of pissed off people.
Yes, all that needs to happen eventually, but it's very painful to actually do.
Medicine is one of those few fields the "socialized" approach is actually the better one. Of course you would prefer a I-don't-want-to-pay-for-others* stance when you are young and healthy (ie provided you were not born with a genetic condition or something similar), but once you start aging and caring, you start appreciating why Medicine as practiced in Europe makes much more sense in the end.
The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives.
People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
Competition in a socialized system exists, it is just at the individual practitioner level, rather than at the administrative level. So, could you explain why administrative (e.g. hospital, insurance, physician network) competition is needed in this field? Historically, it's been more expensive this way, not less.
Normal, free market competition does not apply to healthcare because, unlike any other market segment, transactions between patient and doctor are never fully free (voluntary).
If you go to a mall to buy a TV and see two different models offered by two producers you have THREE choices: buy TV A, buy TV B, or buy none, if both are too expensive.. When you are sick and need to see a doctor the third option is not viable - you need to be treated otherwise your condition will get worse and you might even die.
That's why free market in healthcare causes high price inflation: you are not buying a product, you are buying your own life and well being.
I live in Thailand. Private healthcare is excellent here. In fact, hundreds of thousands of people from around the world come here every year to take advantage of it - Thailand is a huge medical tourism destination.
There is also a public healcare system here which is quite terrible.
Interestingly, some public hospitals offer "special clinic" hours where you can get treatment on a cash basis instead of using the public healthcare system. Since the "special clinics" are not so heavily oversubscribed the wait times are shorter and service is better. Not luxurious like the private hospitals (which are indeed luxurious) but solid care by excellent doctors. I had foot surgery at Siriraj Hospital (oldest and largest public hospital [0]) by an excellent specialist [1] who also practicies at Bumrungrad (pricey private hospital). Total cost of everything, including two nights in hospital, was USD700.
I guess that's a sort of hybrid of public and private and is an excellent value. But the private healthcare is outstanding and (again) luxurious, and while more expensive still only a fraction of western pricing. The thing is, the prices are known and even advertised in advance and you can just pay out of pocket. Wife had surgery at Bumrungrad to remove an ovarian cyst, three nights in hospital with pampered treatment, total cost a little over USD2,000.
I did not explain very well my thoughts on this. By "works", I mean healthcare as a commodity that everyone (including the poorest) can afford. In order to exist, the private system has to be better than the public one, which means better facilities, top doctors and therefore higher prices. The reason the public service is terrible is because the private system exists, top doctors are going private to get better salaries and the public one will never improve.
I'm pretty sure the private healthcare in Thailand is very good, but the only reason it's affordable for us is the difference of the cost of life, I doubt a farmer there can afford those services.
Seems strange to say the public healthcare is bad because of the existence of private healthcare. It's bad due to the fundamentals. Things like:
- it is "free" so it is grossly oversubscribed (basic market forces at work)
- it is taxpayer funded and government run (spending other people's money on other people, the worst way to get value)
- there is no incentive to improve since there is no competition (nobody loses their job and the public system does not go bankrupt and disappear regardless of how much worse it is than the private system)
And those fundamentals are why the private system is so much better. It's not free and consumers are spending their own money on themselves so seek out the best value they can. And the competition between private hospitals is pretty fierce so they are contantly upgrading, innovating, and advertising (including their prices) to attract customers.
It is common here for many of the best doctors to practice in both private and public sectors. My anecdote mentioned the fact that the doctor who did my foot surgery does that.
As for cost, those private hospitals, and there are lots of them, cater primarily to Thais. So plenty of Thais can afford private care. It's not a huge unknown cost going in that is potentially ruinous like in the U.S.
Like you said, in order to exist the private system must be better than the public system. That is the wonderful effect of markets when they are allowed to operate.
IMO the US health system needs stricter regulation. Switzerland is doing fine with a system very similar to Obamacare, with one important difference: Item prices for health services and goods are regulated by the government. Yes I know, small rich country yada yada - but if you look at it a bit more closely, the average Swiss is not that different from the average American - GDP per capita, median income, most live in diverse but smallish cities, lots of cars, lots of guns, high (but still way lower) health spending, all quite comparable - except Swiss have one of the highest life expectancies and can expect treatment for everything treatable while for many Americans this seems to become some sort of raindance.
Have you ever been to Switzerland? I have and I find this comparison absurd. It is a very small, very wealthy country with almost none of the structural problems faced in the US.
The nominal GDP in Switzerland is actually much higher than in the US, it's just that the country is way more expensive to live in. Therefore, when adjusted for cost-of-living (PPP), the GDP are about equal.
Of course, the absolute amount of money per capita is still much higher, which lowers the relative cost of, say, medical equipment.
The private healthcare in Switzerland is also compulsory and insurers are forced to offer a basic, non-profit plan. Furthermore, individual payments may be subsidized by the government. It's therefore not that different from Obamacare, nor are private insurers left to the devices of the "free market".
Hmm. First you call my post absurd, then you basically repeat everything I've written. The only point really left is that medical equipment is cheaper for Swiss. I really don't think this makes much of a difference - the main difference cost wise is what we both wrote: Regulations such that health providers and insurers have strict boundaries. Btw. I'm Swiss, if it hasn't been obvious already.
I called your comparison of the two countries absurd. It's not obvious that you're Swiss, it's obvious that you're out of touch and it's common for Americans to make some simplistic argument, pointing at fringe countries like Norway or Switzerland as an example.
You point at some facts that happen to be similar (when adjusted) for the US and Switzerland, but it's rather arbitrary. What the hell does gun ownership have to do with healthcare? And of course, like most industrialized countries, there are "lots of cars"...
The absolute difference in wealth doesn't affect just medical equipment, it affects practically everything besides labor. One of the reasons why labor is so expensive is the high taxes (VAT etc). When the government subsidizes that expensive labor, it'll get a big part right back.
You also edited your post to agree more with mine (i.e. Obamacare), when the original point was more like "private insurance can work look at Switzerland!".
Yes, it can work, if you're wealthy Switzerland and you regulate the fuck out of everything. Touche...
btw. I never edited in Obamacare, it was in there from start. The US has enormous wealth, with a purchase power per capita almost as high as an average Swiss, times 300 million. I think Americans should stop making excuses. I don't see what's wrong with comparing anything internationally - you have 150 experiments with different parameters, there's no reason not to use that knowledge if you want to figure out on how to improve or what not to do.
It's certainly not the most effective, that would probably be Japan. My point was that Switzerland has probably one of the systems closest to the US, so it's the easiest to compare and would also be one of the easiest for the US to copy, were it not for all the pharmaceutical lobbying going on (maybe Trump will solve that?)
I just like to use it to point out how the common American argument against universal healthcare don't really apply.
"it's socialist!" - no, you can have a system where everyone pays in according to insurer determined risk factors, pay less overall and still be within what people at minimum wages can afford. Below that you subsidize with taxes, but that costs very little compared to total health spending.
> But it is. Insurance works by pooling money from a group of people where only few are going to use it.
Except not everyone paying the same amount. Most pay nothing. That is, in socialist health care system.
And I am not just refering to insurance but also investment toward better medical education. If there is medical advancement going on then we have to collectively make sure that we all get it at good price. I am advocating more proactiviness toward our own health rather than rely on government to do it. But sadly government interference make this very difficult.
> Except not everyone paying the same amount. Most pay nothing. That is, in socialist health care system.
Ehm, the national health care systems in Europe are paid by our taxes. The only persons who do not pay to them are those that are entitled NOT to pay (below poverty level, children, etc).
Here even folks below the poverty level pay a little bit on the VAT taxes and so on, as do children. (Even if the money they are spending originated with the taxpayers)
Health insurance is not really insurance, though. Not only "a few" are going to use it. If auto insurance worked in the same way people would expect it to pay for oil changes, new tires, and other car maintenance expenses.
Was wondering when someone would say this. It always boggles my mind reading the discussions about "insurance". It's what Americans have become used to calling insurance even though much of it isn't insurance at all.
I love how nobody calls military spending "socialized". Only health care and education, for some reason.
The US has a gigantic "socialized" spending on that compared to everyone else. It's just that it's rather focused on one single thing. You can even hear politicians promise to spend even more taxpayer money on it.
Real problem in US with health (and education...) is that cost has skyrocketed out of control. How much is hearth bypass ? $30k? Other countries do that for $4k with similar quality and better post-op care.
Public health care will just transfer more money from poor to corporations (like with education). You need to fix the leaks first, for example sponsor medical tourism to other countries, etc...
I don't think "the cost skyrocketed out of control". The cost is simply reflective of the leverage the health care provider and all the middle men in between hold against the patient.
It's just that in other countries you have the government setting up a monopsony and dictating costs and salaries.
I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.
>> I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.
Wow, just wow. You must not have ever had a family member or close friend fall ill. If you think someone making $50k/year is financially capable of paying $30k up front, you need a reality check.
$30,000 is a very European estimate. It costs between $90,000 and ~$200,000 out of pocket in the US for a bypass surgery. Probably more for the guy in the article given the extreme nature of the situation/complications that arose.
>> In the end, this entire ordeal set me back about 1,300 euros, or $1,455. I sometimes wonder how my health crisis would have played out had I returned to America instead of deciding to stay in Paris more than 20 years ago.
In the U.S., it's likely they would have died; or at least gone $100,000+ in debt - if they could have even qualified for that much credit.
I can understand not covering things like lung transplants for lifetime smokers, or other similar "meh it's their own fault" situations. But when it comes to treating the health of citizens who are not severely at fault for their conditions, there should be absolutely no cost to the individual. Taxes should be enough to handle this, without one's own insurance being part of the equation.
Does France really have that low tax rate? Usually it's not only income tax people are paying over here and once Americans laern the total % of your money regular Joe pays for the government they are in shock, since they are not used to having so little money being left on the table.
here in NZ I pay the high 30% marginal rate (that includes social security) and get mostly free health care. Drugs have a low co-pay, we have one organisation bulk buying for the entire country
The difference of course is I'm not paying for a bunch of cowboys who invade other countries at the drop of a hat
There's several taxes. The tax he talks about is what you pay based on your revenues (with several ties, like in the uk). In france we receive what we call a 'salaire brut' which is a salary on which the employer already payed some taxes (which are quite high if i'm not mistaken). On this 'salaire brut' some taxes are automaticaly taken (including some for healthcare), then you obtain what we call 'salaire net', which the money that you get into your account. On this 'salaire net' you still have to pay income taxes (the next year for the previous for the moment, it my change to be taken immediatly on your salary, like in the uk).
I don't know, altogether how much taxes we pay. It varies depending your salary, your job or location (farmers have a different healthcare for exemple). Including everything, If i remember well, an employee cost twice his salary to the employer. A salaire net is something like 2/3 of the salaire brut. Income taxes depends of your income. In comparison with european countries, I think that it's mainly the employer part of taxes that are high.
No, its much higher than 23% as claimed by the author. At least in the 30 or 40% depends on your level of income. Its also fair to say that there is a large amount of households in France that pay no taxes at all.
Except for the 20% VAT, which affects poorer people much more as percent of their income.
If you're living paycheck to paycheck, that's 20% tax on your income. If you're a multi-millionaire, I doubt you're spending too much on groceries for the VAT to matter.
40% is a marginal rate. For the lower part of the income, you'll have a lower marginal rate. The effective rate is lower than the marginal rate. 23% is the rate of someone single and declaring 75k€ of net income (the marginal rate in this case is 41%). It seems that with such an income, you are part of the 3% wealthiers.
This is normal on all western Europe states. However France has very high standards in general about health care and is regarded as one of the best systems. I think it's time for US citizens to accept that most of Europe has better life expectancy, lower infant mortality than US, and to be ill is not a financial tragedy. Moreover the treatment that a low-income and high-income citizen receives is very similar, so there is a lot less social discrimination. If this is not enough to show that the US system has issues, note that also in US, healthcare procedures are generally overpriced compared to their costs around the world. There is obviously a problem to fix and Obama was going in the right direction.
Thats an interesting point, but it would be interesting to see it compared by regions. Southern Europe generally eats a lot healthier than Northern Europe.
I am not sure that this is true. Many countries in northern Europe such as Iceland, Sweden, and Norway eat quite healthy.
Using body mass index as a (arguably quite bad) proxy for a healthy diet we find [0] that many of the southern countries such as Spain, Greece and Portugal are more overweight than many countries farther north.
Sure, thats why I said generally. The UK and Germany don't have especially healthy diets in my opinion and have a lot more people than the Scandanavian countries that you mentioned.
Agreed. However, Germany is typically not regarded as a part of Northern Europe. Although that can be argued since there is no formal definition if Northern Europe.
With the healthcare being paid for by taxes, there is a lot more incentive for governments to push healthy eating. It also means that policies for bike/walking routes pay off more.
Which to some of us is another reason to resist taxpayer-funded healthcare. Government really doesn't need more incentive to overstep its bounds and interfere in our personal lives.
Look at infant mortality for college educated people in the two countries. Much more interesting. The US has massive population segments on drugs and other segments here illegal that dont get medical care.
Generally if you are well off, the US is a fine place to be. If you are addicted or poor, it's not so great.
Healthcare alone is just one piece of the puzzle. Having a french style healthcare system without corresponding safety nets in other areas to fight poverty/addiction/inequality etc would be better than the status quo, but not very effective.
Important to note that the opioid addiction epidemic is actually exacerbated by flaws in the US healthcare system, so adoption of standards from France or elsewhere could help with that too.
The drug problem is intimately related to the healthcare problem. America's private system is absolutely lousy at preventative medicine and public health.
In most of Europe, it's easy to get into rehab even if you're destitute. We have drug workers out on the streets providing advice, clean needles and referrals to other healthcare services. Homeless addicts still have access to exactly the same services as anyone else. The death toll from addiction falls remarkably quickly if there's a concerted effort to abate it.
We also avoided the opiate epidemic that is currently blighting the US - pill mills simply don't exist when there's no profit motive to dole out opiates like tic-tacs.
Setting aside the obvious humanitarian issues, failing to address the healthcare needs of the very poorest is costing the American taxpayer dearly. The economic benefits of preventative medicine and social care were described better than I could in Gladwell's essay "Million Dollar Murray".
having some kind of health problem is a great way to suddenly not be wealthy in the US, too.
I think this is the real benefit of socialised health care. Your wealth will survive a health problem. You will not lose your house because you got cancer.
Health insurance works when it works (I have some), but when they decide they're not going to pay your bills, for whatever reason, and you have to pay the bills to keep the doctors working until you can take the insurer to court, then it's a nightmare. Socialised health care avoids this.
Really? Maybe a long duration but highly curable health problems. What happens to the blind or someone who loses both arms? Do they really have more wealth than their counterparts in the US?
Wait, what? so your serious answer to "the US system of healthcare endangers the wealth of patients" is that over 70% of Americans don't have wealth anyway?
And furthermore, that the system doesn't affect them because they're not part of it?
What do the 70% of Americans with no savings do when they get sick?
The US healthcare system has lots of problems, but the quality of its infant care isn't really one of them. Infant mortality rates are calculated very differently in different countries which accounts for much of the US's "poor" rating. The biggest factor is that the US considers all births, regardless of how premature they are, towards its mortality rate and is aggressive in its treatment of pre-term births. Many other countries don't count early births or babies born with weights below a certain threshold towards their infant mortality rate.
Those aren't the total chances of dying during a pregnancy, they're the chances of dying from pregnancy-related causes. You can take that 0.006% gap, and then add another 0.004% for 9 months of traffic fatalities.
It'd be interesting to see the numbers after accounting for obesity.
I'm pretty sure the people at the WHO are very aware of these facts. If you look at their numbers the US is still significantly worse off than almost all European nations.
Analysis of the mid-Victorian period in the U.K. reveals that life expectancy at age 5 was as good or better than exists todayhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/ Digging into it you find women have a shorter life expectancy and men had a longer one.
PS: Using birth or at age 70 modern England has longer lifespans.
I've heard many critics of Obamacare (that say it doesn't actually work that well in reality), and in general, it seems that it was only tackling a part of the problem. In Europe, you usually have a single payer, single buyer and single executor (or at least each of those is very regulated, so there's less chance for exploitative monopolistic behaviour than in the US).
ACA is a step in the right direction. Before US healthcare actually improves for a majority (and not just the uninsured - which isn't a small thing in itself) many more steps is needed.
The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider.
> "The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider."
One of the main reasons ACA is more expensive than it should be is because health insurance companies are jacking up the price. The insurance companies are surplus to requirements, once the US gets rid of them (and cuts down on price gouging by the pharmaceutical industry) the overall healthcare costs should drop dramatically.
To give some context to the cost - between my employer and I, a family plan (the options are single or family) was $14,400 for 2017. That's a high deductible plan that requires us to pay the first $6,000 before insurance pays anything.
Back in my native New Zealand, the total income tax for an average household is about $6,000 USD. $14,000 just for insurance vs $6,000 for "free" healthcare and all of the other infrastructure a country needs.
The US healthcare system is a joke. A joke that wastes money and costs lives.
I took my kid to the doctor recently and a 15 minute appointment was $250. It doesn't cost $1,000/hour for a doctor to do a routine exam.
Part of the problem is the US is that the actual cost of insurance is buried in your benefits so people think that the $200/month they pay is the cost of insurance.
The primary issue with the system before Obama was two-fold.
1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations.
By forcing everyone to pay the idea was that you could even out the cost.
2) Pre-existing conditions. I.e. the insurance agencies wouldn't cover you if you came into their plan with an existing condition. To give you an example of that from real life.
I had a stage 1 melanoma. They tried to excise it but didn't get everything out and I had to get more complicated operation.
My insurance wouldn't cover it because they claimed I had that coming into the system. I later convinced them otherwise but until that happened the only thing my doctor could offer me was to monitor my melanoma for the year I had to wait until they would cover me again. Imagine that.
1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations.
This shouldn't be a significant problem. In an actuarial sense, the burden of the cost should largely be born by the party with the risk. If you aren't doing that, it isn't insurance. If you are providing healthcare instead of insurance, you don't pay for it by taxing poor young people (those are the young people opting out of the system, not the wealthier ones).
So the premiums the young people weren't paying should anyway only be high enough to cover the cost of insuring them.
The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
I understand what you are saying. It's like asking people who don't have a car to pay for car insurance. And I agree generally.
But the whole point of insurance is that you make it work because most people wont be needing their insurance so it's a question of interpretation.
And yes I think you are right about your solution. I can compare same treatment in Denmark with those of here in the US and the difference is just too big to be true.
Obamacare was designed to shift the cost of healthcare for the old onto the young, by capping the maximum difference between the premiums paid by the two groups. This had the predictable effect that young people didn't sign up for health insurance in the numbers predicted. So insurance companies lost money and left the market, and the remaining companies are hiking prices at an astronomical rate, far beyond what even its critics predicted. Obamacare is failing because its creators failed to grasp either economics or insurance, and then shot the messenger rather than fixing it.
Worse still, Obamacare was structured with a bunch of subsidies that expire over the next few years, lasting just long enough to push the pain into someone else's presidency.
Let's be a little more careful than that. Obamacare is more than just the exchanges, and the exchanges aren't failing in every state (premiums are even going down in a couple states). There was also a provision for federal funding of the unpredicted expense that was blocked by congress.
Anyway, my point in my other comment was that while Obamacare did try to shift costs to younger people, low participation wasn't a problem to be solved, it was seen as an opportunity to grow the pools and make it sort of work. The pools probably should have been grown by ending group policies.
Broadly speaking, I probably agree with you. Spending is unlikely to solve a pricing problem.
> The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not.
Why then are healthcare costs significantly lower in countries where everybody has "a third party payer that will cover almost anything" (i.e., the national health system)? People in these systems also "don't care whether prices are remotely fair or not"--in many cases people don't even know what the prices might be, because they aren't charged--and yet these countries spend much less than the US for health care. Why is that?
"a third party payer that will cover almost anything" (i.e., the national health system)
National health systems make choices about what to cover. Some of them fix prices.
edit: also, I meant stuff like 'all the expenses of a visit to the ER' rather than 'cosmetic surgery'. So the people I was talking about don't have a lot of visible expenses. If we fixed prices that would work out fine, but we don't fix prices.
> The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
Yes!
The funny thing is people in the U.S. are so indoctrinated and separated from costs that even smart doctors make fun of you (and eventually lash out at you if you EVEN DARE to ask what a specific procedure is going to cost): https://news.ycombinator.com/item?id=12522037
If the participants in the healthcare industry itself have no understanding of the issues it faces, and suffer from such apathy in realizing when told about it, I am afraid there will never be a solution
> We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
Yes!
Employers should have no say who the provider/doctor/lab for an employee should be.
The U.S. has ended up with a system where every party except the patient stands to benefit.
While this is inconvenient for me (I can just fly to another state or at worst, to India for very expensive procedures, it's embarrassing to see Americans get into debt to fix a broken leg!)
> 1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations.
As to one, ObamaCare is still failing, because too many young people are able to do the math and realize that, if they don't have chronic conditions or children, the IRS penalty for not having insurance is significantly cheaper than the premiums on the high-deductible, terrible plans that are available to them at any reasonable price. For anything less than a catastrophic illness or injury, the ObamaCare plans I have seen just don't make any sense.
Also, if you're young, low income, no kids and have no assets declaring bankruptcy (in the event of a high cost health event) seems like a better scenario than being out $150/month for insurance (and still paying for other healthcare costs out of pocket).
> insurance agencies wouldn't cover you if you came into their plan with an existing condition.
Before ACA I went through a period of unemployment and had to buy my own health coverage. I had been on Kaiser previously through my employer, so they had my health records. And they rejected me for a pre-existing condition -- eczema. Seriously. A decidedly non-fatal skin condition, in my case a minor annoyance, and they won't cover me at all.
It's different in different countries. The Netherlands has a system that is similar to Obamacare in that it is a system where everyone is required to have insurance and insurance companies cannot charge more to people with pre-existing conditions, but in the Netherlands there is a lot more competition between insurers. There are 30+ insurance companies and switching is easy. A standard insurance package is €100/month with a €400 deductible.
The important questions is, however, who's setting the prices for the drugs & procedures. I imagine it's the same in NL as in most Europe - the procedures covered by (obligatory) insurance is set by a centralized agency (probably government), along with the costs of said procedures and the drugs that can be prescribed as part of the insured procedures.
IIRC in the US, the main problem is that those setting the prices have much more bargaining power than the insurers (especially the smaller ones), so they're pretty much free to raise prices...
sorry but that boat has already sailed for US. the problem is not just an insurance one. The global tax-payed healthcare of EU could never pay the declared hospital costs of US.
EU's public healthcare works because hospital costs (what the state pays instead of citizens) are still reasonable.
Of course it would work for the US, if the US had sufficiently powerful insurance agencies. If hospitals and doctors want a certain amount of money and insurance agencies have the power to say no, these healthcare providers just won't see any patients or only rich ones.
This is how it works in Germany for example. As a hospital you have to accept the money you'll get or you won't get any at all.
The healthcare market in the US is not balanced and this gives healthcare providers to increase prices to ridiculous levels, especially in rural areas.
> Moreover the treatment that a low-income and high-income citizen receives is very similar, so there is a lot less social discrimination.
Can you expand on this? I don't know where I could take my money and receive better medical care than someone totally indigent. If anything, the experience as a poor person is better: my friend has had a kid and two major surgeries in the past year, plus regular checkups, and has paid nothing as she is on Medicaid. I see the exact same doctors, but I get a flurry of bills that come months after my visit, multiple bills for the same thing, and have to evaluate what's legitimate or if I need to argue and I end up spending a lot of money out of pocket due to the craze for high-deductible health plans - even though my premium is over 20k/year and I am still paying taxes to support Medicaid and Medicare!
I mean, I guess the ultra-rich can buy their own doctors, or visit special superstar doctors, but I feel like that's probably universally true. But my feeling in the US if that if you qualify for Medicaid, you are actually better off than someone in the middle class - for example, I broke a bone early this year and I didn't bother going to the doctor because I didn't want to spend hundreds of dollars for something medical care couldn't do much about anyway - but if I had Medicaid, I could just go and not worry.
On the subject of the ACA, the best thing it did was expand Medicaid eligibility, though unfortunately due to the Supreme Court decision some states were able to refuse the expansion. I'm not really convinced the rest of the bill really advanced us much in the right direction. If only one of the carriers on the exchange was a public option...
It's not just that the costs of getting healthy are taken care of.
Here in austria free, yearly "health checkups" are offered to you by every doctor. Meaning, when you go there because of a cold, he will tell you that you ought to do a checkup every year, which include blood tests, psychological screening for alcoholism and other individualized tests like prostate cancer for men.
It's just convenient to use the system. I even had multiple MRIs and dozens of XRays after minor sport injuries just to be sure.
What makes you think that he doesn't pay into the system already as part of all people who chipped in whether Austrians or not?
Systems like these can be susceptible to abuse and this should be researched and prevented as much as possible but this attitude that any free health care receiver is to be treated with suspicion and distrust till proven innocent is not healthy, sorry for the pun.
>>Systems like these can be susceptible to abuse and this should be researched and prevented as much as possible
This is good in theory but very difficult to implement effectively. The conservatives take an extreme condescending view of social welfare and demand extreme checks on it whereas any checks and balances for abuse is what is attacked by many liberals/leftists.
That's where immigration is playing a destructive force. A lot of immigrants (if not all/most) can be seen abusing social welfare.
Also slightly related is what is happening in Briton w.r.t brexit. Brexit was welcome by many Britons also for this reason.
i remember reading immigrants (in austria) on average pay more into the system than they get out, because most of them are relatively young and thus still healthy.
They're not necessarily wrong. They're just different. If the incentives make it easier for you to get preventative and diagnostic care, then you probably will. Presumably this leads to better outcomes overall than taking the risk that intensive care will otherwise be needed later on.
> How do you determine when "just in case" costs too much?
the physicians usually try to take the safe route just in case - if they deem it worth it. i'm still in the low risk category (~~young~~ not old, passably athletic) so my doctor told me more than once that it's probably nothing and we don't need to do the (expensive) X, the (cheap) Y is enough (maybe Y reveals something that justifies X).
it doesn't always work; as a personal anecdote - my uncle suffered a debilitating headache once and was told to take aspirin for several days until my aunt had enough and drove him to the hospital on her own. turned out to be cerebral bleeding. he barely survived and is now mentally disabled.
this a) takes him out of the workforce, which looses the state money through reduced taxes and b) ensures him an invalidity pension, which costs the state money.
was it worth it to save the money? on paper it's the additional cost of checking N people who're having headaches plus the cost of treating M people who're actually affected vs. the money he would have paid into the system plus the money he now costs the system over, say, 20 years. additionally he consumes less and his wife's business is struggling because he's not much help anymore.
for us, personally, it's still a tragedy, but those cases happen. you have to draw the line somewhere. it's not just additional costs though, it's still a trade off.
At least in Belgium, this just in case behaviour is strongly discouraged by most younger general practitioners, who are made aware of the costs to society during training.
Older doctors might still give you referals to specialists or radiographers upon request, and check every tickbox on a blood test sheet, but younger doctors are tought that every additional test puts strain on the solvency and labor capacity of the health care system, and will not have irrelevant or unnecessary tests performed.
In Belgium, MRI and CAT scan capacity is limited, and you can't have an MRI on a whim - you need to be referred by a general practitioner to get one.
> and dozens of XRays after minor sport injuries just to be sure
Sorry, but this is hard to believe. The use of XRays for minor injuries is not standard anymore. Not only for cost reasons, but also for the still unclear situation about increased cancer risk due to xrays.
There is a difference between retrospectively determining that an injury is minor and doing so prospectively. It might not have looked all that minor when those tests were made.
Remember when Obama was elected? Businesses were complaining ever more strongly about double digit percentage increases in health care insurance costs for their employees. Saying, 'we can't stay in business, compete, if this keeps up.'
The Affordable Care Act was not proposed as some "left", "socialist" initiative. Mainstream America as a whole -- including the "conservative" side, business, etc. -- was clamoring for some sort of effective control on health care costs.
Then, the Republicans made it a political issues. They "lost", and they weren't having any. All their rhetoric and obstruction, not of a "liberal", spendthrift proposal, but of a middle of the road plan that would provide, per their worry, a perceived "win" to the "other side."
Once the ACA was passed -- in its further compromised form -- they did their best to kill it via the budget process / spending, which is a separate activity under control of the legislature (House and Senate). Facets written into the law, such as adjustments to control insurance losses during an initial, transitory period (the demographics and so costs of the newly enrolled not being known in advance), simply were not funded.
That America doesn't have fair, cost-effective, productivity enhancing health care, is a function of political self-interest. And, in a Democracy, said politics are tied back to the electorate, however imperfectly.
Republicans lied about health insurance. People bought the lie. Now we are living it -- ever more.
P.S. Not to mention, blocking actual cost-controlling measures at every chance.
By the way, for all the complaint by insurers about their "losing money" on the ACA, as I understand it, they've seen significant savings due to the ACA in their traditional, employer group plans. Are those mentioned and factored into the rhetoric about the ACA?
Health care in the U.S. is indeed in crisis. At this point, it comes down to a simple trope: If you're not part of the solution, you're part of the problem.
The ACA bashing pols are simply part of the problem. Witness their inability to offer up an alternative of any substance.
P.P.S. In other words, I don't give a flying f-ck whether you are "left" or "right". You make progress towards solving the problem, or you don't.
And, I see it both as a economic and structural problem, and as a moral problem. A "moral" Right that is content to leave its fellow citizens suffering when resources and remedy are at hand (and this country can certainly afford them, in the dollar amounts estimated, if it makes the decision to), is not moral. It is merely hypocritical -- at best. I might contemplate using the word "evil".
I was hospitalised in France last year - and coming from the UK, which has a social healthcare system too, I was likewise blown away by the quality of care.
I was staying in a remote house, miles from the nearest village, an hour from the nearest hospital. After about four days of continuous vomiting in 40 degree heat I caved and called a doctor, in the hope of getting a prescription for antiemetics over the phone. It's Sunday. I figure it's a long shot but can't hurt.
Well, I call and she says "sorry, can't give you a prescription over the phone - but the doctor will be with you in ten minutes". I was sat there expecting a call back when the doctor shows up at my house. Checks me over, says I need IV fluids pronto, do you want an ambulance for €20 or do you want to get yourself there.
Wife gives me a ride to the hospital an hour away. The place has recently undergone big budget cuts so they've mothballed a big chunk of it, and it looked a bit sad, but inside everything was new and clean, and I'm seen within a few minutes of arriving. By a consultant surgeon who was called in to arrive a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and about six hours later an functioning again, and they're saying I can stay or leave, my choice, and here's a folder of information for you to follow up on back home.
All of this cost less than €60, and I honestly felt like I had all of France mustered and rallied to my care.
I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I still got decent treatment, of course, but it was all with a grumbling, discontented overtone - and despite it being a new (15 yr) old hospital, unbelievable amounts of equipment didn't work. There was a diabetic guy on a sugar monitor/drip on my ward that kept crashing - so their solution was to have him wake up and reboot it every 20 minutes so he didn't die. They didn't have another one available.
It's just astonishing to see how two supposedly similar socialised healthcare systems can end up so very different in their output.
> I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!".
I'm 50. I remember what London was like way before Labour first got into power.
Lets look at today. Immigration is way out of control. London has probably 10 million people? It's busting at the seams.
I even travel to the south near the beach. Waiting for a doctor there? Sometimes up to a month.
I can remember when I would call a doctor and be seen the next day. Not any more.
The reason for the attitude is that doctors and nurses are at breaking point. I'm sorry if the down voters don't like hearing this but it's true.
Incidentally I voted to leave. But I think it's too late. We should have left before Labour got into power with Tony Blair. Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.
The uk hospital was in North Wales - the most overwhelmingly white corner of the country that suffers from a decreasing and aging population. Most of the doctors and nurses were immigrants, from the EU and beyond.
I'm not even going to venture to disagree with you, I'll just provide those facts.
>> Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.
You're being downvoted to unreadability anyway, but I feel I should clarify this just for the sake of people who are unaware of it: immigrants to the UK don't get a vote in parliamentary elections and therefore Blair's Labour could bring in the entire population of Asia, he still wouldn't have got a single vote out of them.
And he couldn't have just given them all British citizenship either: in general one needs to have residence before being elligible for citizenship.
Residency is obtained automatically after five years of living in the UK (if you can prove it anyway). Parliamentary elections happen every four years. We now have a Tory government, the second after ten ish years of Labour. Clearly, if Blair had a cunning plan it wasn't cunning enough.
And even if the numbers don't move you, think of it this way: if immigrants had any say in the governing of the UK, the country would not have just jumped off a cliff with a weight tied around its neck (a.k.a. Brexit).
If doctors and nurses are at breaking point, its down to them been underfunded and under resourced. Blaming this on immigration is unhelpful and wrong!!
It's not a zero-sum game, there aren't a finite number of hospitals and doctors. 26% of our doctors are immigrants. Immigrants pay tax, which we can spend on more hospitals and doctors. They're disproportionately young, so they have a disproportionately low need for healthcare. Immigrants are part of the solution, not part of the problem.
We simply don't spend enough on healthcare. We have an ageing population with increasing medical needs, but our spending hasn't increased commensurately. As more people reach retirement age, the ratio of workers to pensioners falls. We don't want to pay more in tax, so inevitably we'll end up spreading our resources more thinly.
There are a number of problems with this statement.
First, immigrants are overwhelmingly young and healthy. They are overwhelmingly in work (and therefore paying National insurance....)
So, to answer your questions directly:
1) you can't get an appointment because GPs are either going bankrupt, or retiring faster than they can be replaced.
2) Baby boomers are all starting to succumb to chronic problems like diabetes, cancer, dementia etc. This costs a very large amount.
3) Diabetes costs 20% of the total NHS budget[1].
3) Social care budgets have been slashed, which means that old people come in to hospital for X, go home too early and with no support and come back with either a compound fracture or pneumonia.
4) The increase in NHS demand is 4% annually.
5) the "funding increase" comes from the cut in community & social care.
6) the degradation is entirely down to the lack of funding since 2010
Well ever since Thatcher i get the impression that the UK has been trying to dismantle the NHS. Supposedly one of the first things done in Scotland after getting more internal autonomy was to reverse the changes from back then.
Increasing private provision in the NHS would probably make it more similar to the French system!
There's a lot of talk about privatisation of the NHS, but personally I'm really not ideologically attached to the idea of a state-owned health service provided coverage is still universal and free at the point of use.
The current system - a bunch of clinical commissioning groups buying care from GPs employed by their surgeries not "The NHS" and from a bunch of separate hospital and mental health trusts not "The NHS" is pretty much what you describe.
We see a lot of private provision via the NHS (NHS patients going into private hospitals) in mental healthcare, and it's almost all lousy. (Even worse than the NHS MH care, and that's saying something.)
When you have 1 million patient contacts every 36 hours the gap between "good enough" and "good" is a lot of people and a lot of harm.
I guess it can be attributed to work conditions of health care professionals in both systems. May be they are better paid and not overworked and hence have a better attitude towards patients under their care as a result.
I'm not sure if they're better paid, but I did get the impression they were infinitely happier than their British equivalents - quality of life probably accounts for an awful lot. I don't know though, I'm basing my assumption off a few French medics I know who definitely don't make great money, but do have some pretty great quality of living - near Swiss border, one has a cabin in the woods and a fishing pond, the other paraglides seemingly non-stop. I think there's a different approach to on/off in France, and working hours are definitely far more strictly limited.
In the UK (Wales) I got to see a hospital, a relative-in-law was terminally ill. The hospital was like a knock off slaughterhouse with thick dust everywhere and blood stains on the walls that stayed for weeks. After that I decided to get a check up every time before I go to the UK to not need the hospital there. I hope not all hospitals are like that there.
Health is devolved in the UK. That means there are 4 separate NHS systems - one in England, another in Wales, another in Scotland, and another in Northern Ireland.
I agree that there are severe problems with the Welsh NHS.
Didn't know that but I guess the problems are not limited to Wales. My uncles and cousins are expats in the UK, some in Wales and some in London and they come to Turkey (where we're from) whenever they need the dentist. Whenever they got their teeth done there they had to get it fixed here. What I saw in the hospital is that the medical staff work like salesmen, whereas here there is great respect and love towards doctors and other medical staff, and these in turn work with great devotion. A virtuous circle absent there, unfortunately.
The system in France is very different from the system in the U.K. Instead of having a national health service that employs the doctors, they have a system a lot like Obamacare, but with national price controls.
For details on the French system see The Healing of America by T.R. Reid. It also covers the U.K. and several other countries.
Britain spends about 20% less than France on healthcare per capita. The British National Health Service is ruthlessly efficient, for better and for worse; it's really good at keeping people alive cheaply, but it's terrible at everything else. Efficiency inevitably means that resources are spread as thinly as possible, that equipment is used until it disintegrates, that hospitals are purely functional production lines for medical procedures.
British people have both a strong sentimental attachment to the NHS and a strong aversion to taxation. They're willing to overlook the flaws of the service if it means they don't have to pay more for it. I can't say it's an unreasonable position.
There is little evaluation of physicians so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go.
The system runs a massive financial deficit.
It is run in an administrative way which creates odds behaviors. For instance department allowances based on % of occupation of hospital beds, which lead them to keep people overnight unnecessarily to preserve their budgets.
The system is very liberal in term of allowing you to see specialists. That's great in certain ways. The UK suffers from the opposite, where generalists' job seem to be to prevent people from seeing a specialist. But it is also a paradise for hypochondriac patients who will do dozens of useless exams subsidised by the tax payer.
Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
>There is little evaluation of physician so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go.
There are always variations, obviously but in general we have pretty good doctors AFAIK. If anything we don't have enough of them. I'm not sure how it relates to the article though, would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones? I'm really asking, I honestly don't know about that.
>The system runs a massive financial deficit.
It's still pretty massive but it's steadily shrinking these past few years, although parts of it might be caused by degrading the service slightly.
>Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
What does that even mean? You went full tinfoil here. Whose career are you talking about anyway? Do you have any source?
> would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones?
I am not sure it is a liberal vs non liberal. But doctors like any profession need to have a way to be evaluated. It is a fact that there are good, average and bad doctors (like any other profession). I understand that in the US, insurance companies play this role. They are maintaining detailed statistics of acceptable success rates and will apply pressure when they see physicians underperforming.
On careers, I come from a family of doctors, so it's rather a long succession of first hand anecdotes than articles. Careers in public hospitals are very much driven by these things at a more senior level. I'm afraid no tinfoil there.
French person here. Although the deficit of the healthcare system is often pointed at by the media, it is far from "massive".
From [1] translated in English:
"This budget is in deficit, (...) but this deficit is far less than the budget of the State. In 2011, the deficit of the Social Security represented 2,66% of its total budget (11,7 / 440,8 billions €) compared to 45% for the State budget (92 / 200 billions €)."
I'm not saying that it's OK to have a deficit because the State deficit is bigger. But we should keep orders of magnitude in mind (the French budget would be in super-duper-massive deficit then?). Plus, as you can also see in [1], the deficit is shrinking since 2010 and getting close to zero.
Yes, there are some optimizations possible in the French Social Security. I can't find the source anymore but the cost of running the public Social Security is lower, in percentage, than French private healthcares (if my memory is right its 8% vs 25% of the total budget of each organization)
It is not hard to imagine that economies of scale play a major impact for this.
Careful, I think you lumped together the retirement and health branches, the health side has a lower deficit than the retirement side, that means that the health insurance has a lower deficit than what you stated.
Yes. And in my quote it is mentioned "Social Security" not "Healthcare branch of the Social Security". I took the Social Security as a whole because it's the total deficit of the Social Security that is often pointed at by the media.
The "Healthcare branch" is not the one performing the best but the order of magnitudes are the same
You know what also runs a deficit? Your gym membership. Going to the movies. Eating at restaurants.
Sometimes things cost money. I imagine that keeping the country healthy is a plus.
Not to say that making improvements isn't a bad idea, but a cost-centric view on things almost always ends in bad decision-making. Decisions based on revenue generation, instead of the "real" objective (keeping people healthy).
I still giggle a bit every single time one of these EU healthcare stories pops up.
It highlights a core difference between one of the two most "advanced" places in the western world.
For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right.
It is a as essential as a core human function as breathing and blinking. We don't notice it, it's just there.
And most of us are more than happy to pay higher taxes in order for us ( or our fellow citizens ) to enjoy these.
Granted , our taxes could be better managed, institutions could be more efficient, and governments less corrupt. But until someone shows us - with long term data backing up these claims - that there is a better alternative , we will keep giggling .
I guess what the parents refer to is that Universities in France are not as elitist as in other countries; the most prestigious higher education public schools are often considered to be the so-called "grandes ecoles" (engineering schools) or some specific administration/economics schools.
The facs in France are well known for their laissez-faire attitude vis à vis students' personal work.
The faculty personnel has a limited engagement with the integration of the students into the cursus. Combined with the moderate interest post-high school students show this leads to about 50% of the promotion not quite dropping out.(+)
And then there's the 'diplomas for all' aspect which incentivises the faculty to reach out and lower the barrier of passage into the next year, with obvious consequences....
30% of the ranking's rating is based on nobel laureate/fields medal in alumni or staff. 20% based just on amount of publications in Nature and Science.
I never know why people rate these rankings so highly when there are such unimpressive metrics like these.
Not to mention that this particular ranking does not seem to consider education at all anyway, which is what the GP was talking about.
Shame this is being downvoted. Non-UK EU countries have some pretty shitty universities given how rich they are. Of the top 40 in the Shanghai Rankings, two are non-UK EU and five are in the UK. Cost-to-user in the UK isn't free but it's pretty cheap when compared to the American competition.
The Shanghai Rankings are about research more than teaching. I don't know in other EU countries, but in Germany and in France almost all of the research is done by public institutions unaffiliated with universities (Max Planck Society, CNRS...).
There's another way to look at it that I don't think the USA will be ready to understand any time soon: Universal health and education are (key parts of) freedom.
You can even put a market spin on it: None of the risks involved in starting a small business in Australia have to do with health care for myself, or for people who might consider joining my small business as employees.
I've never felt as if I'm giving up autonomy or surrendering to the yoke of the state or whatever. Public universal health care gives me freedom. From and for so many things.
With the election in US, I have to say that civilization in the country has been set back for many centuries.. not surprised to see a dog bites dog environment in the States...
But someone has to pay for the health care, so they're losing some freedom (money in this case). That person gives up freedom also on the pricing of your healthcare.
Note: that person may be you, depending on taxation
You're equating money with freedom where the question is philosophical: can you be 'free' in any meaningful way if your life is burdened by a lack of education, the financial ruin of having been seriously ill, or the handicap of having been poorly treated for a disease?
So yes, that's precisely the trade-off. We accept to lose a little bit of money in exchange for the ability to flourish.
This is a fundamental difference in view point on the concept of "Freedom".
That's also why it's important to call taxation for what it truly is. Until people can be born free without automatic obligation to the state to provide for "your freedom", then they're not really free. That is the only freedom that matters and is definable outside of feel-good politics. So lets be honest: I'm losing the "Freedom" to spend all my money how I choose, so you can be free of the worry that certain "bad" things may happen to you.
How are you "free" when you're being scammed by your insurance companies and hospitals into paying more than twice what you should be for your inferior healthcare?
If insurance companies and hospitals are scamming people, then why aren't people investing in those companies? Or why aren't people starting a insurance company or hospital?
If there's really a scam, people could make good money from it.
I know i pay for these things through taxes, but i think in the end it's cheaper if we handle this through a tax system. No huge corporations looking to improve their profits at the cost of service to customers.
I like to think of western-europe as an all-in or full-service country. Maybe you pay a bit more, but you get way better service, and by not having to decide and buy yourself you're left with more of what's really important: free time.
Most of what is state provided is fairly high quality: from health-care, to education to infrastructure our government does a pretty good job.
Australia has exceptional demographics that make this possible - for the moment. It won't last, for the same reason it won't in Europe. But, you get to gloat for quite a while as an Australian, it'll last decades longer than in Europe, where unemployment makes the current situation untenable. To put it bluntly: Australia has a participation rate of 65%, dropping slowly (ie. pretty much perfectly stable for the past, frankly, almost the past century). Europe has a participation rate of 55%. Now you might think that's not a big difference, but it's the difference between 1 worker paying for 50% of a non-worker versus 1 worker paying for 80% of a non-worker. That means the life of close to 2 people needs to be financed from one job in the EU, whereas in Australia it's just slightly over 1.
Keep in mind that there is even more leverage, as people who are only employed to take care of the elderly, the young, ... make up a significant part of the workforce and shouldn't be counted as employed for this purpose (a geriatrician, a teacher, a nurse, ... is paid from taxes to take care of non-workers, that means he doesn't contribute to the economy). Therefore the numbers in Australia, are about 1 for 1 (ie. tax rate of just shy of ~50%), in Europe the numbers are really about 1 for 3 (ie. total tax rate of slightly over ~75%)
But even in Australia it's essentially over. Australians should have started to have way more kids about a decade ago to prevent what's now pretty much inevitable. Although once again Australia gets to sit back and watch what happens in other economies before it's forced to take action itself, like in the financial crisis. It should do well. Doesn't change the outcome though : taxes in Australia will have to rise to halve your post-tax income over the next 2-3 decades. In Europe ... let's not go there, taxing at 100% would not allow for enough economic activity to support the pensions and healthcare at the current level of provided care. Dedicating all economic activity in the EU to just that single purpose is ... not enough. Therefore, elderly care and health care will have to scale down, a LOT (and may God help them if Trump follows through on forcing Europe into defense spending). The basic problem is, the lower the working population gets the more massive the advances in productivity (the economic kind) have to be. There is a slight issue with that:
(I've had healthcare in both Europe and Australia though. Let me tell you, Europe is better. Though I guess it does greatly vary based on the exact location)
I think the story of not having enough young people to pay for older people is missing a bit of evidence. Especially since if labor were scarce we would be seeing increases in wages, inflation and a tight labor market. Instead we have the exact opposite. Really the economy's limiting reactant for the past few years has been demand not labor especially considering that a 2x improvement on productivity is not that big if we consider that worker productivity has been increasing much faster than that over the same period of time. How governments fund their programs is an issue but relative scarcity of labor (or resources) in the economy isn't one of them. This is especially true in europe where lack of inflation has been a real issue for so long.
Ever since the 2000 crisis labour has been abundant. So we can't even use the labour capacity we have (not enough jobs for everybody). But that is one perspective. It very much depends on viewpoint even here. On one hand Obama and the government are lying : there certainly aren't enough jobs to go around, and so many people are desperate for work. They do tend to "have work", so the government is not technically lying, but they have part-time jobs that they would very much like to replace with a full time job.
A simplification that has been valid for pretty much the entire 20th century has been that a given labourer has a given productivity. So I assume that if we have 2 young people for every 1 old person or child, for example, that the economy would work to make that actually happen. This is not guaranteed, of course, but historically this worked.
As for the productivity measure you mention, that's not what I've seen in the data. Productivity measurements rose for most of the 20th century, then flattened across the world starting around 1985 or so. There has been little to no productivity rise in the US since 2000, and most of the world is worse off, with the notable exception of China and some smaller parts of Asia.
Lack of inflation rises are masked more than a little bit by government fudging. By the inflation measures of the 1980s we've consistently seen 3-4% inflation in Europe (except in the south). The measure currently used in the US is called "PCE deflator". You should look up why it's called that.
> You can even put a market spin on it: None of the risks involved in starting a small business in Australia have to do with health care for myself, or for people who might consider joining my small business as employees.
Though you may have heard politicians in the USA profess their love of small business, in general, their actions are contrary to it. Both parties regularly do things which are good for big business, but which do hardly anything to 1. reduce the tax burden on small businesses, 2. reduce the paperwork/bureaucracy burden on small businesses, 3. make it easier for a larger percentage of society to engage in the creation of new businesses. Even though ACA (Obamacare) has been somewhat of a step in the right direction, it's still the case that if you want _good_ insurance, you better be part of a group healthcare plan (i.e. not an individual plan.)
keep in mind that this is not a given in all EU countries. In the UK (still an EU country, though not for long) one has to either get a student loan from the British state, or cover their own tuition fees.
The British student loan system is essentially a graduate tax in disguise. You only repay 9% of your income over £21,000, deducted automatically from your wages in the same way as income tax. The loan is cancelled after 30 years, regardless of how much you have repaid. Young people understand that it's not a "debt" in the conventional sense of the word.
But this is fairly practical and honest: I'd want to know if the person had student loans taken out of their paycheck before giving a mortgage. It might make a difference on how much I loan the person: They obviously don't have the disposable income as another person making the same wages yet not having a loan taken out.
It only counts against you for mortgage applications because it reduces your net income, just like any tax does. A rise in general Income Tax rates would have a similar impact.
It doesn't show up on your credit report, you can't miss a payment and damage your future creditworthiness, and lenders don't include the value of the loan when calculating your total indebtedness.
It's much closer to a graduate tax than a personal loan for mortgage purposes.
That's not entirely true. Your student loan repayments are deducted from your net income when calculating affordability, for very obvious reasons. The amount of debt isn't a factor and student loans aren't recorded with credit reference agencies. Student loans don't significantly affect the affordability of housing. If you're on a salary of £30,000, your student loan repayments will reduce your net income by less than 4%.
And yet if they'd proposed putting a 9% rate of income tax above £21000 there would have been riots in the Tory party. It's a tax on people born after 1980 who want to have professional jobs, not all graduates. Ironically, this hugely favours immigrants from EU countries with free or cheap education systems.
And I do think some people are put off by the debt-ness of it, but that's very tricky to measure.
Well, I already have one - I was in the last generation to get an actual student grant and no tuition fees - but I suspect the main obstacle people will face is language skills and the difficulty of a course not taught in one's first language.
Then there's the plausible scenario of having to apply for a visa in a hurry if the Brexit balloon goes up.
A lot of European universities now offer courses in English to attract cross-border students. British students are notoriously poor at learning second languages, but they have the advantage of being native speakers of the global lingua franca.
One, why tax graduates? In other EU countries, free is free as in beer and you never need to pay anyone anything, for higher education.
Two, why double-tax the future workforce? I mean, they'll pay taxes once they start working anyway. And obviously, those who do go into higher education will end up making more money, and therefore pay more taxes. The state will get back its penny'orth alright, so what's the point of adding a cherry on top?
Full disclosure- I'm from Greece originally but graduated from a UK university, and am repaying a tuition free loan, to which I was entitled as an EU citizen; so personally I benefit from the system (because I'd probably not be eligible for free education anyway). It still doesn't make sense to me.
How high are the fees ? In France, even in public Universities you still have to pay something, granted it's borderline free, from the top of my head, 400€ per year.
I once chatted with a US girl thinking about going to college, IIRC one year there was almost the price a full fledged private school 5 year cursus. We both went silent for a minute.
> For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right.
Many people in the UK fear for the life expectancy of the NHS. It's featured in the media very often. Ditto welfare benefits.
We pay for dental care and prescriptions. Hospitals and health centre are closing left, right and centre. Benefits are being slashed in cruel ways. Many have private health care through their employers. Kids are leaving University with £40,000+ loans now.
Don't downvote the parent comment, those following British news sources will know that for quite some time UK government seems to be trying to undermine the system and make it so bad that they can then point to how bad it is as justification for privatization.
Other articles were written by doctors in the NHS, what they had to say didn't sound good at all. But the problem is that the government wants to abolish the "socialized" system and mishandles it (deliberately, as many article writers claim).
I similar, but much less medically severe, experience with a gallbladder infection due to stones. This was in Germany. The cost of the sonogram and and ultrasound was c.a. 100 euro. The blood test was a pittance. And, becuase my medical German was/is very poor I had an exensive private consultation with the director of the E.R. who spoke near-natively fluent English.
The total cost: 250 euro out-of-pocket
The cost of one sonogram in the US: $1500 (before insurance)
Healthcare in the US is a byzantine protection racket and very potentially a means to mass surveilance beyond the scope of public health.
This is a topic that has come up on HN so many times that I have lost count. I have come to the conclusion that the US milieu is so dogmatically against any alternative that the standards of a proof that they will demand to be acceptable far outstrips the standards that they will demand of other things. This is the diametric opposite of preaching to the choir. Ultimately its them who gets handed the shorter end of the stick. Some are rich enough that it does not affect them as much. What intrigues me is the behavior and rationalizations of those who cannot escape the adverse consequences. Forget drug and hospitalization pricing for the moment, just the institutionalized control (cartelization) of the license to practice medicine is a tell tale sign.
Healthcare professionals are expensive since they require significant preparation.
But there is fishy stuff going on too...
1 liter sterile bag of saltwater for intervenous use in American hospitals is charged at over $300, not considering the cost of the procedure, which can total $500.
The pharmaceutical industry also does some sort of disservice to society by inflating prices so much.
Then, some money stays at the insurance companies instead of going to actually improving healthcare itself.
That said, even single-payer systems as the ones in Western Europe can have this exact same problem. Like when Region Stockholm / Stockholm County (Responsible for Health Care and Public Transport) in Sweden bought supplies like support socks for 6000 SEK/pair (~645 USD) [1].
I'm guessing - but I do not think it's a good thing when people who make the purchasing and oversight of things are far away from the actual practitioners. It leaves a lot of room for different kinds of shenanigans, fraud and sub-optimal choices. I think that applies regardless if you're for Private or Public health care.
For one operation I had, I was given a turkey sandwich to eat in the recovery room before they would let me leave. Two slices of wonder-bread, one slice of turkey. $36 on the itemized bill that was sent to my insurance.
High charges of low cost items are because of the amount of free care hospitals provide. I'm a physician in South Carolina and I take care of a tremendous number of fully employed people with no health insurance. Those of us with insurance pay for those without by paying higher costs. This gentleman would have probably received the same treatment in the US (at least at my facility) and received a $300,000 bill, of which he would probably never pay (bc he cannot). That artificial aortic graft sewn in probably cost the hospital $1500. It doesn't receive that for free. Nor does it expect the 7-8 people in the operating room or the post operative care to work for free. My hospital has an operating profit of less than 1% mainly because it provides so much free care. All I have to do to take care of a patient is declare it an emergency and there is no stopping of whatever care I feel is necessary to care for the patient, e.g., a newly diagnosed cancer patient. This, I believe, is true throughout the USA. And most of the people I take care of have jobs, but no insurance. Ask how many people that clean hotel rooms have insurance. How about people that work call centers? That, plus monopolist practices of the pharmaceutical industry and you have high costs.
And if you want physicians to make 100k - 150k, don't expect me to work 80+ hours a week, not including call. Attorneys give me $500 / hr for consultations, but in my real job I make $80 / hr, but just work a ton more hours a week (no overtime bonus, tho). I don't get sick days. I don't get vacation days. When I don't work, I don't get paid. When I was in private practice, when I didn't work, I not only didn't get paid, but still had to pay rent / malpractice / insurance / electric / employees which was about $5000/week for me. So taking a week off cost me lost revenue and $5000/week. Medicare pays $600 for taking out a gallbladder. Do the math to see how many have to be done to take care of the bills.
I think universal healthcare would definitely improve the system. So in the US, healthy, employed by big corporation people, pay about $17k / year for family healthcare. Then, when they turn 65, they join medicare and the insurance companies laugh bc they received premiums for 40 years and then when people need services, they don't pay.
Imagine if medicare started receiving payment at age 20. By the time someone turned 60 the return on investment / interest would more than pay for their care. Insurance companies don't want the average american to know that. I think that either 1) offer medicare plan for anyone, regardless of age and discount based upon years of contributions or 2) make insurance companies allow individuals to pay medicare rates once they turn 65 if they've participated for, let's say, 15 years.
I'm almost 50 and have used less than $400/year since 21. Yet, I pay $4400 for a $6000/deductible plan. So I've given my insurance companyn $100k at least in my lifetime. But when I turn 65, all my care will be covered by medicare. Trust me, I know what symptoms to say and may have multiple bad symptoms from age 62-64 and undergo lots of tests, instead of medicare paying for preventive tests.
The system is broken, but so is politics, so nothing will change. Even Trump ran under the pretense of allowing us to buy pharmaceuticals overseas, allow purchase of insurance plans across state lines, make hospital costs transparent ---> all that would lower costs, but apparently, they won't happen.. Just like with the democrats. The US healthcare system is controlled by the pharmaceuticals, suppliers, and hospitals and nothing soon, other than a Bernie Sanders, will change it. The 3 competing hospitals in my area, serving less than 1million people have a CEO cost of more than $7 million! So across the US, I would imagine that total CEO cost is in the billions.
I don't have solutions, only depressing facts.........
A healthcare system that I like quite a lot is the Belgian one, which is a nice mix between free market and socialised medicine. In Belgium the government sets standard rates for different kind of medicines and treatments. You pay 8% of your income towards a state health fund that refunds all your health-related spending up to the standard rate. You are free to choose where, when, and what treatment you get. You pay the cost up-front, and then you get refunded by the state. But you only get refunds up to a 'reasonable' rate. In practice most doctors demand little-more than that rate, and thus you get a full refund. You can also subscribe to a private health insurance if you want to get refunds for better options.
I agree. The general standard is good (my wife's experience of giving birth here was much better than my sisters'in the UK) and if you have the money you can choose to pay more for comfort or convenience.
Of course, this is perfectly normal in the developed world.
My brother broke his leg horribly a few years ago. Ambulance, helicopter, plane, 3 surgeries, a month in hospital, steel plates, etc. etc.
In Australia, you don't pay a cent out of pocket for that, it's all covered with taxes.
Similar story in Canada too. Even little stuff like I broke my nose - into hospital, xrays, time with dr to straighten, appointment a few days later to check, etc. All free.
The difference is simply that Health Care is run for profit in the USA. Someone wants to profit off your health (or lack thereof) so you must pay a lot of money to line their pockets. Some story for Higher education, incarceration, etc.
Its the same in Canada, it's not because it appears free that they don't run for profits. Health care is a massive public spending and shows when you look at the taxes you (or your employer) pay
Just to give a different perspective, I think it's fair to say French people are very worried that healthcare quality is decreasing. I don't know if it's really the case but in any case, the system is far from being perfect.
For one thing, some care are very expensive, like dental crowns and implants. In the article, the author says he had to pay 1300 euros for 47 days in the hospital. You're likely to pay more for one dental implant, unless you have a very good insurance in addition to the regular social security (most people don't).
If you have to go to the ER and if you don't have a life threatening condition, expect to wait many hours in an overcrowded waiting room. Moreover, to see some specialists (e.g. eye doctor), you may have to wait for months to get an appointment. The list goes on...
It seems to me that, as a society, to choose for a longer waiting list and uglier waiting room it's a small price to pay in exchange of healthcare for everybody.
About the decreasing quality: there is a clear pattern where, you cut financing of public resources and, then, you can show how bad they work and how best a private system would be.
The eye doctor thing always confused me. I would have to call 2 months in advance to get a routine eye check! What??
It feels like it's purely because of government limiting the number of optomitrists. It reeks of some doctor's association lobbying the education ministry to keep the incoming number low (there's a hard limit set by the gov't on the amount of people who can study medicine).
For comparison, in Tokyo I can walk into any optometrist office without an appointment and just wait 15 minutes or so
I heard an argument some time that European healthcare and health R&D is indirectly subsidised by the US. The mechanism at works is 1) US consumers are ripped off by pharma; 2) pharma's higher profits lead to higher investment in R&D; 3) everyone profits from that and in the European case negotiate lower prices. I've always wondered to what extent this is true.
Couldnt the US Gov just use Medicare as a private health insurance option that runs not for profit and offers a lower cost than private insurers? It could then negotiate low rates with pharma companies and hospitals on behalf of its customers and eventually justify tax assistance. That would essentially let the 'free market' stay in effect and be a shortcut past the lobbiests.
I think one of the reasons the French can afford it is because their doctors don't get paid an asinine amount like in North America. Imo one of the reasons healthcare system sucks here is because our doctors get paid way too much, and that is probably caused by neeldless high entry requirements to become a doctor.
I think I (living in the UK, currently an EU country) understand the mentality behind the US healthcare system(s).
I think it's along the lines of "Why should I pay for someone else's healthcare?".
I've heard similar arguments from British people (I'm rather more socialist in my outlook than average, for a UK resident, I fear) and I don't really have an answer to that. Why indeed?
I'm probably conditioned to answer this with a "duh, because they're your fellow citizens". But I guess that's not everyone's cup of tea.
>"Why should I pay for someone else's healthcare?".
>and I don't really have an answer to that. Why indeed?
Because you don't know what is going to happen in the future. One day you may wind up broke and be diagnosed with a serious illness. And what about any children you may have. Wouldn't you like to know that they will receive care after you are dead no matter what is going on in their life?
Actually, I know exactly what's going to happen (to me) in the future: I'll eventually grow old, get sick and die in pain. Or maybe I'll just get the "die in pain" part. That's how it goes, right?
And in the past I was very young and couldn't yet fend for myself. I benefitted from being born in a developed nation and, like you say, if my parents had died while I was young, I'd have been taken care of (though in my country's case it would probably be my extended family that'd have looked after me, first, and the state would only intervene if I had noone to care for me).
Like, I totally get what you're saying, but a significant number of people don't see it that way. Maybe they forget they were once too young, or that they will one day be too old. Maybe they just think they can do well enough for themselves that they'll just wing it.
My point is that for many people contributing to things like public healthcare doesn't make sense.
For instance- in the UK education is not free, and you will hear lots of people saying, indeed "why should I pay for someone else's education?". That's much more common than grumbling about having to pay for the NHS, but in the end it's just the same thing.
I supported Jeremy Corbyn, so I am also way more socialist than you average Brit, but the answer to "Why should I pay for someone else's healthcare?" is actually quite simple - human decency.
Do you really want people to actually DIE? I hope not and that you'll rather pay "for someone else's healthcare" than to see them suffer and if YOU are ever bad on your luck and need the help, I'll gladly pay for your healthcare if you need it, because I know that you paid into the system when you could and now we're just paying you back.
I am already paying taxes for a lot of things that I may not want to anyway, like overbudget defense spending, over the top salaries for MPs, failed research, government websites that cost way more than they should and other initiatives that nobody asked for, financial support for hugely profitable multinationals etc. etc. - if I am paying for that, OF COURSE I'll pay into a system that will help a human being when they need it and be confident that I or my family members can expect the same, should it ever come to it.
It always seemed to me that in the U.S. they're fed up with having to pay for an excessive budget, yet they always blame the wrong part of it for their high taxes - don't blame healthcare spending, blame the way it's implemented, blame the fact that over 50% of your tax dolars is spent on the military, blame the failed, overbudget F-35 project etc. etc. DON'T blame Flint residents who don't even have access to clean water - where's the logic in that?
I think it's interesting to ask why people separate themselves from other people, I.e. people who are sick and possibly dieing, who need help.
Something I read on hn a while ago involved trying to place others who have had bad things happen to them in mental categories apart from oneself, to not have to deal with the possibility of bad things happening to yourself without any reason. E.g. a traffic accident, cancer etc.
With traffic accidents, is very instructive to see that people will reflexively think that the persons involved did something wrong, this removes the need to accept that life isn't safe and that our behavior often has little influence at all on wether bad things happen to us. I think it's the same with healthcare. The defense mechanism is: they got sick so they must have lived unhealthily - granted, there are a lot of things your behavior can influence: cardiopulmonary disease, some forms of cancer but not all of the tragedies of health that can befall you are in any way under ones control. By sticking together we can shoulder the burden of the few that didn't have any blame on their fate.
Your virtue signaling trivializes a vastly difficult issue. The immensely complex question remains, putting aside the problem of organizing a massive state system, of how you balance non-infinite resources with never-ending demand continually extended by medical advances of which people naturally enough wish to take advantage? Given no financial constraints, you don't have to be a socialist to assent to free health treatment for all comers.
OK, but maybe don't assume any motives on my part?
What I'm saying is that free healthcare and education (and other stuff like that) is a cost that civilised societies are prepared to pay to remain civilised, and it's weird that one such society seems to think very differently than the rest in that respect.
Having had two melanomas and most likely to have more and having grown up in Denmark with universal health-care and now living in the US with insurance based healthcare I have been thinking about health care in general a lot.
Some random thoughts:
You can never spend enough on healthcare. There is always new machines, new technologies, new drugs, new treatment types, better educated doctors we could spend our money on if we wanted to. Furthermore we are treating people earlier and earlier and for more and more things. The old saying that if you are not sick it's just because we haven't found the right diagnosis for you seems to be true.
In effect whether you are in a private healthcare system or a universal one whether you pay double or your get taxed 100% there will never be enough money for healthcare.
Now depending on whether you have private healthcare or public healthcare the way you measure it is completely opposite. In a private healthcare system everything is a potential profit center. I.e. the more people who are sick the more money can you potentially make.
In a public universal healthcare system everything is a cost center. You have a budget and you have to deliver to a politically decided standard.
Both have pro's and cons. To give you an example.
It took me 3 weeks to get a time with my dermatologist in Denmark, when i finally got it it was the day before I moved to the US. The Danish dermatologist found one they considered troublesome, but they couldn't themselves do the biopsy and I had to get a time at a hospital to get it.
I decided to wait until I got to the US ignorant as I was I thought it was just a question of formalia. But no I had to wait a whole month for my insurance to work (that is a whole other discussion for another time)
When I finally got it though, I got a reference for a dermatologist same day and they did the biopsy, same day. Today I am at Sloan Memorial with one of the best dermatologist in the world getting checked every 3 months having a complete 3d scan of my body (in blue speedos and a white net) and hopefully we will be able to make sure that I am being managed properly.
What I am trying to say is that the level of expertise a private healthcare system allow for is more flexible than a public one because it allow for the allocation of resources. On the other hand if you look at those let fortunate than me, with worse healthcare plans etc they will get a less favorable treatment. I.e. the system isn't evenly distributed.
What the public healthcare system secures is that it's mostly evenly distributed but with less of a flexibility to build experts as there are budgets and a bigger need for priorities in any publicly funded system as it's a cost center.
So you have fundamentally two system where one covers only those with insurance but allow them to potentially pay their way to the latest treatments with the best doctors and the other where everyone gets treated but you don't have the same amount of experts and potential treatments.
Neither systems are really optimal. Do we want to have people die because they can't get healthcare coverage or because they can't get the necessary treatment because it doesn't exist in the country they live.
I know it's more complicated than this of course but in broad strokes thats at least my perspective and this has lead me to the following observations.
1) Both systems are fundamentally financially unsustainable in the long run. Whether the system succumbs to it's own weight by costing the tax payer too much to pay for everyone while only delivering average treatments or whether it's impossible for the insurance companies to secure a large enough part of the population without leaving too many without proper coverage. Both just doesn't sound "right" (I know Germany, and Switcherland have some variations that sound more right but I am not sure they don't fall into the trap of either the cost center, or the insurance cost issues....
I am French and live in France right now.
Recently I had to undergo a surgical procedure. Nothing as serious as heart surgery, but still one day at the hospital and general anesthesia.
This has not affected my personal finances and I only had to focus on getting better.
I would like to move to the USA but I have got to admit that it frightens me that this kind of issue would have costed me a lot and a serious health condition could bankrupt me.
This is not ok. It saddens me that USA have not been able to instore a sane health care system.
That also wouldn't mean anything, if the State is not taxing you so much, but it still has money to finance these things, it is obviously because it is taxing other people a lot more and using the money to treat your health.
I would not find it very good to have my needs fulfilled with stolen money, as you seems to be finding.
VAT is 20% in France, and the biggest source of income for the State. But social security has a separate budget and is not paid by taxes, but by special levees on salaries and income.
310 comments
[ 2.7 ms ] story [ 254 ms ] threadIt's interesting that my comment is somehow controversial, because it's been down to -2, is now back to -1. I wonder whether they are objecting to my calling "universal healthcare funded by taxes on the general populace" socialism, or whether they are objecting to the claim that the USA populace would ever accept a socialist policy.
Indeed, while I've been editing this comment it's gone back down to -2. Interesting to watch, and I really do wonder what it is that's provoking people into downvoting it.
... and now back to -1. Fascinating!
https://en.wikipedia.org/wiki/List_of_countries_by_military_...
...but maybe that doesn't count as "socialism" because most of the profits ends up in the hands of private companies?
Also for some reason this reminded me of a BBC story I read a while back - where "Heavy Legs" is described as a medical condition that only exists in France: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspon...
The military health system (for veterans, the VA) mostly have their own facilities, but don't have the best reputation (and have had some scandals recently... https://en.wikipedia.org/wiki/Veterans_Health_Administration... )
Medicaid (for poor people) is managed at the state level, and is 50% federal funded (and each state has different income limits for who is covered)
All three of the above make up roughly half of all US health care spending. At the state level, some states have additional programs and subsidies, like https://en.wikipedia.org/wiki/Massachusetts_health_care_refo... and Obamacare tried to create something similar for all states with uniform availability and coverages along with subsidies (and penalties for people who voluntarily decline to purchase health insurance).
https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...
So yes, it's a complex kinda mess...but there are too many stakeholders in the current system for it to be easily changed.
Thus while individual states could implement their own health care system, it would have to be on top of everything that's federally mandated, which they're already paying for. The tax burden would be outrageous, so it just doesn't happen.
It's also odd to see other Europeans dismiss the argument many Americans have for a smaller federal government, while in practice that's pretty much what we have over here in the EU. Could you imagine a EU-wide single-payer health care system? It would be a complete disaster.
So in that sense I wonder if the better solution for the EU would be to roll back all federal health entitlements (Medicare etc.) and just implement this completely on the state levels, then states like California and the like could have European-like single-payer health care systems, while perhaps other states would opt for different systems.
Maybe he has some kind of private health insurance. Here it's very common when you have kids or you don't want to wait for your turn for non critical medical assistance.
> an American might assume. I pay an annual income tax of
> about 23%.
How comes this number is that low? Tax revenue in France account for about 48% of the country's GDP[1].
I'm living in Belgium, and my payroll tax is already higher than these 23%.
--
[1] https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...
[1] https://fr.wikipedia.org/wiki/Bar%C3%A8mes_de_l'imp%C3%B4t_s...
You pay nothing on the first 9700€
You pay 14% on the money you make above that, that is 14% of ~17k€
You then pay 30% on the money above that, that is 30% of the extra 5k.
My example was for a system that doesn't work in that way but switches from 14% to 30% for all the income, and not only for the amount above the threshold.
Maybe I should have worded it better but I take the downvotes I got as a demonstration of my point, that it would be insane.
http://www.journaldunet.com/business/salaire/paris/departeme...
A low income person in the US can pay effectively 0%. Your percentage in most countries depends heavily on how much you make.
Some other taxes go to fund the medical system (e.g. Forfait social, Taxe sur les salaires, TVA on drugs), but as far as I know those two are the main ones.
Long story short: the level of care is fantastic but it costs the country a fortune and there's huge waste within the system (seen it first hand). Note too: most French also pay for private health insurance to augment the default level of state care (for things like dentistry work, optician etc.).
So it ain't cheap but if I had a serious condition there's no place in Europe I'd rather be to have it treated.
http://kff.org/health-costs/issue-brief/snapshots-health-car...
And yet the US has lower life expectancy than those countries:
https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...
births out of 1000 that are stillbirths:
France 3.87
UK 3.50
USA 2.95
Germany 2.43
Infant Mortality (under 5) per 1000 live births
USA 5.87
UK 4.38
France 4.30
Germany 3.70
Combining the two for a birthed (Still or not) and didn't make it to 5 rate:
USA: 8.8
France: 8.2
UK: 7.9
Germany: 6.1
Obviously the studies aren't matched, but it does suggest that the variance isn't as great as either statistic shows, and there likely is a very strong ranking.
On a purely statistical level, it makes very little sense. Does he believe that poverty and drug addiction are uniquely American phenomena? Does he believe that the healthcare system has no impact on the number of people with drug addictions or chronic poverty-related diseases?
France is closer in composition to New Hampshire than the US as a whole.
So comparing health outcomes of the US as a whole to France is wrong.
Compare health outcomes of say New Hampshire or Vermont to France....
This is the same mistake the news and popular politicians use to exploit the groupthink. "Look how bad the US is at X compared to this homogenous European country". Be it prison rate or poverty level or what have you.
Does New Hampshire have any cities where 30-40% of the population are Muslim?
http://www.pbs.org/newshour/bb/resentment-growing-christians...
To describe France as homogeneous is utterly, profoundly ignorant.
If you want actual numbers, you can start here:
https://en.wikipedia.org/wiki/List_of_countries_ranked_by_et...
It is not a huge difference, but it's there. I wouldn't consider religion the top factor to pivot on, I would consider things like native language a better model.
Here is data that suggests infant mortality ranges from 9.6 in Mississippi to 4.2 in MA. So by this metric, infant mortality is in fact LOWER for many people than in France (or many parts of Europe).
http://kff.org/other/state-indicator/infant-death-rate/?curr...
If anything, healthcare systems ought to be ranked on the life expectancies of the bottom percentile. Making a great health care system for the not-poor, not-addicted and those without preexisting conditions isn't a hard problem.
Part of the difference in mindset might be that addiction or poverty is partly seen as self inflicted in the US whereas I would always classify both as being mostly beyond the control of the individual. Even with our socialized medicine rich people eat bettter, excercise more, stress less and thus live longer. I'm glad our healthcare system offsets the life expectancy difference down to 5-10 years between me and a poor person, and I'm happy to pay for it.
If that is the case the interesting comparison would be the rate for the populace excluding those people.
http://kff.org/other/state-indicator/infant-death-rate/?curr...
Sure, but the French social security system (la secu) is completely bankrupt and survives only because France continues growing its national debt. NO matter how you look at it, all these health systems are not sustainable anywhere on Earth.
An example of how much money is in the system: I was talking to a nurse in the US whose adult son had a series of mental illnesses. She was going to see a specialist neurologist about one of them. "Why not ask him about all of them?", asks I. Turns out that in the US, it's quite common for specialists to specialise into a single syndrome, and will happily reject similar things in their field that aren't their specialty. I was horrified - here are people that take a decade and a half of training, all to become a glorified lookup table. I used to work in a neuro lab myself, and while I could see a motor neuron specialist perhaps referring on a brain problem to someone more suitable, the idea that any of the doctors would only take patients with a single, prediagnosed syndrome... was just alien.
But in the US you can do that, and get ridiculous amounts of money for it.
If an MD cost zero to get, doctors would still be paid well, but not crazy well.
The US also takes in a lot of foreign-trained doctors, who don't have those same education costs.
Foreign doctors can certainly help lower salaries for doctors but they need to be a large fraction, if they are a small fraction they'll just enjoy the high salaries of their US educated peers.
Its harder to make health care cheaper because of the salaries, drug cost, hospital costs, etc.
A lot of those things are expensive because of education costs, housing cost, etc. And don't forget the lawyer happy culture that raises costs too.
Then once you fix that, you have to take into account the added cost of the current poor demographic, illegal immigration, etc.
Then when you fix that...etc etc etc.
Its a very complicated net of problems. Its not as simple as "LOL wave a wand and make it free".
It's made worse in that you have to kick down some people a few notches to have similar taxes (upper middle class would get taxed way more) combined with how a lot of people moved to the US because they did better $$ money with low taxes, and you'll have a lot of pissed off people.
Yes, all that needs to happen eventually, but it's very painful to actually do.
*even Ayn Rand allegedly made use of the "social benefits" when the shit hit the fan and it's perfectly alright (https://www.quora.com/Did-Ayn-Rand-really-accept-Social-Secu...)
US health system needs competition more than socialism [1].
[1] https://mises.org/blog/lack-epipen-competitors-fdas-fault
EDIT: A really good comment from link above.
Mark S - https://mises.org/blog/lack-epipen-competitors-fdas-fault#co...
The culprit in virtually all health care or drug price gouging outrages is insurance and "free" taxpayer money. Americans want someone else to pay for their health care -- the insurance pool, Medicare, Medicaid, the VA, the hospital (if they are indigent). Drug makers know that someone else (not the patient) is paying for the drug, that payee has no economic incentive to minimize costs, and so drug makers do not care or have an economic incentive to control their costs or limit their prices. Somebody else is paying, so who care what the drug costs. Insurance companies pass costs along in the form of escalating premiums, so they have no incentive to control costs (especially in the Obamacare environment where health insurance providers are exiting the market leaving the remaining firms with a monopoly); giverment health programs have virtually unlimited access to taxpayer money (and, in the end, money printed by the Fed), so they have no incentive to control costs; health care providers also know that the patient is not paying the bill, so they have no incentive to prescribe or investigate more afforadable alternatives.
People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
If you go to a mall to buy a TV and see two different models offered by two producers you have THREE choices: buy TV A, buy TV B, or buy none, if both are too expensive.. When you are sick and need to see a doctor the third option is not viable - you need to be treated otherwise your condition will get worse and you might even die.
That's why free market in healthcare causes high price inflation: you are not buying a product, you are buying your own life and well being.
There is also a public healcare system here which is quite terrible.
Interestingly, some public hospitals offer "special clinic" hours where you can get treatment on a cash basis instead of using the public healthcare system. Since the "special clinics" are not so heavily oversubscribed the wait times are shorter and service is better. Not luxurious like the private hospitals (which are indeed luxurious) but solid care by excellent doctors. I had foot surgery at Siriraj Hospital (oldest and largest public hospital [0]) by an excellent specialist [1] who also practicies at Bumrungrad (pricey private hospital). Total cost of everything, including two nights in hospital, was USD700.
I guess that's a sort of hybrid of public and private and is an excellent value. But the private healthcare is outstanding and (again) luxurious, and while more expensive still only a fraction of western pricing. The thing is, the prices are known and even advertised in advance and you can just pay out of pocket. Wife had surgery at Bumrungrad to remove an ovarian cyst, three nights in hospital with pampered treatment, total cost a little over USD2,000.
[0] https://en.wikipedia.org/wiki/Siriraj_Hospital [1] https://www.bumrungrad.com/doctors/Bavornrit-Chuckpaiwong
I'm pretty sure the private healthcare in Thailand is very good, but the only reason it's affordable for us is the difference of the cost of life, I doubt a farmer there can afford those services.
And those fundamentals are why the private system is so much better. It's not free and consumers are spending their own money on themselves so seek out the best value they can. And the competition between private hospitals is pretty fierce so they are contantly upgrading, innovating, and advertising (including their prices) to attract customers.
It is common here for many of the best doctors to practice in both private and public sectors. My anecdote mentioned the fact that the doctor who did my foot surgery does that.
As for cost, those private hospitals, and there are lots of them, cater primarily to Thais. So plenty of Thais can afford private care. It's not a huge unknown cost going in that is potentially ruinous like in the U.S.
Like you said, in order to exist the private system must be better than the public system. That is the wonderful effect of markets when they are allowed to operate.
The nominal GDP in Switzerland is actually much higher than in the US, it's just that the country is way more expensive to live in. Therefore, when adjusted for cost-of-living (PPP), the GDP are about equal.
Of course, the absolute amount of money per capita is still much higher, which lowers the relative cost of, say, medical equipment.
The private healthcare in Switzerland is also compulsory and insurers are forced to offer a basic, non-profit plan. Furthermore, individual payments may be subsidized by the government. It's therefore not that different from Obamacare, nor are private insurers left to the devices of the "free market".
You point at some facts that happen to be similar (when adjusted) for the US and Switzerland, but it's rather arbitrary. What the hell does gun ownership have to do with healthcare? And of course, like most industrialized countries, there are "lots of cars"...
The absolute difference in wealth doesn't affect just medical equipment, it affects practically everything besides labor. One of the reasons why labor is so expensive is the high taxes (VAT etc). When the government subsidizes that expensive labor, it'll get a big part right back.
You also edited your post to agree more with mine (i.e. Obamacare), when the original point was more like "private insurance can work look at Switzerland!".
Yes, it can work, if you're wealthy Switzerland and you regulate the fuck out of everything. Touche...
I just like to use it to point out how the common American argument against universal healthcare don't really apply.
"it's socialist!" - no, you can have a system where everyone pays in according to insurer determined risk factors, pay less overall and still be within what people at minimum wages can afford. Below that you subsidize with taxes, but that costs very little compared to total health spending.
But it is. Insurance works by pooling money from a group of people where only few are going to use it.
>People never ask "So, what does this drug/treatment cost?" but rather "Do you accept my insurance?"
Which makes sense, as survival and physical and mental well-being are humans primary needs.
Except not everyone paying the same amount. Most pay nothing. That is, in socialist health care system.
And I am not just refering to insurance but also investment toward better medical education. If there is medical advancement going on then we have to collectively make sure that we all get it at good price. I am advocating more proactiviness toward our own health rather than rely on government to do it. But sadly government interference make this very difficult.
Ehm, the national health care systems in Europe are paid by our taxes. The only persons who do not pay to them are those that are entitled NOT to pay (below poverty level, children, etc).
The US has a gigantic "socialized" spending on that compared to everyone else. It's just that it's rather focused on one single thing. You can even hear politicians promise to spend even more taxpayer money on it.
Public health care will just transfer more money from poor to corporations (like with education). You need to fix the leaks first, for example sponsor medical tourism to other countries, etc...
It's just that in other countries you have the government setting up a monopsony and dictating costs and salaries.
I don't see how charging $30k for a heart bypass is unreasonable for somebody making $50k/year.
Unfortunately, a free market for helathcare does not exist in the U.S.
Wow, just wow. You must not have ever had a family member or close friend fall ill. If you think someone making $50k/year is financially capable of paying $30k up front, you need a reality check.
>> In the end, this entire ordeal set me back about 1,300 euros, or $1,455. I sometimes wonder how my health crisis would have played out had I returned to America instead of deciding to stay in Paris more than 20 years ago.
In the U.S., it's likely they would have died; or at least gone $100,000+ in debt - if they could have even qualified for that much credit.
I can understand not covering things like lung transplants for lifetime smokers, or other similar "meh it's their own fault" situations. But when it comes to treating the health of citizens who are not severely at fault for their conditions, there should be absolutely no cost to the individual. Taxes should be enough to handle this, without one's own insurance being part of the equation.
The difference of course is I'm not paying for a bunch of cowboys who invade other countries at the drop of a hat
I don't know, altogether how much taxes we pay. It varies depending your salary, your job or location (farmers have a different healthcare for exemple). Including everything, If i remember well, an employee cost twice his salary to the employer. A salaire net is something like 2/3 of the salaire brut. Income taxes depends of your income. In comparison with european countries, I think that it's mainly the employer part of taxes that are high.
No, its much higher than 23% as claimed by the author. At least in the 30 or 40% depends on your level of income. Its also fair to say that there is a large amount of households in France that pay no taxes at all.
If you're living paycheck to paycheck, that's 20% tax on your income. If you're a multi-millionaire, I doubt you're spending too much on groceries for the VAT to matter.
It should be specified that this is because the French tax code provides exemptions to people making less than I-forget-how-much per year.
https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven...
In the US, that's 26.9%. In France it's much higher, at 47.9%.
Diet has a lot more to to about that than medical care.
Using body mass index as a (arguably quite bad) proxy for a healthy diet we find [0] that many of the southern countries such as Spain, Greece and Portugal are more overweight than many countries farther north.
[0] http://apps.who.int/bmi/index.jsp
With the healthcare being paid for by taxes, there is a lot more incentive for governments to push healthy eating. It also means that policies for bike/walking routes pay off more.
Generally if you are well off, the US is a fine place to be. If you are addicted or poor, it's not so great.
In most of Europe, it's easy to get into rehab even if you're destitute. We have drug workers out on the streets providing advice, clean needles and referrals to other healthcare services. Homeless addicts still have access to exactly the same services as anyone else. The death toll from addiction falls remarkably quickly if there's a concerted effort to abate it.
We also avoided the opiate epidemic that is currently blighting the US - pill mills simply don't exist when there's no profit motive to dole out opiates like tic-tacs.
Setting aside the obvious humanitarian issues, failing to address the healthcare needs of the very poorest is costing the American taxpayer dearly. The economic benefits of preventative medicine and social care were described better than I could in Gladwell's essay "Million Dollar Murray".
http://www.newyorker.com/magazine/2006/02/13/million-dollar-...
I think this is the real benefit of socialised health care. Your wealth will survive a health problem. You will not lose your house because you got cancer.
Health insurance works when it works (I have some), but when they decide they're not going to pay your bills, for whatever reason, and you have to pay the bills to keep the doctors working until you can take the insurer to court, then it's a nightmare. Socialised health care avoids this.
Really? Maybe a long duration but highly curable health problems. What happens to the blind or someone who loses both arms? Do they really have more wealth than their counterparts in the US?
http://www.usatoday.com/story/money/personalfinance/2016/10/...
I can almost guarantee that nearly all of the 30% of Americans WITH savings have health insurance with an out of pocket max.
I can almost guarantee that many of the people without insurance are in the no savings group.
So perhaps I am missing something, but I am not seeing a huge group of Americans that have their wealth in danger by the current healthcare system.
And furthermore, that the system doesn't affect them because they're not part of it?
What do the 70% of Americans with no savings do when they get sick?
From http://data.worldbank.org/indicator/SH.STA.MMRT?view=map
* 0.014% of dying during a pregnancy in the US
* 0.008% of dying during a pregnancy in France
It'd be interesting to see the numbers after accounting for obesity.
Analysis of the mid-Victorian period in the U.K. reveals that life expectancy at age 5 was as good or better than exists today https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/ Digging into it you find women have a shorter life expectancy and men had a longer one.
PS: Using birth or at age 70 modern England has longer lifespans.
Can you expand on this?
I've heard many critics of Obamacare (that say it doesn't actually work that well in reality), and in general, it seems that it was only tackling a part of the problem. In Europe, you usually have a single payer, single buyer and single executor (or at least each of those is very regulated, so there's less chance for exploitative monopolistic behaviour than in the US).
The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider.
One of the main reasons ACA is more expensive than it should be is because health insurance companies are jacking up the price. The insurance companies are surplus to requirements, once the US gets rid of them (and cuts down on price gouging by the pharmaceutical industry) the overall healthcare costs should drop dramatically.
Back in my native New Zealand, the total income tax for an average household is about $6,000 USD. $14,000 just for insurance vs $6,000 for "free" healthcare and all of the other infrastructure a country needs.
The US healthcare system is a joke. A joke that wastes money and costs lives.
I took my kid to the doctor recently and a 15 minute appointment was $250. It doesn't cost $1,000/hour for a doctor to do a routine exam.
Part of the problem is the US is that the actual cost of insurance is buried in your benefits so people think that the $200/month they pay is the cost of insurance.
1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations.
By forcing everyone to pay the idea was that you could even out the cost.
2) Pre-existing conditions. I.e. the insurance agencies wouldn't cover you if you came into their plan with an existing condition. To give you an example of that from real life.
I had a stage 1 melanoma. They tried to excise it but didn't get everything out and I had to get more complicated operation.
My insurance wouldn't cover it because they claimed I had that coming into the system. I later convinced them otherwise but until that happened the only thing my doctor could offer me was to monitor my melanoma for the year I had to wait until they would cover me again. Imagine that.
This shouldn't be a significant problem. In an actuarial sense, the burden of the cost should largely be born by the party with the risk. If you aren't doing that, it isn't insurance. If you are providing healthcare instead of insurance, you don't pay for it by taxing poor young people (those are the young people opting out of the system, not the wealthier ones).
So the premiums the young people weren't paying should anyway only be high enough to cover the cost of insuring them.
The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
But the whole point of insurance is that you make it work because most people wont be needing their insurance so it's a question of interpretation.
And yes I think you are right about your solution. I can compare same treatment in Denmark with those of here in the US and the difference is just too big to be true.
Because this is a bit bait-y, I think a better analogy would be to say: "it's like forcing safe drivers to also have insurance".
Worse still, Obamacare was structured with a bunch of subsidies that expire over the next few years, lasting just long enough to push the pain into someone else's presidency.
Anyway, my point in my other comment was that while Obamacare did try to shift costs to younger people, low participation wasn't a problem to be solved, it was seen as an opportunity to grow the pools and make it sort of work. The pools probably should have been grown by ending group policies.
Broadly speaking, I probably agree with you. Spending is unlikely to solve a pricing problem.
Why then are healthcare costs significantly lower in countries where everybody has "a third party payer that will cover almost anything" (i.e., the national health system)? People in these systems also "don't care whether prices are remotely fair or not"--in many cases people don't even know what the prices might be, because they aren't charged--and yet these countries spend much less than the US for health care. Why is that?
National health systems make choices about what to cover. Some of them fix prices.
edit: also, I meant stuff like 'all the expenses of a visit to the ER' rather than 'cosmetic surgery'. So the people I was talking about don't have a lot of visible expenses. If we fixed prices that would work out fine, but we don't fix prices.
> The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
Yes!
The funny thing is people in the U.S. are so indoctrinated and separated from costs that even smart doctors make fun of you (and eventually lash out at you if you EVEN DARE to ask what a specific procedure is going to cost): https://news.ycombinator.com/item?id=12522037
Or look at the condescending post at Quora: https://www.quora.com/How-do-I-find-a-general-physician-in-S...
If the participants in the healthcare industry itself have no understanding of the issues it faces, and suffer from such apathy in realizing when told about it, I am afraid there will never be a solution
> We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
Yes!
Employers should have no say who the provider/doctor/lab for an employee should be.
Quora: https://www.quora.com/Would-the-average-person-who-gets-his-...
The U.S. has ended up with a system where every party except the patient stands to benefit.
While this is inconvenient for me (I can just fly to another state or at worst, to India for very expensive procedures, it's embarrassing to see Americans get into debt to fix a broken leg!)
As to one, ObamaCare is still failing, because too many young people are able to do the math and realize that, if they don't have chronic conditions or children, the IRS penalty for not having insurance is significantly cheaper than the premiums on the high-deductible, terrible plans that are available to them at any reasonable price. For anything less than a catastrophic illness or injury, the ObamaCare plans I have seen just don't make any sense.
Before ACA I went through a period of unemployment and had to buy my own health coverage. I had been on Kaiser previously through my employer, so they had my health records. And they rejected me for a pre-existing condition -- eczema. Seriously. A decidedly non-fatal skin condition, in my case a minor annoyance, and they won't cover me at all.
IIRC in the US, the main problem is that those setting the prices have much more bargaining power than the insurers (especially the smaller ones), so they're pretty much free to raise prices...
This is how it works in Germany for example. As a hospital you have to accept the money you'll get or you won't get any at all.
The healthcare market in the US is not balanced and this gives healthcare providers to increase prices to ridiculous levels, especially in rural areas.
Can you expand on this? I don't know where I could take my money and receive better medical care than someone totally indigent. If anything, the experience as a poor person is better: my friend has had a kid and two major surgeries in the past year, plus regular checkups, and has paid nothing as she is on Medicaid. I see the exact same doctors, but I get a flurry of bills that come months after my visit, multiple bills for the same thing, and have to evaluate what's legitimate or if I need to argue and I end up spending a lot of money out of pocket due to the craze for high-deductible health plans - even though my premium is over 20k/year and I am still paying taxes to support Medicaid and Medicare!
I mean, I guess the ultra-rich can buy their own doctors, or visit special superstar doctors, but I feel like that's probably universally true. But my feeling in the US if that if you qualify for Medicaid, you are actually better off than someone in the middle class - for example, I broke a bone early this year and I didn't bother going to the doctor because I didn't want to spend hundreds of dollars for something medical care couldn't do much about anyway - but if I had Medicaid, I could just go and not worry.
On the subject of the ACA, the best thing it did was expand Medicaid eligibility, though unfortunately due to the Supreme Court decision some states were able to refuse the expansion. I'm not really convinced the rest of the bill really advanced us much in the right direction. If only one of the carriers on the exchange was a public option...
Here in austria free, yearly "health checkups" are offered to you by every doctor. Meaning, when you go there because of a cold, he will tell you that you ought to do a checkup every year, which include blood tests, psychological screening for alcoholism and other individualized tests like prostate cancer for men.
It's just convenient to use the system. I even had multiple MRIs and dozens of XRays after minor sport injuries just to be sure.
I'm not sure where to draw the line, though. How do you determine when "just in case" costs too much?
Remember, all Austrians paid for your mris and X-rays. I don't doubt it was worth it this specific case, but aren't the incentives wrong?
Systems like these can be susceptible to abuse and this should be researched and prevented as much as possible but this attitude that any free health care receiver is to be treated with suspicion and distrust till proven innocent is not healthy, sorry for the pun.
This is good in theory but very difficult to implement effectively. The conservatives take an extreme condescending view of social welfare and demand extreme checks on it whereas any checks and balances for abuse is what is attacked by many liberals/leftists.
That's where immigration is playing a destructive force. A lot of immigrants (if not all/most) can be seen abusing social welfare.
Also slightly related is what is happening in Briton w.r.t brexit. Brexit was welcome by many Britons also for this reason.
https://translate.google.com/translate?sl=auto&tl=en&js=y&pr...
the physicians usually try to take the safe route just in case - if they deem it worth it. i'm still in the low risk category (~~young~~ not old, passably athletic) so my doctor told me more than once that it's probably nothing and we don't need to do the (expensive) X, the (cheap) Y is enough (maybe Y reveals something that justifies X).
it doesn't always work; as a personal anecdote - my uncle suffered a debilitating headache once and was told to take aspirin for several days until my aunt had enough and drove him to the hospital on her own. turned out to be cerebral bleeding. he barely survived and is now mentally disabled.
this a) takes him out of the workforce, which looses the state money through reduced taxes and b) ensures him an invalidity pension, which costs the state money.
was it worth it to save the money? on paper it's the additional cost of checking N people who're having headaches plus the cost of treating M people who're actually affected vs. the money he would have paid into the system plus the money he now costs the system over, say, 20 years. additionally he consumes less and his wife's business is struggling because he's not much help anymore.
for us, personally, it's still a tragedy, but those cases happen. you have to draw the line somewhere. it's not just additional costs though, it's still a trade off.
Older doctors might still give you referals to specialists or radiographers upon request, and check every tickbox on a blood test sheet, but younger doctors are tought that every additional test puts strain on the solvency and labor capacity of the health care system, and will not have irrelevant or unnecessary tests performed.
In Belgium, MRI and CAT scan capacity is limited, and you can't have an MRI on a whim - you need to be referred by a general practitioner to get one.
No. If you see bad outcomes from wrong incentives, come forth.
Sorry, but this is hard to believe. The use of XRays for minor injuries is not standard anymore. Not only for cost reasons, but also for the still unclear situation about increased cancer risk due to xrays.
Mass screening of healthy men for prostate cancer is probably more harmful than helpful.
The Affordable Care Act was not proposed as some "left", "socialist" initiative. Mainstream America as a whole -- including the "conservative" side, business, etc. -- was clamoring for some sort of effective control on health care costs.
Then, the Republicans made it a political issues. They "lost", and they weren't having any. All their rhetoric and obstruction, not of a "liberal", spendthrift proposal, but of a middle of the road plan that would provide, per their worry, a perceived "win" to the "other side."
Once the ACA was passed -- in its further compromised form -- they did their best to kill it via the budget process / spending, which is a separate activity under control of the legislature (House and Senate). Facets written into the law, such as adjustments to control insurance losses during an initial, transitory period (the demographics and so costs of the newly enrolled not being known in advance), simply were not funded.
That America doesn't have fair, cost-effective, productivity enhancing health care, is a function of political self-interest. And, in a Democracy, said politics are tied back to the electorate, however imperfectly.
Republicans lied about health insurance. People bought the lie. Now we are living it -- ever more.
P.S. Not to mention, blocking actual cost-controlling measures at every chance.
By the way, for all the complaint by insurers about their "losing money" on the ACA, as I understand it, they've seen significant savings due to the ACA in their traditional, employer group plans. Are those mentioned and factored into the rhetoric about the ACA?
Health care in the U.S. is indeed in crisis. At this point, it comes down to a simple trope: If you're not part of the solution, you're part of the problem.
The ACA bashing pols are simply part of the problem. Witness their inability to offer up an alternative of any substance.
P.P.S. In other words, I don't give a flying f-ck whether you are "left" or "right". You make progress towards solving the problem, or you don't.
And, I see it both as a economic and structural problem, and as a moral problem. A "moral" Right that is content to leave its fellow citizens suffering when resources and remedy are at hand (and this country can certainly afford them, in the dollar amounts estimated, if it makes the decision to), is not moral. It is merely hypocritical -- at best. I might contemplate using the word "evil".
I was staying in a remote house, miles from the nearest village, an hour from the nearest hospital. After about four days of continuous vomiting in 40 degree heat I caved and called a doctor, in the hope of getting a prescription for antiemetics over the phone. It's Sunday. I figure it's a long shot but can't hurt.
Well, I call and she says "sorry, can't give you a prescription over the phone - but the doctor will be with you in ten minutes". I was sat there expecting a call back when the doctor shows up at my house. Checks me over, says I need IV fluids pronto, do you want an ambulance for €20 or do you want to get yourself there.
Wife gives me a ride to the hospital an hour away. The place has recently undergone big budget cuts so they've mothballed a big chunk of it, and it looked a bit sad, but inside everything was new and clean, and I'm seen within a few minutes of arriving. By a consultant surgeon who was called in to arrive a few minutes before me. I'm given fluids, blood tests, a CT and an MRI, and about six hours later an functioning again, and they're saying I can stay or leave, my choice, and here's a folder of information for you to follow up on back home.
All of this cost less than €60, and I honestly felt like I had all of France mustered and rallied to my care.
I had a similar experience earlier this year in the U.K., and the contrast was significant - in the U.K. one feels like an irritation and an inconvenience. "Bloody hell, what's a patient doing here? This is a hospital!". I still got decent treatment, of course, but it was all with a grumbling, discontented overtone - and despite it being a new (15 yr) old hospital, unbelievable amounts of equipment didn't work. There was a diabetic guy on a sugar monitor/drip on my ward that kept crashing - so their solution was to have him wake up and reboot it every 20 minutes so he didn't die. They didn't have another one available.
It's just astonishing to see how two supposedly similar socialised healthcare systems can end up so very different in their output.
I'm 50. I remember what London was like way before Labour first got into power.
Lets look at today. Immigration is way out of control. London has probably 10 million people? It's busting at the seams.
I even travel to the south near the beach. Waiting for a doctor there? Sometimes up to a month.
I can remember when I would call a doctor and be seen the next day. Not any more.
The reason for the attitude is that doctors and nurses are at breaking point. I'm sorry if the down voters don't like hearing this but it's true.
Incidentally I voted to leave. But I think it's too late. We should have left before Labour got into power with Tony Blair. Like the Democrats in the US, they wanted immigrants from all over to change the political landscape and keep them in power. Regardless of native population.
I'm not even going to venture to disagree with you, I'll just provide those facts.
You're being downvoted to unreadability anyway, but I feel I should clarify this just for the sake of people who are unaware of it: immigrants to the UK don't get a vote in parliamentary elections and therefore Blair's Labour could bring in the entire population of Asia, he still wouldn't have got a single vote out of them.
And he couldn't have just given them all British citizenship either: in general one needs to have residence before being elligible for citizenship.
Residency is obtained automatically after five years of living in the UK (if you can prove it anyway). Parliamentary elections happen every four years. We now have a Tory government, the second after ten ish years of Labour. Clearly, if Blair had a cunning plan it wasn't cunning enough.
And even if the numbers don't move you, think of it this way: if immigrants had any say in the governing of the UK, the country would not have just jumped off a cliff with a weight tied around its neck (a.k.a. Brexit).
We simply don't spend enough on healthcare. We have an ageing population with increasing medical needs, but our spending hasn't increased commensurately. As more people reach retirement age, the ratio of workers to pensioners falls. We don't want to pay more in tax, so inevitably we'll end up spreading our resources more thinly.
There are a number of problems with this statement.
First, immigrants are overwhelmingly young and healthy. They are overwhelmingly in work (and therefore paying National insurance....)
So, to answer your questions directly:
1) you can't get an appointment because GPs are either going bankrupt, or retiring faster than they can be replaced.
2) Baby boomers are all starting to succumb to chronic problems like diabetes, cancer, dementia etc. This costs a very large amount.
3) Diabetes costs 20% of the total NHS budget[1].
3) Social care budgets have been slashed, which means that old people come in to hospital for X, go home too early and with no support and come back with either a compound fracture or pneumonia.
4) The increase in NHS demand is 4% annually.
5) the "funding increase" comes from the cut in community & social care.
6) the degradation is entirely down to the lack of funding since 2010
[1]http://www.nhs.uk/news/2012/04april/Pages/nhs-diabetes-costs...
So they have socialised health care and they also fund it very generously.
https://en.wikipedia.org/wiki/World_Health_Organization_rank...
There's a lot of talk about privatisation of the NHS, but personally I'm really not ideologically attached to the idea of a state-owned health service provided coverage is still universal and free at the point of use.
We see a lot of private provision via the NHS (NHS patients going into private hospitals) in mental healthcare, and it's almost all lousy. (Even worse than the NHS MH care, and that's saying something.)
When you have 1 million patient contacts every 36 hours the gap between "good enough" and "good" is a lot of people and a lot of harm.
Infact most of the NHS is being deliberately underfunded. Its partly what the junior doctor strikes about.
I agree that there are severe problems with the Welsh NHS.
For details on the French system see The Healing of America by T.R. Reid. It also covers the U.K. and several other countries.
British people have both a strong sentimental attachment to the NHS and a strong aversion to taxation. They're willing to overlook the flaws of the service if it means they don't have to pay more for it. I can't say it's an unreasonable position.
http://data.worldbank.org/indicator/SH.XPD.PCAP
- Severe diarrhea accompanied with excruciating abdominal cramps (hot knife w/ twisting, etc)
- Call ambulance. Taken to Saint-Anne within 15 minutes.
- Given IV fluids, pain-killers and anti-spasmatics
- Released one hour later; was able to walk home (I live near Denfert-Rochereau)
- Total time in care: 2 hours. Total bill: 0 (after reimbursements).
Say what you will about France, but they care for their own.
There is little evaluation of physicians so picking a hospital is very much a lottery, unless you know insiders who will tell you where to go and not to go.
The system runs a massive financial deficit.
It is run in an administrative way which creates odds behaviors. For instance department allowances based on % of occupation of hospital beds, which lead them to keep people overnight unnecessarily to preserve their budgets.
The system is very liberal in term of allowing you to see specialists. That's great in certain ways. The UK suffers from the opposite, where generalists' job seem to be to prevent people from seeing a specialist. But it is also a paradise for hypochondriac patients who will do dozens of useless exams subsidised by the tax payer.
Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
There are always variations, obviously but in general we have pretty good doctors AFAIK. If anything we don't have enough of them. I'm not sure how it relates to the article though, would a more liberal system improve the average quality of hospitals? Are US hospitals and doctors offer better service that the french ones? I'm really asking, I honestly don't know about that.
>The system runs a massive financial deficit.
It's still pretty massive but it's steadily shrinking these past few years, although parts of it might be caused by degrading the service slightly.
The government plans for a balanced budget in 2017, although the opposition says it's not completely true: http://www.publicsenat.fr/lcp/politique/budget-securite-soci...
This article gives a good overview of the situation as far as I can tell: http://www.lemonde.fr/financement-de-la-sante/article/2016/0...
>Like many centralised etatic system (and particularly in France), friends in the right places, political affiliation and freemasonry are more important drivers for a career than medecine.
What does that even mean? You went full tinfoil here. Whose career are you talking about anyway? Do you have any source?
I am not sure it is a liberal vs non liberal. But doctors like any profession need to have a way to be evaluated. It is a fact that there are good, average and bad doctors (like any other profession). I understand that in the US, insurance companies play this role. They are maintaining detailed statistics of acceptable success rates and will apply pressure when they see physicians underperforming.
On careers, I come from a family of doctors, so it's rather a long succession of first hand anecdotes than articles. Careers in public hospitals are very much driven by these things at a more senior level. I'm afraid no tinfoil there.
French person here. Although the deficit of the healthcare system is often pointed at by the media, it is far from "massive". From [1] translated in English:
"This budget is in deficit, (...) but this deficit is far less than the budget of the State. In 2011, the deficit of the Social Security represented 2,66% of its total budget (11,7 / 440,8 billions €) compared to 45% for the State budget (92 / 200 billions €)."
I'm not saying that it's OK to have a deficit because the State deficit is bigger. But we should keep orders of magnitude in mind (the French budget would be in super-duper-massive deficit then?). Plus, as you can also see in [1], the deficit is shrinking since 2010 and getting close to zero.
Yes, there are some optimizations possible in the French Social Security. I can't find the source anymore but the cost of running the public Social Security is lower, in percentage, than French private healthcares (if my memory is right its 8% vs 25% of the total budget of each organization) It is not hard to imagine that economies of scale play a major impact for this.
[1] https://fr.wikipedia.org/wiki/Budget_de_la_S%C3%A9curit%C3%A...
Sometimes things cost money. I imagine that keeping the country healthy is a plus.
Not to say that making improvements isn't a bad idea, but a cost-centric view on things almost always ends in bad decision-making. Decisions based on revenue generation, instead of the "real" objective (keeping people healthy).
It highlights a core difference between one of the two most "advanced" places in the western world.
For us Europeans, we don't even think that free healthcare, free education ( university included ) , and free state support when things go wrong is a right.
It is a as essential as a core human function as breathing and blinking. We don't notice it, it's just there.
And most of us are more than happy to pay higher taxes in order for us ( or our fellow citizens ) to enjoy these.
Granted , our taxes could be better managed, institutions could be more efficient, and governments less corrupt. But until someone shows us - with long term data backing up these claims - that there is a better alternative , we will keep giggling .
La Fac is one of the worst places to get an education though.
what is a "fac mindset"?
I guess what the parents refer to is that Universities in France are not as elitist as in other countries; the most prestigious higher education public schools are often considered to be the so-called "grandes ecoles" (engineering schools) or some specific administration/economics schools.
And then there's the 'diplomas for all' aspect which incentivises the faculty to reach out and lower the barrier of passage into the next year, with obvious consequences....
(+) oh the humanities, mostly
While it is true that there are some very bad Facs and cursuses, dissing 'La fac' altogether seems a bit harsh
I never know why people rate these rankings so highly when there are such unimpressive metrics like these.
Not to mention that this particular ranking does not seem to consider education at all anyway, which is what the GP was talking about.
You can even put a market spin on it: None of the risks involved in starting a small business in Australia have to do with health care for myself, or for people who might consider joining my small business as employees.
I've never felt as if I'm giving up autonomy or surrendering to the yoke of the state or whatever. Public universal health care gives me freedom. From and for so many things.
Oh come ON, Internet...
Note: that person may be you, depending on taxation
So yes, that's precisely the trade-off. We accept to lose a little bit of money in exchange for the ability to flourish.
But you lose the freedom to decide.
That's also why it's important to call taxation for what it truly is. Until people can be born free without automatic obligation to the state to provide for "your freedom", then they're not really free. That is the only freedom that matters and is definable outside of feel-good politics. So lets be honest: I'm losing the "Freedom" to spend all my money how I choose, so you can be free of the worry that certain "bad" things may happen to you.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
How are you "free" when you're being scammed by your insurance companies and hospitals into paying more than twice what you should be for your inferior healthcare?
If there's really a scam, people could make good money from it.
http://insights.som.yale.edu/insights/why-is-healthcare-so-e...
People do. Generally wealthy people. That there is so much money being made in the healthcare industry is a large part of the problem.
I like to think of western-europe as an all-in or full-service country. Maybe you pay a bit more, but you get way better service, and by not having to decide and buy yourself you're left with more of what's really important: free time.
Most of what is state provided is fairly high quality: from health-care, to education to infrastructure our government does a pretty good job.
Keep in mind that there is even more leverage, as people who are only employed to take care of the elderly, the young, ... make up a significant part of the workforce and shouldn't be counted as employed for this purpose (a geriatrician, a teacher, a nurse, ... is paid from taxes to take care of non-workers, that means he doesn't contribute to the economy). Therefore the numbers in Australia, are about 1 for 1 (ie. tax rate of just shy of ~50%), in Europe the numbers are really about 1 for 3 (ie. total tax rate of slightly over ~75%)
But even in Australia it's essentially over. Australians should have started to have way more kids about a decade ago to prevent what's now pretty much inevitable. Although once again Australia gets to sit back and watch what happens in other economies before it's forced to take action itself, like in the financial crisis. It should do well. Doesn't change the outcome though : taxes in Australia will have to rise to halve your post-tax income over the next 2-3 decades. In Europe ... let's not go there, taxing at 100% would not allow for enough economic activity to support the pensions and healthcare at the current level of provided care. Dedicating all economic activity in the EU to just that single purpose is ... not enough. Therefore, elderly care and health care will have to scale down, a LOT (and may God help them if Trump follows through on forcing Europe into defense spending). The basic problem is, the lower the working population gets the more massive the advances in productivity (the economic kind) have to be. There is a slight issue with that:
http://www.tradingeconomics.com/european-union/productivity
(I've had healthcare in both Europe and Australia though. Let me tell you, Europe is better. Though I guess it does greatly vary based on the exact location)
A simplification that has been valid for pretty much the entire 20th century has been that a given labourer has a given productivity. So I assume that if we have 2 young people for every 1 old person or child, for example, that the economy would work to make that actually happen. This is not guaranteed, of course, but historically this worked.
As for the productivity measure you mention, that's not what I've seen in the data. Productivity measurements rose for most of the 20th century, then flattened across the world starting around 1985 or so. There has been little to no productivity rise in the US since 2000, and most of the world is worse off, with the notable exception of China and some smaller parts of Asia.
Lack of inflation rises are masked more than a little bit by government fudging. By the inflation measures of the 1980s we've consistently seen 3-4% inflation in Europe (except in the south). The measure currently used in the US is called "PCE deflator". You should look up why it's called that.
I am now a net beneficiary but for the first 30+years of employment I wasn't that's how it works.
Everyone's on the payer side of the bills. We're happy being on this side.
If you pay 10 dollars and get a car while someone else pays 100000 and get the same car you're on the receiving side.
Though you may have heard politicians in the USA profess their love of small business, in general, their actions are contrary to it. Both parties regularly do things which are good for big business, but which do hardly anything to 1. reduce the tax burden on small businesses, 2. reduce the paperwork/bureaucracy burden on small businesses, 3. make it easier for a larger percentage of society to engage in the creation of new businesses. Even though ACA (Obamacare) has been somewhat of a step in the right direction, it's still the case that if you want _good_ insurance, you better be part of a group healthcare plan (i.e. not an individual plan.)
keep in mind that this is not a given in all EU countries. In the UK (still an EU country, though not for long) one has to either get a student loan from the British state, or cover their own tuition fees.
It doesn't show up on your credit report, you can't miss a payment and damage your future creditworthiness, and lenders don't include the value of the loan when calculating your total indebtedness.
It's much closer to a graduate tax than a personal loan for mortgage purposes.
http://www.moneysavingexpert.com/students/student-loans-tuit...
And I do think some people are put off by the debt-ness of it, but that's very tricky to measure.
You do know that there's (currently) literally nothing stopping you from getting your degree in those EU countries, right?
Then there's the plausible scenario of having to apply for a visa in a hurry if the Brexit balloon goes up.
One, why tax graduates? In other EU countries, free is free as in beer and you never need to pay anyone anything, for higher education.
Two, why double-tax the future workforce? I mean, they'll pay taxes once they start working anyway. And obviously, those who do go into higher education will end up making more money, and therefore pay more taxes. The state will get back its penny'orth alright, so what's the point of adding a cherry on top?
Full disclosure- I'm from Greece originally but graduated from a UK university, and am repaying a tuition free loan, to which I was entitled as an EU citizen; so personally I benefit from the system (because I'd probably not be eligible for free education anyway). It still doesn't make sense to me.
I once chatted with a US girl thinking about going to college, IIRC one year there was almost the price a full fledged private school 5 year cursus. We both went silent for a minute.
Many people in the UK fear for the life expectancy of the NHS. It's featured in the media very often. Ditto welfare benefits.
We pay for dental care and prescriptions. Hospitals and health centre are closing left, right and centre. Benefits are being slashed in cruel ways. Many have private health care through their employers. Kids are leaving University with £40,000+ loans now.
:(
Just a few examples:
- https://www.theguardian.com/society/2016/oct/15/bma-theresa-...
- http://www.huffingtonpost.co.uk/dr-zoe-norris/nhs-cameron-hu...
- http://www.thetimes.co.uk/tto/health/news/article4713380.ece
- https://www.ft.com/content/35a3e764-705a-11e6-a0c9-1365ce54b... (or without paywall: https://www.theguardian.com/society/2016/aug/31/bma-announce...)
Other articles were written by doctors in the NHS, what they had to say didn't sound good at all. But the problem is that the government wants to abolish the "socialized" system and mishandles it (deliberately, as many article writers claim).
The total cost: 250 euro out-of-pocket The cost of one sonogram in the US: $1500 (before insurance)
Healthcare in the US is a byzantine protection racket and very potentially a means to mass surveilance beyond the scope of public health.
But there is fishy stuff going on too...
1 liter sterile bag of saltwater for intervenous use in American hospitals is charged at over $300, not considering the cost of the procedure, which can total $500.
The pharmaceutical industry also does some sort of disservice to society by inflating prices so much.
Then, some money stays at the insurance companies instead of going to actually improving healthcare itself.
I'm guessing - but I do not think it's a good thing when people who make the purchasing and oversight of things are far away from the actual practitioners. It leaves a lot of room for different kinds of shenanigans, fraud and sub-optimal choices. I think that applies regardless if you're for Private or Public health care.
[1] http://www.svt.se/nyheter/lokalt/stockholm/landstinget-kopte...
It's nuts.
And if you want physicians to make 100k - 150k, don't expect me to work 80+ hours a week, not including call. Attorneys give me $500 / hr for consultations, but in my real job I make $80 / hr, but just work a ton more hours a week (no overtime bonus, tho). I don't get sick days. I don't get vacation days. When I don't work, I don't get paid. When I was in private practice, when I didn't work, I not only didn't get paid, but still had to pay rent / malpractice / insurance / electric / employees which was about $5000/week for me. So taking a week off cost me lost revenue and $5000/week. Medicare pays $600 for taking out a gallbladder. Do the math to see how many have to be done to take care of the bills.
How would you improve this system? Do you think universal healthcare would help?
Imagine if medicare started receiving payment at age 20. By the time someone turned 60 the return on investment / interest would more than pay for their care. Insurance companies don't want the average american to know that. I think that either 1) offer medicare plan for anyone, regardless of age and discount based upon years of contributions or 2) make insurance companies allow individuals to pay medicare rates once they turn 65 if they've participated for, let's say, 15 years.
I'm almost 50 and have used less than $400/year since 21. Yet, I pay $4400 for a $6000/deductible plan. So I've given my insurance companyn $100k at least in my lifetime. But when I turn 65, all my care will be covered by medicare. Trust me, I know what symptoms to say and may have multiple bad symptoms from age 62-64 and undergo lots of tests, instead of medicare paying for preventive tests.
The system is broken, but so is politics, so nothing will change. Even Trump ran under the pretense of allowing us to buy pharmaceuticals overseas, allow purchase of insurance plans across state lines, make hospital costs transparent ---> all that would lower costs, but apparently, they won't happen.. Just like with the democrats. The US healthcare system is controlled by the pharmaceuticals, suppliers, and hospitals and nothing soon, other than a Bernie Sanders, will change it. The 3 competing hospitals in my area, serving less than 1million people have a CEO cost of more than $7 million! So across the US, I would imagine that total CEO cost is in the billions.
I don't have solutions, only depressing facts.........
My brother broke his leg horribly a few years ago. Ambulance, helicopter, plane, 3 surgeries, a month in hospital, steel plates, etc. etc.
In Australia, you don't pay a cent out of pocket for that, it's all covered with taxes.
Similar story in Canada too. Even little stuff like I broke my nose - into hospital, xrays, time with dr to straighten, appointment a few days later to check, etc. All free.
The difference is simply that Health Care is run for profit in the USA. Someone wants to profit off your health (or lack thereof) so you must pay a lot of money to line their pockets. Some story for Higher education, incarceration, etc.
For one thing, some care are very expensive, like dental crowns and implants. In the article, the author says he had to pay 1300 euros for 47 days in the hospital. You're likely to pay more for one dental implant, unless you have a very good insurance in addition to the regular social security (most people don't).
If you have to go to the ER and if you don't have a life threatening condition, expect to wait many hours in an overcrowded waiting room. Moreover, to see some specialists (e.g. eye doctor), you may have to wait for months to get an appointment. The list goes on...
About the decreasing quality: there is a clear pattern where, you cut financing of public resources and, then, you can show how bad they work and how best a private system would be.
It feels like it's purely because of government limiting the number of optomitrists. It reeks of some doctor's association lobbying the education ministry to keep the incoming number low (there's a hard limit set by the gov't on the amount of people who can study medicine).
For comparison, in Tokyo I can walk into any optometrist office without an appointment and just wait 15 minutes or so
I think it's along the lines of "Why should I pay for someone else's healthcare?".
I've heard similar arguments from British people (I'm rather more socialist in my outlook than average, for a UK resident, I fear) and I don't really have an answer to that. Why indeed?
I'm probably conditioned to answer this with a "duh, because they're your fellow citizens". But I guess that's not everyone's cup of tea.
>and I don't really have an answer to that. Why indeed?
Because you don't know what is going to happen in the future. One day you may wind up broke and be diagnosed with a serious illness. And what about any children you may have. Wouldn't you like to know that they will receive care after you are dead no matter what is going on in their life?
And in the past I was very young and couldn't yet fend for myself. I benefitted from being born in a developed nation and, like you say, if my parents had died while I was young, I'd have been taken care of (though in my country's case it would probably be my extended family that'd have looked after me, first, and the state would only intervene if I had noone to care for me).
Like, I totally get what you're saying, but a significant number of people don't see it that way. Maybe they forget they were once too young, or that they will one day be too old. Maybe they just think they can do well enough for themselves that they'll just wing it.
My point is that for many people contributing to things like public healthcare doesn't make sense.
For instance- in the UK education is not free, and you will hear lots of people saying, indeed "why should I pay for someone else's education?". That's much more common than grumbling about having to pay for the NHS, but in the end it's just the same thing.
Do you really want people to actually DIE? I hope not and that you'll rather pay "for someone else's healthcare" than to see them suffer and if YOU are ever bad on your luck and need the help, I'll gladly pay for your healthcare if you need it, because I know that you paid into the system when you could and now we're just paying you back.
I am already paying taxes for a lot of things that I may not want to anyway, like overbudget defense spending, over the top salaries for MPs, failed research, government websites that cost way more than they should and other initiatives that nobody asked for, financial support for hugely profitable multinationals etc. etc. - if I am paying for that, OF COURSE I'll pay into a system that will help a human being when they need it and be confident that I or my family members can expect the same, should it ever come to it.
It always seemed to me that in the U.S. they're fed up with having to pay for an excessive budget, yet they always blame the wrong part of it for their high taxes - don't blame healthcare spending, blame the way it's implemented, blame the fact that over 50% of your tax dolars is spent on the military, blame the failed, overbudget F-35 project etc. etc. DON'T blame Flint residents who don't even have access to clean water - where's the logic in that?
Something I read on hn a while ago involved trying to place others who have had bad things happen to them in mental categories apart from oneself, to not have to deal with the possibility of bad things happening to yourself without any reason. E.g. a traffic accident, cancer etc.
With traffic accidents, is very instructive to see that people will reflexively think that the persons involved did something wrong, this removes the need to accept that life isn't safe and that our behavior often has little influence at all on wether bad things happen to us. I think it's the same with healthcare. The defense mechanism is: they got sick so they must have lived unhealthily - granted, there are a lot of things your behavior can influence: cardiopulmonary disease, some forms of cancer but not all of the tragedies of health that can befall you are in any way under ones control. By sticking together we can shoulder the burden of the few that didn't have any blame on their fate.
What I'm saying is that free healthcare and education (and other stuff like that) is a cost that civilised societies are prepared to pay to remain civilised, and it's weird that one such society seems to think very differently than the rest in that respect.
Some random thoughts:
You can never spend enough on healthcare. There is always new machines, new technologies, new drugs, new treatment types, better educated doctors we could spend our money on if we wanted to. Furthermore we are treating people earlier and earlier and for more and more things. The old saying that if you are not sick it's just because we haven't found the right diagnosis for you seems to be true.
In effect whether you are in a private healthcare system or a universal one whether you pay double or your get taxed 100% there will never be enough money for healthcare.
Now depending on whether you have private healthcare or public healthcare the way you measure it is completely opposite. In a private healthcare system everything is a potential profit center. I.e. the more people who are sick the more money can you potentially make.
In a public universal healthcare system everything is a cost center. You have a budget and you have to deliver to a politically decided standard.
Both have pro's and cons. To give you an example.
It took me 3 weeks to get a time with my dermatologist in Denmark, when i finally got it it was the day before I moved to the US. The Danish dermatologist found one they considered troublesome, but they couldn't themselves do the biopsy and I had to get a time at a hospital to get it.
I decided to wait until I got to the US ignorant as I was I thought it was just a question of formalia. But no I had to wait a whole month for my insurance to work (that is a whole other discussion for another time)
When I finally got it though, I got a reference for a dermatologist same day and they did the biopsy, same day. Today I am at Sloan Memorial with one of the best dermatologist in the world getting checked every 3 months having a complete 3d scan of my body (in blue speedos and a white net) and hopefully we will be able to make sure that I am being managed properly.
What I am trying to say is that the level of expertise a private healthcare system allow for is more flexible than a public one because it allow for the allocation of resources. On the other hand if you look at those let fortunate than me, with worse healthcare plans etc they will get a less favorable treatment. I.e. the system isn't evenly distributed.
What the public healthcare system secures is that it's mostly evenly distributed but with less of a flexibility to build experts as there are budgets and a bigger need for priorities in any publicly funded system as it's a cost center.
So you have fundamentally two system where one covers only those with insurance but allow them to potentially pay their way to the latest treatments with the best doctors and the other where everyone gets treated but you don't have the same amount of experts and potential treatments.
Neither systems are really optimal. Do we want to have people die because they can't get healthcare coverage or because they can't get the necessary treatment because it doesn't exist in the country they live. I know it's more complicated than this of course but in broad strokes thats at least my perspective and this has lead me to the following observations.
1) Both systems are fundamentally financially unsustainable in the long run. Whether the system succumbs to it's own weight by costing the tax payer too much to pay for everyone while only delivering average treatments or whether it's impossible for the insurance companies to secure a large enough part of the population without leaving too many without proper coverage. Both just doesn't sound "right" (I know Germany, and Switcherland have some variations that sound more right but I am not sure they don't fall into the trap of either the cost center, or the insurance cost issues....
This has not affected my personal finances and I only had to focus on getting better.
I would like to move to the USA but I have got to admit that it frightens me that this kind of issue would have costed me a lot and a serious health condition could bankrupt me.
This is not ok. It saddens me that USA have not been able to instore a sane health care system.
So you don't pay any kind of VAT?
That also wouldn't mean anything, if the State is not taxing you so much, but it still has money to finance these things, it is obviously because it is taxing other people a lot more and using the money to treat your health.
I would not find it very good to have my needs fulfilled with stolen money, as you seems to be finding.