Has anyone considered that perhaps the cost of treating Americans is going up, too? Notwithstanding existing understood market failures, etc., the growth in medicaid/medicare spending tracks the growth in obesity very well.
Well I mean being unable to afford to get your broken ankle re-set when it heals weird the first or spending a life in chronic pain or never getting treatment for sleep apnea etc... all seem like good ways to make obesity grow as a result of in ability to pay for medical care and a good way to eventually find your way to being on disability, poor and in poor health and then on medicaid/medicare.
So you know maybe it's a vicious fucking cycle.
Oh wait actually we know for a damn fact it is and has nothing to do with obesity: preventative care just keeps shit way cheaper that's half the point of the ACA forcing insurance companies to cover at least some of it (the other half being a basic belief in human dignity).
Like so many things that are broken in America, it's not one thing that's to blame - it's multiple:
People lives longer; more illness we can treat; growing administration; new expensive technology; few doctors; price gouging; anti-competitive behavior; malpractice lawsuits; lack of preventative care; uninsured bumping in and out of emergency rooms; and so on...
Some of these are successfully solved by most western countries. Some of them are quite plausibly not solvable.
As we have more technology and treatments to keep people alive, cost will necessarily go up.
Kenneth Arrow's seminal 1963 paper[1] is what started this line of argument. It's not very long, and most of the technical details are left to the appendix.
Classical economics mostly assumes that all participants in the market have access to relevant information to make the right decisions. Arrow's work on signaling theory really started economics on thinking about what happens when that assumption is broken.
As anyone who's worked with large distributed systems knows, putting information where it's needed is key to making it work.
The economy happens to be a large distributed system.
There is a burgeoning medical tourism industry (e.g. fly to India to do your surgery for a fraction of the price), but since the cost of airfare, lodging, food, etc. is at least a few thousand, there's competition with other countries only for well-understood procedures with large out-of-pocket expense.
Otherwise, how is the information relevant? Let's say you know that some medicine in the US is $1000 per month , but only $20 per month in India.
Well, if a patient is insured, then they don't care about the cost. If that drug is medically necessary, then the insurer has to pay for it even if they're getting gouged by the manufacturer.
We're getting the worst of both worlds in a way -- regulations to protect patients make it very difficult for insurers to negotiate on price, but then we also don't generally allow the government to step in and force lower drug prices directly. So in the pharmaceutical market, the US just pays higher prices than everyone else days; American consumers basically subsidize drug research for the rest of the world, including other developed countries.
This is definitely true, so far as it goes. For many types of medical care it is unreasonable to expect a patient to act in a price setting capacity on the demand side.
However there are many types of medical care where that is very reasonable! LASIK and cosmetic surgery are classic examples because they elective and have historically not been covered by any insurance. You can see cosmetic surgery prices on ads in the NY city subway. Other kinds of care, such as dentistry, orthodontia, and vision services, also have very well-functioning markets, largely because insurance has historically not covered these things. Lots of non-urgent care (primary medicine, pediatrics, dermatology, psychiatrics, orthopedics, many surgeries) would probably have well-functioning markets if they were separated from the insurance system.
Now, that's all the cheap stuff. The expensive stuff (hospitalizations, cancers, chronic disease) that makes up the bulk of the US health expenditure - yeah. You can't expect a patient to come in and argue with the doctor about whether they really need that saline drip. But in a properly functioning market, there is another entity that can and should (and does) act as a price-setter mechanism on the demand side, and that is the insurance company.
The problems show up when
1. there is only one supplier in a market
2. the insurer is required by law to cover a certain thing
3. the supplier does not face a price control, and through (1) and (2) has unlimited pricing power
This is very acute with prescription drugs. Even generic drugs sometimes only have one supplier because the process of getting FDA approval is so onerous. It is also very acute when you have hospital and physician consolidation within markets, so that medical suppliers can effectively act as a cartel.
So - deal with the supply side problems. Stop the cartel behavior. Make it easier to sell prescription drugs and open hospitals. Allow consumers to act as consumers when it makes sense (by excluding basic medical services from the insurance system) and reserve insurance for the risky, expensive, hairy stuff. This is the path forward, and it all follows very neatly from basic supply and demand.
I like your comparison to LASIK and cosmetic surgery, which I agree are functioning markets. But I'm not sure I agree with the rest.
There are two components to healthcare funding: (1) insurance which protects from the serious unforeseen health expenditures; and (2) healthcare, which includes routine health checkups, preventative care, and also, the very common ailments as one gets older. The two are somewhat inter-related (if you're generally unhealthy, you're more likely to have serious ailments), but makes sense to separate the two as separate products.
Even for relatively wealthy people, it's difficult to afford serious medical care out-of-pocket (it can cost >$20k/day in the hospital). So that's one product people can buy, with its own deductibles.
However, routine medical care that everyone needs no matter what is a different product, and the cost of that product could be more closely tied to the value of the services received.
Separating these two products may bring about more competition in each, and perhaps more efficiencies.
One large problem with making preventative care a separate market is that people who are too poor to get preventative care and get sick usually end up in an ER, where the rest of society ends up footing the bill.
And a sick person in the ER can easily cost tens to hundreds of times as much as the preventative care would have been in the first place.
So making preventative care mandatory actually saves everyone a lot of money in the long run -- even if the preventative care is run extremely inefficiently and poorly, it would still be cheaper than what we have now, which is socialized medicine that only kicks in after people get incredibly sick and expensive to treat.
Unfortunately, this article is very light on details and makes some assertions and comparisons without any serious rigor. I wish someone would publish something that were rigorous and easy to understand for the average reader. instead we have either this, or very dry and incomprehensible reports.
According to this article, the main culprit is keeping a for-profit health insurance system and addressing its shortcomings with ever increasing bureaucracy which adds more costs (bureaucratic complexity). I'm sure there is way more to it than that.
I'm in favor of single-payer, but the main argument against it is that in a government run system, there is little incentive to correct inefficiencies. In a private system, if you become inefficient, you'll fail and cease to exist.
Advocates of single-payer needs to at least recognize this issue and be able to account for it.
Oh look, another attempt to argue that market forces somehow don't apply to medical care.
In this one, the author makes the argument that "competition" leads to a proliferation of firms, a proliferation of firms leads to administrative complexity, and administrative complexity leads to additional cost. Supposedly, removing this cost would save us enough money "to provide health care to all Americans."
It is easy to attempt to verify this claim by looking at actual data.
OECD: "Administration of the US health system alone accounts for about 7% share of total spending. This is on a par with other systems such as France and Germany which also have multipayer systems (even if in some of them there is no or little competition across payers). In comparison, Canada and Japan devote around 4% of health spending on administration."
So, if we adopted a true single payer system, by this math, the total spend in the US healthcare system would drop by 3%. US healthcare costs have recently been growing by 6% per year, so this would bring our costs all the way down to where they were on election day, 2016.
Wait what? Your math is completely off. The 3% drop in administrative costs is not directly deductible from the 6% growth because that 3% drop would mean the growth would also be lower (since it's a %age of the total costs).
Jun 2016: US spends $100 on health care ($7 on administration)
Dec 2016: US spends $103 on health care ($7.21 on administration)
Jun 2017: US spends $106 on health care ($7.42 on administration)
--> US administration costs drops from 7% to 4%, saving $3.18
Now US spends ~$102.82 on health care
I also think that there's benefits that are harder to calculate. I switch health insurance often, and I always seem to have a bunch of healthcare bills to deal with.
Even just calling all the billing companies to get my insurance applied is a huge hassle, and when it comes due it can take a number of hours out of my day.
And occasionally, I'll get a bill from long ago that didn't have insurance applied, and it can be a big hassle all around.
The hassle and aggravation is almost certainly worse than the IRS that people are always complaining about (and rightfully so).
It looks like we spend a large amount more than every other country in every category they define, but the primary difference thing that makes the huge difference is we pay for specialists a lot more. Their conclusion is just that, well, the cost is higher.
My personal opinion is that it's because insurance leads to, basically, 1/2 of a market. We allow suppliers to set prices however they want, but we mandate that insurance buy the thing, which essentially gives them no negotiating leverage. (Worse: post-obamacare, we mandate that insurance co profits are a fixed percentage of insurance premiums, so they don't have any incentive to negotiate low prices anyway). The data showing "specialists are expensive", I think, is mostly just a historical accident; primary care and prescription drugs have traditionally been more sensitive to demand pressure because of the way deductibles and copays worked. I suspect that since primary care is now a required $0 copay service, in 10 years those costs will look aberrantly high as well.
How does our system not work as well as say Switzerland's system? After ocare, we're closer to their system. Also history? I admit I'm not super knowledgeable about this.
> We allow suppliers to set prices however they want, but we mandate that insurance buy the thing, which essentially gives them no negotiating leverage.
As far as I can tell, it's the opposite -- insurers have the most negotiating power by virtue of aggregated information about pricing and services and a revenue stream that's subscription/toll rather than service.
Patients are limited in their power to negotiate with providers by some combination of largely inelastic demand (nothing's more valuable than life itself, full health or as close to it as possible is a close second) and a lack of expertise (how do you know what you can forgo or substitute?).
Providers are in a better position (and generally do somewhere from pretty well to very well), but often carry heavy investment costs and must continue to provide services to collect fees.
> mandate that insurance co profits are a fixed percentage of insurance premiums, so they don't have any incentive to negotiate low prices anyway
This is only true to the extent that (a) they've already maxed out that profit and (b) don't have any other constraints. When you're suddenly forced to community rate, have new customers who've probably been under/uninsured joining your pool, have new care requirements to meet, dealing with an absence of lifetime limits, and limited in your ability to raise premiums without approval among other things, there might well still be financial incentives to reduce costs.
Secondly, other countries have more doctors and hospital beds per patient. That whole refrain about "we get better service for the money" really starts to sound hollow when you realize that, at some point, everyone having a hospital bed is better than half the people having a super amazing hospital bed.
yes administration is part of the cost. but when single payer healthcare means that you get two things: full coverage and full regulation. in most single-payer systems, the government is a monopolist of healthcare, and it acts as a price-setter. In the OECD article you linked, the next page explains that high prices are the main reason for expensive healthcare in the US.
OECD: "Leaving aside spending on administration, the high level of spending in the United States may be due to:
The cost (or price) of health care being higher in the United States than elsewhere
The United States providing more health care – more doctors’ appointments, more surgery, more
drugs, more diagnostic tests, longer stays in hospital – than in other countries"
The government would do away with insurers, you would pay $50 straight for a broken arm or whatever, everywhere, at every hospital.
The fundamental point is that incentives are horribly misaligned between making money and providing health care the way the current system works.
Try having a pre-existing condition before ACA - no one will insure you because you're too expensive, or your premiums go ridiculously high. Think about that. The people who need insurance the most were denied it - this is perfectly in line with market forces of course because its cheaper. The other alternative is to believe healthcare is expensive for everyone because the healthy subsidize the ill, but oops if you're ill your costs are astronomically high anyways and insurance companies will fight you tooth and nail over expensive claims, so that doesn't hold much water either.
If you want to talk data look at spending on health care vs outcomes [1]. If market forces were working so well maybe we wouldn't spend 2x - 4x more than other countries with worse life expectancy to show for it? We can argue over where the money is going but its clear theres a lot more of it going in for worse outcomes coming out than most of the world.
Honestly, seeing that if you don't see ANY contradiction or perverse misalignment between the ideal goals of a health system and the current system, you must be a very healthy guy.
> Try having a pre-existing condition before ACA - no one will insure you because you're too expensive, or your premiums go ridiculously high.
Insurance is paying someone (the insurer) to take ownership of a risk from you (the insured) by compensating you if the risk is realized. If the risk has already been realized then, of course, no insurer will be willing to take ownership of it for less than the cost of the compensation.
The system we have today can hardly be considered "insurance".
Yup. There's a very real issue of people conflating health insurance "coverage" and health care coverage. The ACA doesn't ensure care, it ensures insurance coverage. Many people may now be able "afford" insurance coverage but just as many or more still can't "afford" care.
> There's a very real issue of people conflating health insurance "coverage" and health care coverage.
The Essential Benefits defined in the ACA guarantee that, within certain bounds, that isn't an inaccurate equivalency. It's true that every version of then Republican modifications characterized as “repeal and replace” has not only attacked insurance coverage but also made insurance coverage less likely to be care coverage, so it's certainly important to recognize the difference.
Price discovery requires the ability to price some customers out of the market. For serious healthcare (the only kind that costs a lot of money) that means life-long disability or death. There is no such thing as a free market without the ability to set prices for maximal profit (vs maximal coverage).
BY DEFINITION a free market in healthcare MUST kill people (or allow them to die of treatable diseases if you prefer). Period. Full-stop. Do not pass GO, do not collect $200.
A free market means if you are unlucky and born into a poor family, get bonked in the head, and have a retinal detachment then you should go blind. Despite the massive dead-weight economic loss to our society of converting an able-bodied person into one with a life-long disability, if you can't pay for retinal re-attachment then fuck you buddy.
I wish all your free-market healthcare proponents would address this fundamental inescapable fact. I suspect most don't because the idea is repugnant and the argument falls apart. Please don't bring out the charity canard. That's largely how our system functioned in the past (and still does for some people thanks to states refusing Medicaid expansion) and it simply doesn't work.
I don't want to live in a society that so prizes the god of free markets that it is willing to let people suffer and die of completely treatable diseases. I'm happy to seize as much money as required from whoever is required to make non-elective healthcare free for all citizens. Fortunately a minor tax on the top 10% along with a larger tax on the 0.1% is more than enough to cover healthcare. As a member of the top 10% I say that knowing I will pay higher taxes.
> BY DEFINITION a free market in healthcare MUST kill people
I'm not sure this is true. Does a free market in food require that some people starve to death? Right-wing ideology says that even the poor have enough to buy food, clothing, shelter and medical insurance. If a poor person buys a mobile phone instead of health insurance, it's because they value the phone more than their health - why should you force someone to buy something that is less valuable?
Perhaps you argue that the poor don't have enough money to buy health insurance. In that case the right-wing answer is to give the poor money with which to buy whatever they prefer. Hypotheically everyone could buy health insurance and noone would die of treatable diseases.
Please cut it out with pretending the poor prefer to buy a cellphone instead of health care. The most expensive phone on the market, the iPhone, costs less than one month of health insurance premiums. And most poor people aren't using iPhones - most are using Androids they bought for a few bucks on a plan. That is to say, a modern smartphone costs the same as a landline phone of yore. That's not even getting into the whole discussion of their smartphone is typically the only computer they have. Try navigating our healthcare system without a phone or a computer. Good luck with that.
Actually I'm not pretending anything - I'm just stating the right-wing, free-market ideology. I happen to support a single-payer healthcare model because it will reduce overall health costs and maximise long-term GDP. But let me play devils advocate for a minute and respond your your comment about smartphones:
Nobody is claiming that a smartphone would pay the full cost of a persons healthcare. But it would pay for some health insurance - perhaps two or three weeks, by your count. (And don't confuse this with internet access: A 5-year-old smartphone with a cracked screen costs next to nothing on eBay). Therefore anyone who buys a brand new phone - either outright or on a contract - has given up the opportunity to buy a few weeks of health insurance.
And there are many other similar opportunities for poor people, including:
- If you buy branded goods like Nike or Adidas, buy non-branded clothes and shoes instead
- If you drink or smoke, stop
- If you are overweight or obese, eat less
- If you buy food from convenience stores or restaurants, stop. Instead, make a weekly trip to Costco or Walmart and buy food in bulk.
- Change your diet to the cheapest foods that still provide nutrition. For example, maybe potatoes are cheaper than bread and just as healthy. Don't like potatoes? Too bad.
- Typically the best-paid jobs are in a city or town center, while cheapest accommodation is far away. So if your total weekly commute and work time is less than 60 hours per week, live further away from your job to increase your commute time and decrease your rent or mortgage payments.
- Look up the top 5 cities in the US with the highest wages and lowest unemployment, then move to one of them.
- If there are less than 2 people per bedroom in your household, take in a paying lodger. If your landlord doesn't allow it, move. If you are a single person then move into a 3-bedroom house with 5 other single people.
You may think that these opportunities are not valid, or that they still would not pay the full cost of health insurance. In that case the right-wing solution is to give money to poor people - and not to force them to buy health insurance or provide government-run healthcare.
Well strictly speaking the free market would say "you're on your own, you're not our problem". And then you'd hopefully look cute, and do some neat tricks to get a benefactor to voluntarily help you pay for your needs. Otherwise, sorry, the needs of the many outweigh, you.
The reality is, the only thing that makes for-profit free market people alter their perspective, is if they or someone they care about gets really sick and is subject to the bad aspects of the for-profit system. It's like anti-gay uncle who finally starts to moderate once he learns he has a gay nephew. Oh really, hmm, guess I need to moderate my total ignorance of the complexity of the world and things aren't so simple afterall.
I attribute this to lack of imagination identifying with other people. People confuse that with feeling sorry for others, or pity. John Rawls "veil of ignorance" thought experiment should be a political test. If you aren't willing to imagine yourself or a family member directly subject to the deleterious side effects of policies you want made into law, you're incompetent. Instead of having "regular Joe Bob" as politicians, they should be professional, interdisciplinary, ethical, and be auditable.
Your math is completely wrong, though not in the way the other poster said. You're making the classic mistake treating percentages as though they add and subtract when they really multiply.
> "So, if we adopted a true single payer system, by this math, the total spend in the US healthcare system would drop by 3%. US healthcare costs have recently been growing by 6% per year, so this would bring our costs all the way down to where they were on election day, 2016."
Assuming the numbers are right, if we adopted a true single payer system, costs would drop from 7% to 3%, a 42% reduction. After such a reduction, the spending would take nearly 10 years to grow back to whatever its original dollar value was at a 6% growth rate, not 6 months.
In summary, respecting "market forces" acting in a market created by the people, for the people is more important than ensuring peoples health - arguably the most basic of human needs... right. ALL HAIL THE FREE MARKET WOO.
What are you talking about. Health is the definition of inelastic demand. Then add the almost missing negotiating powers of a single consumer vs an insurance giant and you have a very efficient system for those on the supply side of the equation and a death sentence for a lot of people on the demand side. The American system is efficient only for health insurance companies and no one else.
Given that countries with single payer systems achieve similar or better life expectancy outcomes for in most cases half the cost of the US system, I'm inclined to believe that you have no idea what you're talking about. The US system is literary the only first world system that's not working.
Some people are questioning your math - I think this is due ambiguity in the expression, "Administration of the US health system alone accounts for about 7% share of total spending". My initial thought was this meant 7% of GDP, but it seems the OECD article means 7% of health spending.
> So, if we adopted a true single payer system, by this math, the total spend in the US healthcare system would drop by 3%. US healthcare costs have recently been growing by 6% per year, so this would bring our costs all the way down to where they were on election day, 2016.
But with the "true single payer" system you mentioned, everyone would be covered, and have equal access to care?
Including the ~28 million Americans without care?[1]
How much competition is there in health care, really?
An oligopoly controls most of the insurance market, another oligopoly controls most of the hospitals, and medical schools openly collude (through the AAMC) to limit the number of doctors.
All sanctioned by a government run by politicians funded by these organizations.
Exactly. That's not an exactly free market to operate in to begin with. Contrast that with the software/hardware markets, or even consumer goods markets, and the difference in terms of outcomes is pretty obvious. The problem with healthcare is that there is no direct "pay for service" system. It's all a mix of insurances, hidden costs, complex pricing systems (with little to no elasticity once fixed) defined by governments and third parties that have nothing to do with the end user.
Agreed that it's not exactly a free market right now, but pretending a truly free market would improve things is a little ridiculous. If you fall off a ladder are you going to be shopping around for a good price on an ambulance ride, calling ER's to get the best deal, etc? That assumes there is more than one hospital nearby, more than one ambulance company, etc. Much of the country only has one nearby ER. What happens in a "free" market when you absolutely have to purchase something from a monopoly?
it would anyway benefit from being more Free than it is right now, no need to go into philosophical hypotheses of what fully free markets would look like. This is not my poInt at all.
As someone who has never lived in the US I'm curious as to why there's so little debate about moving towards a single payer or universal system. It seems that the only option ever on the table is tweaking the current system.
To make a few people rich at the expense of many others' health and lives. That clearly is the goal of not having a single payer system and the reason for the private health insurance industry existing in the first place.
Most of the argument centers around one's belief in the competency of the government. If you think they can do things well, you will probably argue for a single health payer system, or maybe a German model. If you think they are incompetent, bought, fools, then you argue against a single payer system. Humorously both sides point to Medicare and Medicaid as evidence of their views.
There is too much money in the US system, and the current employees would never agree to losing what they have. It's far more lucrative to be in medicine in the US than in other countries.
In short, it's not just the insurance companies or the administration, but the industry as a whole. You try telling a group of doctors that they have to take a pay cut for the good of society, and they'll laugh you out of the room.
This is not to say that doctors don't work hard or aren't worth a lot in a career with a decade or more of training, but it's pretty clear that doctors in the US don't work particularly harder than their foreign contemporaries, yet they earn a ton more.
One, existing medical insurers comprise an industry worth tens of billions of dollars and have shown they are willing to every last cent they have on ads and lobbying to oppose such ideas, which of course completely threatens their existence. Any plan has to find a way to funnel them money in order to avoid that.
Two, partisan politics has gotten so bad that it is starting to warp and twist people's brains. "Obamacare" was demonized relentlessly by Republicans even though it was essentially a copy of a leading Republican health care plan at the time. The plan originally came from the Heritage Foundation and was championed by Mitt Romney, both of whom immediately turned around and demonized it as soon as a Democrat proposed it.
Third, the US right wing is fairly unique compared to the right wings of other countries, it has immense power, and it generally opposes this kind of thing for a variety of reasons. To varying degrees of justification they would tend to dismiss whatever arguments you might make or empirical evidence you might try to cite.
Fourth, the average American has no idea what single payer is, and has absolutely no idea that every other country in the rest of the developed world has something like it. Americans have no idea what life is like in other countries. They might know that Canada has some form of socialized medicine but might assume that to be a curiosity unique to Canada; and have never thought much about whether the Canadian system is any good or not.
Fifth, Americans would not generally assume that such a thing in any event is within the realm of possibility or competence of the US government. It's been many decades since the US has attempted any grand national experiment like this.
Sixth, because racism. Socialist programs would easily be seen as mostly benefitting other races; even if it was not at all true. Politicians can benefit themselves by exploiting this to varying degrees of subtlety.
It's a relatively simple mix of economics and politics.
If the only thing we changed was a single payer, without changing anything else, prices would continue skyrocketing and the government would either have huge deficits or very high taxes, even compared to most of Europe: US healthcare is that expensive.
To make single payer work, what the US would have to do is to also force prices down. This can be done through price controls, like in Singapore, by directly owning hospitals and employing doctors, like a good percentage of Europe, or by increasing the supply of healthcare providers so much that prices must go down. Any and all of those things would cause an upheaval in the healthcare industry: A lot of jobs would be lost, and others would pay a lot less. Many investments, like those of hospitals that compete with each other by being the most luxurious and with the most MRI machines, or pharma companies that expected to be able to charge a whole lot more to US patients than they do in Europe, would go down the drain.
Every single bit of extra US healthcare expense an inefficiency is benefitting someone else. More efficiency when driven directly by government mandates, like a single payer system would aim to do, is a wonderful way to lose elections. This is not just why democrats don't really pursue single payer seriously, but why republicans don't propose any changes that would really make the system more market driven: It's hard to rein the profits of an industry that is over 17% of GDP.
Perhaps we could compare costs for procedures paid for by private or government insurers, vs those that are not covered by insurance i.e. cosmetic procedures.
Bottom line is that where there is no 3rd party payer, competition works.
There is a large set of non-optional and emergency medical procedures where competition will remain nonexistent. Personally, I hope for AI to provide answers to cost-benefit analysis (treatment costs X, will reduce/improve chances by Y).
Not sure how AI is gonna help here. For many of these questions, we have committees of skilled humans with all of the information looking at the details, and they often cannot come to a consensus.
Being able to make data-driven healthcare decisions would help to improve the 'last mile' of health care delivery. Not everyone has a committee of experts at their disposal. I hope that we will rely on more on big data to deliver smarter and individualized healthcare. There should be a whole branch of quantitative analysis dedicated to improving outcomes and reducing costs (unnecessary medication, surgeries, tests, etc).
This is right, the problem with healthcare has to be insurance. The biggest pocket of customers for health care companies don't pay out of pocket. They are covered by their employers. So they don't see money going out of their pocket and in a perverse way the higher the amount the insurance company pays the better the customer might feel thinking they got good service or a great treatment. So there is no incentive for the health care company to reduce costs at all. Since people don't care about the costs of procedures there is no set/prescribed cost for any procedure and everything just gets bloated every year.
More so, these pocket of customers have no idea how the other pocket, that pays out of pocket, feels. They have never experienced it and will never know, so they have no incentive to fight for them. The health care lobby and republicans are putting a good spin that these out of pocket people are causing the costs to rise. IF the majority of the people actually pay out of pocket the costs will immediately come down for everything. Both hospitals, doctors and medicine. I have seen things in India where most of them pay out of pocket and the costs are very low. I heard, these days insurance is screwing things up there as well. Extending that logic, a single payer health care system where one party has the power to negotiate could actually help a lot in bringing the price down.
> Extending that logic, a single payer health care system where one party has the power to negotiate could actually help a lot in bringing the price down.
Which was another big argument for single-payer. Medicare is know for negotiating the lowest prices, and practices prefer higher rate negotiated insurances than Medicare.
Medicare does not have market forces guiding it. Consumers are a massive repository of localized knowledge. Once government takes them out of the picture, the industry's dynamism is severely limited.
Insurers don't care. I recently got mono. It took three visits to a doctor, who just prescribe two back to back courses of antibiotics, a referral to see an ENT on the last visit (which did not seem right and would have taken three weeks to get an appointment for). And finally me deciding "fuck it" and making a trip to the ER to get to the bottom of it. At the ER I sat in a chair four or five hours. They took some blood and ran a simple test and it was done. Total cost to my insurer was something around $4000. I paid about $160 all up. I tried contacting my insurer and the provider to explain this was ridiculous cost to sit in a chair, give some blood, and have a test done. My insurer is Cigna. They literally have no online way of sending them email or a message. And their call center is useless. So I gave that effort half an hour and gave up.
> the problem with healthcare has to be insurance.
It's a big part of the problem. For example, I believed that a certain medical procedure was in my best interests. I was told that insurance often doesn't cover the costs (i.e., the considered the procedure "elective." When I asked the price, I was told $700 – but if I forego insurance claims it's $400. And this was a super-reputable medical establishment. (Half of Silicon Valley probably uses it.)
Market competition? As if the US healthcare market was free recently? Nowadays, many educated people believe that without the ACA, the US healthcare market is a laissez faire system, which is why it has so many problems.
This could not be further from reality.
We have more government distortions in our healthcare market than countries with completely socialized healthcare. For example:
Medicare: socialized medicare for the elderly, which alone creates more distortion than a universal program would cause, by inflating demand/prices for non-qualifying citizens.
Medicaid: socialized healthcare for specially qualifying poor people, which creates the same distortion as Medicare.
An oppressive FDA: which, coupled with overly-powered IP laws, grants de-facto monopolies in the medical product industry. We have an incredibly expensive and subjective medical equipment pre-approval process (as compared to a less-terrible FDA that would just be in charge of labeling, preventing fraud, and maintaining accountability in the event of incidents). Then there's the length and flexibility of patent protections in our current system (maybe we could cut those protection times in half, and patent trolling would not be a lucrative industry).
Oppressive occupational licensing: It's way too hard to become a doctor of any kind, even the kinds that don't manually put things into your heart. This will be a major battle as AI comes to the point where it can better diagnose conditions and largely replace generic/non-specialized pediatrics. Of course, the government will not make this easy.
Plus a slew of more minor things like malpractice regulation, and now the ACA (which is not so minor, and which will apparently be replaced with something similar and even messier).
If we cleaned up/removed all of the problems in the above and replaced it with single payer, it would be OK and we would have something similar to Canada/other countries with long wait times, not as much access to specialists, slow innovation, and a system where a government bureaucrat gets to decide who gets the last liver transplant and who dies. That would be a less distorted market than we have today, but ONLY if accompanied by fixing the aforementioned problems.
OR we could try going the free-ish market approach and try to find a much freer balance with the FDA/USDA/occupational-licensing/scrap Medicare/Medicaid,etc., which we do not currently have AT ALL. And maybe even declare health insurance fraudulent and pay everything out of pocket (accident insurance makes more sense as a hedge against risk, which is what insurance is supposed to be, whereas all people are expected to develop health problems at some point, with a probability approaching one).
It seems to me that our US HC system is operating in a manner that optimizes the wrong thing. It currently maximizes jobs and an odd form of wealth redistribution. It should be minimizing costs subject to "good" HC (or "adequate"?) for the target recipients (all citizens?).
Let's name our HC goals (the objective function) and then tackle the strategies.
The methods are wrong too, and spin off unfair side effects. For example, corporations by the (insurance) product, not consumers. This gives companies leverage in employment activities.
Edit-> Some form of tort reform (e.g., limitations of liabilities) would help as well. I don't have a current number, but layers of malpractice insurance drive substantial costs.
I like the free market. However, when something has completely inelastic demand and the people most in need of your product is not your target group (as in, sick people often have problems making ends meet, since they're sick and all) and the economy as a whole is far better off if everyone got the benefits of the system, I think it's super bad to use the free market.
In the US, you spend 17% of your GDP on healthcare, in Sweden we spend 11%. The US has a lower life expectancy, lower survival rate for most heart diseases and types of cancer and has healthcare bills as the leading cause for bankruptcy. It could just be me, but it looks like universal healthcare systems in the Nordic model runs circles around the US system based on all the relevant metrics.
The healthcare market is not feee enterprise. In fact, it is a government sponsored Trust. Nobody can practice medicine unless the government says so, and no one can take medication unless the government says so. No one can give even medical advice without the governments permission. This is the exact opposite of a free market, and the reason it is so stinking king expensive.
The regulations are passed through fearmongering, and only serve to raise prices unbearably. The government created the problem, now wants to "fix" it with universal healthcare. As with any monopoly, prices will be higher and quality lower than with the free alternative.
The answer to the problem is to introduce the free market to medicine.
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[ 4.6 ms ] story [ 121 ms ] threadSo you know maybe it's a vicious fucking cycle.
Oh wait actually we know for a damn fact it is and has nothing to do with obesity: preventative care just keeps shit way cheaper that's half the point of the ACA forcing insurance companies to cover at least some of it (the other half being a basic belief in human dignity).
People lives longer; more illness we can treat; growing administration; new expensive technology; few doctors; price gouging; anti-competitive behavior; malpractice lawsuits; lack of preventative care; uninsured bumping in and out of emergency rooms; and so on...
Some of these are successfully solved by most western countries. Some of them are quite plausibly not solvable.
As we have more technology and treatments to keep people alive, cost will necessarily go up.
[1] https://web.stanford.edu/~jay/health_class/Readings/Lecture0...
Classical economics mostly assumes that all participants in the market have access to relevant information to make the right decisions. Arrow's work on signaling theory really started economics on thinking about what happens when that assumption is broken.
As anyone who's worked with large distributed systems knows, putting information where it's needed is key to making it work.
The economy happens to be a large distributed system.
Otherwise, how is the information relevant? Let's say you know that some medicine in the US is $1000 per month , but only $20 per month in India.
Well, if a patient is insured, then they don't care about the cost. If that drug is medically necessary, then the insurer has to pay for it even if they're getting gouged by the manufacturer.
We're getting the worst of both worlds in a way -- regulations to protect patients make it very difficult for insurers to negotiate on price, but then we also don't generally allow the government to step in and force lower drug prices directly. So in the pharmaceutical market, the US just pays higher prices than everyone else days; American consumers basically subsidize drug research for the rest of the world, including other developed countries.
However there are many types of medical care where that is very reasonable! LASIK and cosmetic surgery are classic examples because they elective and have historically not been covered by any insurance. You can see cosmetic surgery prices on ads in the NY city subway. Other kinds of care, such as dentistry, orthodontia, and vision services, also have very well-functioning markets, largely because insurance has historically not covered these things. Lots of non-urgent care (primary medicine, pediatrics, dermatology, psychiatrics, orthopedics, many surgeries) would probably have well-functioning markets if they were separated from the insurance system.
Now, that's all the cheap stuff. The expensive stuff (hospitalizations, cancers, chronic disease) that makes up the bulk of the US health expenditure - yeah. You can't expect a patient to come in and argue with the doctor about whether they really need that saline drip. But in a properly functioning market, there is another entity that can and should (and does) act as a price-setter mechanism on the demand side, and that is the insurance company.
The problems show up when 1. there is only one supplier in a market 2. the insurer is required by law to cover a certain thing 3. the supplier does not face a price control, and through (1) and (2) has unlimited pricing power
This is very acute with prescription drugs. Even generic drugs sometimes only have one supplier because the process of getting FDA approval is so onerous. It is also very acute when you have hospital and physician consolidation within markets, so that medical suppliers can effectively act as a cartel.
So - deal with the supply side problems. Stop the cartel behavior. Make it easier to sell prescription drugs and open hospitals. Allow consumers to act as consumers when it makes sense (by excluding basic medical services from the insurance system) and reserve insurance for the risky, expensive, hairy stuff. This is the path forward, and it all follows very neatly from basic supply and demand.
There are two components to healthcare funding: (1) insurance which protects from the serious unforeseen health expenditures; and (2) healthcare, which includes routine health checkups, preventative care, and also, the very common ailments as one gets older. The two are somewhat inter-related (if you're generally unhealthy, you're more likely to have serious ailments), but makes sense to separate the two as separate products.
Even for relatively wealthy people, it's difficult to afford serious medical care out-of-pocket (it can cost >$20k/day in the hospital). So that's one product people can buy, with its own deductibles.
However, routine medical care that everyone needs no matter what is a different product, and the cost of that product could be more closely tied to the value of the services received.
Separating these two products may bring about more competition in each, and perhaps more efficiencies.
And a sick person in the ER can easily cost tens to hundreds of times as much as the preventative care would have been in the first place.
So making preventative care mandatory actually saves everyone a lot of money in the long run -- even if the preventative care is run extremely inefficiently and poorly, it would still be cheaper than what we have now, which is socialized medicine that only kicks in after people get incredibly sick and expensive to treat.
https://web.stanford.edu/~jay/health_class/Readings/Lecture0...
Which is we knew 50 years ago that markets for healthcare just don't work. And now we have 50 years of evidence they don't work.
According to this article, the main culprit is keeping a for-profit health insurance system and addressing its shortcomings with ever increasing bureaucracy which adds more costs (bureaucratic complexity). I'm sure there is way more to it than that.
Then it inexplicably turns into a bad appeal for single payer.
Advocates of single-payer needs to at least recognize this issue and be able to account for it.
In this one, the author makes the argument that "competition" leads to a proliferation of firms, a proliferation of firms leads to administrative complexity, and administrative complexity leads to additional cost. Supposedly, removing this cost would save us enough money "to provide health care to all Americans."
It is easy to attempt to verify this claim by looking at actual data.
OECD: "Administration of the US health system alone accounts for about 7% share of total spending. This is on a par with other systems such as France and Germany which also have multipayer systems (even if in some of them there is no or little competition across payers). In comparison, Canada and Japan devote around 4% of health spending on administration."
https://www.oecd.org/unitedstates/49084355.pdf
So, if we adopted a true single payer system, by this math, the total spend in the US healthcare system would drop by 3%. US healthcare costs have recently been growing by 6% per year, so this would bring our costs all the way down to where they were on election day, 2016.
Next.
Jun 2016: US spends $100 on health care ($7 on administration) Dec 2016: US spends $103 on health care ($7.21 on administration) Jun 2017: US spends $106 on health care ($7.42 on administration) --> US administration costs drops from 7% to 4%, saving $3.18 Now US spends ~$102.82 on health care
I rounded
Even just calling all the billing companies to get my insurance applied is a huge hassle, and when it comes due it can take a number of hours out of my day.
And occasionally, I'll get a bill from long ago that didn't have insurance applied, and it can be a big hassle all around.
The hassle and aggravation is almost certainly worse than the IRS that people are always complaining about (and rightfully so).
It looks like we spend a large amount more than every other country in every category they define, but the primary difference thing that makes the huge difference is we pay for specialists a lot more. Their conclusion is just that, well, the cost is higher.
Interesting but leaves a huge question as to why.
My personal opinion is that it's because insurance leads to, basically, 1/2 of a market. We allow suppliers to set prices however they want, but we mandate that insurance buy the thing, which essentially gives them no negotiating leverage. (Worse: post-obamacare, we mandate that insurance co profits are a fixed percentage of insurance premiums, so they don't have any incentive to negotiate low prices anyway). The data showing "specialists are expensive", I think, is mostly just a historical accident; primary care and prescription drugs have traditionally been more sensitive to demand pressure because of the way deductibles and copays worked. I suspect that since primary care is now a required $0 copay service, in 10 years those costs will look aberrantly high as well.
As far as I can tell, it's the opposite -- insurers have the most negotiating power by virtue of aggregated information about pricing and services and a revenue stream that's subscription/toll rather than service.
Patients are limited in their power to negotiate with providers by some combination of largely inelastic demand (nothing's more valuable than life itself, full health or as close to it as possible is a close second) and a lack of expertise (how do you know what you can forgo or substitute?).
Providers are in a better position (and generally do somewhere from pretty well to very well), but often carry heavy investment costs and must continue to provide services to collect fees.
> mandate that insurance co profits are a fixed percentage of insurance premiums, so they don't have any incentive to negotiate low prices anyway
This is only true to the extent that (a) they've already maxed out that profit and (b) don't have any other constraints. When you're suddenly forced to community rate, have new customers who've probably been under/uninsured joining your pool, have new care requirements to meet, dealing with an absence of lifetime limits, and limited in your ability to raise premiums without approval among other things, there might well still be financial incentives to reduce costs.
https://www.google.com/amp/www.sandiegouniontribune.com/sdut...
Secondly, other countries have more doctors and hospital beds per patient. That whole refrain about "we get better service for the money" really starts to sound hollow when you realize that, at some point, everyone having a hospital bed is better than half the people having a super amazing hospital bed.
OECD: "Leaving aside spending on administration, the high level of spending in the United States may be due to: The cost (or price) of health care being higher in the United States than elsewhere The United States providing more health care – more doctors’ appointments, more surgery, more drugs, more diagnostic tests, longer stays in hospital – than in other countries"
The government would do away with insurers, you would pay $50 straight for a broken arm or whatever, everywhere, at every hospital.
Try having a pre-existing condition before ACA - no one will insure you because you're too expensive, or your premiums go ridiculously high. Think about that. The people who need insurance the most were denied it - this is perfectly in line with market forces of course because its cheaper. The other alternative is to believe healthcare is expensive for everyone because the healthy subsidize the ill, but oops if you're ill your costs are astronomically high anyways and insurance companies will fight you tooth and nail over expensive claims, so that doesn't hold much water either.
If you want to talk data look at spending on health care vs outcomes [1]. If market forces were working so well maybe we wouldn't spend 2x - 4x more than other countries with worse life expectancy to show for it? We can argue over where the money is going but its clear theres a lot more of it going in for worse outcomes coming out than most of the world.
Honestly, seeing that if you don't see ANY contradiction or perverse misalignment between the ideal goals of a health system and the current system, you must be a very healthy guy.
[1] https://ourworldindata.org/the-link-between-life-expectancy-...
Insurance is paying someone (the insurer) to take ownership of a risk from you (the insured) by compensating you if the risk is realized. If the risk has already been realized then, of course, no insurer will be willing to take ownership of it for less than the cost of the compensation.
The system we have today can hardly be considered "insurance".
The Essential Benefits defined in the ACA guarantee that, within certain bounds, that isn't an inaccurate equivalency. It's true that every version of then Republican modifications characterized as “repeal and replace” has not only attacked insurance coverage but also made insurance coverage less likely to be care coverage, so it's certainly important to recognize the difference.
BY DEFINITION a free market in healthcare MUST kill people (or allow them to die of treatable diseases if you prefer). Period. Full-stop. Do not pass GO, do not collect $200.
A free market means if you are unlucky and born into a poor family, get bonked in the head, and have a retinal detachment then you should go blind. Despite the massive dead-weight economic loss to our society of converting an able-bodied person into one with a life-long disability, if you can't pay for retinal re-attachment then fuck you buddy.
I wish all your free-market healthcare proponents would address this fundamental inescapable fact. I suspect most don't because the idea is repugnant and the argument falls apart. Please don't bring out the charity canard. That's largely how our system functioned in the past (and still does for some people thanks to states refusing Medicaid expansion) and it simply doesn't work.
I don't want to live in a society that so prizes the god of free markets that it is willing to let people suffer and die of completely treatable diseases. I'm happy to seize as much money as required from whoever is required to make non-elective healthcare free for all citizens. Fortunately a minor tax on the top 10% along with a larger tax on the 0.1% is more than enough to cover healthcare. As a member of the top 10% I say that knowing I will pay higher taxes.
I'm not sure this is true. Does a free market in food require that some people starve to death? Right-wing ideology says that even the poor have enough to buy food, clothing, shelter and medical insurance. If a poor person buys a mobile phone instead of health insurance, it's because they value the phone more than their health - why should you force someone to buy something that is less valuable?
Perhaps you argue that the poor don't have enough money to buy health insurance. In that case the right-wing answer is to give the poor money with which to buy whatever they prefer. Hypotheically everyone could buy health insurance and noone would die of treatable diseases.
Nobody is claiming that a smartphone would pay the full cost of a persons healthcare. But it would pay for some health insurance - perhaps two or three weeks, by your count. (And don't confuse this with internet access: A 5-year-old smartphone with a cracked screen costs next to nothing on eBay). Therefore anyone who buys a brand new phone - either outright or on a contract - has given up the opportunity to buy a few weeks of health insurance.
And there are many other similar opportunities for poor people, including:
- If you buy branded goods like Nike or Adidas, buy non-branded clothes and shoes instead
- If you drink or smoke, stop
- If you are overweight or obese, eat less
- If you buy food from convenience stores or restaurants, stop. Instead, make a weekly trip to Costco or Walmart and buy food in bulk.
- Change your diet to the cheapest foods that still provide nutrition. For example, maybe potatoes are cheaper than bread and just as healthy. Don't like potatoes? Too bad.
- Typically the best-paid jobs are in a city or town center, while cheapest accommodation is far away. So if your total weekly commute and work time is less than 60 hours per week, live further away from your job to increase your commute time and decrease your rent or mortgage payments.
- Look up the top 5 cities in the US with the highest wages and lowest unemployment, then move to one of them.
- If there are less than 2 people per bedroom in your household, take in a paying lodger. If your landlord doesn't allow it, move. If you are a single person then move into a 3-bedroom house with 5 other single people.
You may think that these opportunities are not valid, or that they still would not pay the full cost of health insurance. In that case the right-wing solution is to give money to poor people - and not to force them to buy health insurance or provide government-run healthcare.
The reality is, the only thing that makes for-profit free market people alter their perspective, is if they or someone they care about gets really sick and is subject to the bad aspects of the for-profit system. It's like anti-gay uncle who finally starts to moderate once he learns he has a gay nephew. Oh really, hmm, guess I need to moderate my total ignorance of the complexity of the world and things aren't so simple afterall.
I attribute this to lack of imagination identifying with other people. People confuse that with feeling sorry for others, or pity. John Rawls "veil of ignorance" thought experiment should be a political test. If you aren't willing to imagine yourself or a family member directly subject to the deleterious side effects of policies you want made into law, you're incompetent. Instead of having "regular Joe Bob" as politicians, they should be professional, interdisciplinary, ethical, and be auditable.
> "So, if we adopted a true single payer system, by this math, the total spend in the US healthcare system would drop by 3%. US healthcare costs have recently been growing by 6% per year, so this would bring our costs all the way down to where they were on election day, 2016."
Assuming the numbers are right, if we adopted a true single payer system, costs would drop from 7% to 3%, a 42% reduction. After such a reduction, the spending would take nearly 10 years to grow back to whatever its original dollar value was at a 6% growth rate, not 6 months.
Exactly. And that's a result of regulations.
Next.
Hypothetically, if that figure was 30% would you be in favour of a single payer system?
But with the "true single payer" system you mentioned, everyone would be covered, and have equal access to care?
Including the ~28 million Americans without care?[1]
For the same costs as Election Day, 2016?
That sounds like a pretty good start to me.
[1] https://www.cdc.gov/nchs/fastats/health-insurance.htm
An oligopoly controls most of the insurance market, another oligopoly controls most of the hospitals, and medical schools openly collude (through the AAMC) to limit the number of doctors.
All sanctioned by a government run by politicians funded by these organizations.
That being said, there is some talk about it, even today for example: http://www.politico.com/story/2017/03/sanders-to-introduce-s...
In short, it's not just the insurance companies or the administration, but the industry as a whole. You try telling a group of doctors that they have to take a pay cut for the good of society, and they'll laugh you out of the room.
This is not to say that doctors don't work hard or aren't worth a lot in a career with a decade or more of training, but it's pretty clear that doctors in the US don't work particularly harder than their foreign contemporaries, yet they earn a ton more.
Two, partisan politics has gotten so bad that it is starting to warp and twist people's brains. "Obamacare" was demonized relentlessly by Republicans even though it was essentially a copy of a leading Republican health care plan at the time. The plan originally came from the Heritage Foundation and was championed by Mitt Romney, both of whom immediately turned around and demonized it as soon as a Democrat proposed it.
Third, the US right wing is fairly unique compared to the right wings of other countries, it has immense power, and it generally opposes this kind of thing for a variety of reasons. To varying degrees of justification they would tend to dismiss whatever arguments you might make or empirical evidence you might try to cite.
Fourth, the average American has no idea what single payer is, and has absolutely no idea that every other country in the rest of the developed world has something like it. Americans have no idea what life is like in other countries. They might know that Canada has some form of socialized medicine but might assume that to be a curiosity unique to Canada; and have never thought much about whether the Canadian system is any good or not.
Fifth, Americans would not generally assume that such a thing in any event is within the realm of possibility or competence of the US government. It's been many decades since the US has attempted any grand national experiment like this.
Sixth, because racism. Socialist programs would easily be seen as mostly benefitting other races; even if it was not at all true. Politicians can benefit themselves by exploiting this to varying degrees of subtlety.
If the only thing we changed was a single payer, without changing anything else, prices would continue skyrocketing and the government would either have huge deficits or very high taxes, even compared to most of Europe: US healthcare is that expensive.
To make single payer work, what the US would have to do is to also force prices down. This can be done through price controls, like in Singapore, by directly owning hospitals and employing doctors, like a good percentage of Europe, or by increasing the supply of healthcare providers so much that prices must go down. Any and all of those things would cause an upheaval in the healthcare industry: A lot of jobs would be lost, and others would pay a lot less. Many investments, like those of hospitals that compete with each other by being the most luxurious and with the most MRI machines, or pharma companies that expected to be able to charge a whole lot more to US patients than they do in Europe, would go down the drain.
Every single bit of extra US healthcare expense an inefficiency is benefitting someone else. More efficiency when driven directly by government mandates, like a single payer system would aim to do, is a wonderful way to lose elections. This is not just why democrats don't really pursue single payer seriously, but why republicans don't propose any changes that would really make the system more market driven: It's hard to rein the profits of an industry that is over 17% of GDP.
http://healthblog.ncpa.org/why-cant-the-market-for-medical-c...
More so, these pocket of customers have no idea how the other pocket, that pays out of pocket, feels. They have never experienced it and will never know, so they have no incentive to fight for them. The health care lobby and republicans are putting a good spin that these out of pocket people are causing the costs to rise. IF the majority of the people actually pay out of pocket the costs will immediately come down for everything. Both hospitals, doctors and medicine. I have seen things in India where most of them pay out of pocket and the costs are very low. I heard, these days insurance is screwing things up there as well. Extending that logic, a single payer health care system where one party has the power to negotiate could actually help a lot in bringing the price down.
Which was another big argument for single-payer. Medicare is know for negotiating the lowest prices, and practices prefer higher rate negotiated insurances than Medicare.
It's a big part of the problem. For example, I believed that a certain medical procedure was in my best interests. I was told that insurance often doesn't cover the costs (i.e., the considered the procedure "elective." When I asked the price, I was told $700 – but if I forego insurance claims it's $400. And this was a super-reputable medical establishment. (Half of Silicon Valley probably uses it.)
http://healthblog.ncpa.org/why-cant-the-market-for-medical-c...
https://news.ycombinator.com/item?id=14642625
This could not be further from reality.
We have more government distortions in our healthcare market than countries with completely socialized healthcare. For example:
Medicare: socialized medicare for the elderly, which alone creates more distortion than a universal program would cause, by inflating demand/prices for non-qualifying citizens.
Medicaid: socialized healthcare for specially qualifying poor people, which creates the same distortion as Medicare.
An oppressive FDA: which, coupled with overly-powered IP laws, grants de-facto monopolies in the medical product industry. We have an incredibly expensive and subjective medical equipment pre-approval process (as compared to a less-terrible FDA that would just be in charge of labeling, preventing fraud, and maintaining accountability in the event of incidents). Then there's the length and flexibility of patent protections in our current system (maybe we could cut those protection times in half, and patent trolling would not be a lucrative industry).
Oppressive occupational licensing: It's way too hard to become a doctor of any kind, even the kinds that don't manually put things into your heart. This will be a major battle as AI comes to the point where it can better diagnose conditions and largely replace generic/non-specialized pediatrics. Of course, the government will not make this easy.
Plus a slew of more minor things like malpractice regulation, and now the ACA (which is not so minor, and which will apparently be replaced with something similar and even messier).
If we cleaned up/removed all of the problems in the above and replaced it with single payer, it would be OK and we would have something similar to Canada/other countries with long wait times, not as much access to specialists, slow innovation, and a system where a government bureaucrat gets to decide who gets the last liver transplant and who dies. That would be a less distorted market than we have today, but ONLY if accompanied by fixing the aforementioned problems.
OR we could try going the free-ish market approach and try to find a much freer balance with the FDA/USDA/occupational-licensing/scrap Medicare/Medicaid,etc., which we do not currently have AT ALL. And maybe even declare health insurance fraudulent and pay everything out of pocket (accident insurance makes more sense as a hedge against risk, which is what insurance is supposed to be, whereas all people are expected to develop health problems at some point, with a probability approaching one).
Let's name our HC goals (the objective function) and then tackle the strategies.
The methods are wrong too, and spin off unfair side effects. For example, corporations by the (insurance) product, not consumers. This gives companies leverage in employment activities.
Edit-> Some form of tort reform (e.g., limitations of liabilities) would help as well. I don't have a current number, but layers of malpractice insurance drive substantial costs.
In the US, you spend 17% of your GDP on healthcare, in Sweden we spend 11%. The US has a lower life expectancy, lower survival rate for most heart diseases and types of cancer and has healthcare bills as the leading cause for bankruptcy. It could just be me, but it looks like universal healthcare systems in the Nordic model runs circles around the US system based on all the relevant metrics.
http://www.scb.se/en/finding-statistics/statistics-by-subjec... http://www.who.int/gho/mortality_burden_disease/en/
The regulations are passed through fearmongering, and only serve to raise prices unbearably. The government created the problem, now wants to "fix" it with universal healthcare. As with any monopoly, prices will be higher and quality lower than with the free alternative.
The answer to the problem is to introduce the free market to medicine.