The expense problem (which is overstated in the article) would just shift from premiums to taxes if there was "universal healthcare" in America. Besides that, a large part of the expenses comes from subsidizing drugs that get sold abroad for low prices. It's easy to whine about "dumb Americans" when your own country is subsidized by them
Please explain because it sounds like you might not have as good of insurance as you think. I have good insurance and pay basically nothing out of pocket beyond around $200 deductible.
I had the highest level of insurance from my company working for one of the big named ones. It took over six months to get a scheduled neurologist visit and that was after needing to wait four or so months to see a GP for a referral and some other things I needed done.
The fact that you immediately jumped to 'you might not have as good insurance as you think' tells me either you are fundamentally out of touch with how disastrous the system is or have had no need to engage with medical care outside of visiting a doctor once per year.
Your insurance is almost certainly a factor here, in that they require you to see a GP before escalating the issue to a specialist (one of the most highly-paid, I might add, who might have a busy schedule also). But what you've described is not uncommon for any insurance company.
Other countries with "universal healthcare" also have times consuming referral processes and wait lists for stuff. But they have it worse because there are more people seeking service, and less providing it (because profits are capped). I've heard plenty of stories of people in those countries dying on the wait lists for things that sound urgent or mundane, like appendectomy surgery. I even heard a few where people with ordinary problems like trouble walking were offered euthanasia. You should do a bit of research before you whine too much.
So, what would solve the problem of having to wait? Ultimately more supply of service providers, less demand, or an unlimited budget to pay for the scarce ones that exist.
> I've heard plenty of stories of people in those countries dying on the wait lists for things that sound urgent or mundane, like appendectomy surgery.
Emergency procedures like this wouldn't be put on a waitlist, you can just go to ER and settle administrative stuff later.
First of all, a problem should not have to take you to within an inch of your life to be treated.
Secondly, good luck with getting treatment in the ER! https://www.cbc.ca/news/canada/toronto/ont-teen-death-1.7616... Emergency rooms offer advanced first aid. They are not equipped to do specialist surgery. They have to call doctors in and stall you or even send you away until the proper care can be arranged.
That isn't even the case I was referring to. I've seen many stories and verbal accounts of people waiting for months for essential treatment in "universal healthcare" countries. Anyone with a rudimentary understanding of how supply and demand works would expect long waits.
Ok, let's say you have excellent insurance. That's great for you. But what about the rest of the US citizens? Should they be satisfied with zero or little insurance?
Maybe you didn't have good health insurance? If you have children or anything big happen, you want to be in major metro area of the US with broad network, expensive insurance. It's the best in the world, by miles.
What would a public insurance option involve? Do you mean insurance that's provided at-cost without a company profiting?
Insurance companies are already required to spend at least 80% (or 85%) of the premiums they collect on paying out claims. If they spend less, they are required to give rebates / premium refunds to policy holders.
It wouldn't be crazy to increase that percentage even more, since it's effectively a cap on the profit margin insurers are allowed to earn on premiums.
In theory, they'd be incentivized by the free market to provide the best coverage for the lowest cost to retain and get new customers. But not sure how well that holds up in practice.
The universal healthcare system in many countries is like they said, a publicly funded and operated insurer. I can look in the government portal and see what each healthcare provider billed to the public system for example. One can also have their private insurance cover services or just pay out of pocket. But copying that part blindly in the USA is doomed to fail because along with the universal coverage, there are also strict regulations on what services can be offered privately, how much can be charged for services and what must be covered by private insurance (a fun example I experienced recently was my private insurance not wanting to cover a certain drug treatment; if one doesn't have insurance, the government will pay 100% for the drugs but if you do, they force the private insurer to cover the cost). All areas where there USA is lacking.
Health insurance companies know that the health insurance arm is capped at 80% so they have added vertical companies to capture the profits. Check the full breath of CVS for example. Their Health Insurance may be capped at 80% profits but their doctor’s offices, their pharmacy and so on don’t have a cap. It’s just moving the money around to comply with the 80% rule while moving the profits to sister companies along the stack. Basically Hollywood accounting in health insurance.
"Backlog" - there is never a moment that this isn't just wrong.
I'm from Australia. If I want to "skip the line" I can just pay to do so. Private practice exists. People don't, because it's expensive and they can't afford it.
This is exactly like the US, except in the US you just don't get healthcare at all and die instead.
The "backlog" in any public healthcare system is a triage line. If you actually need care, you get it immediately. If you can live with it but keep it monitored, you might not for longer then is optimally comfortable if you can't afford private consults.
Unless you have good insurance, and then you get everything, the best, the quickest. Australia is a joke compared to healthcare in the US with good insurance.
Now, the US sucks really bad if you don't have good insurance / any insurance....
Such as? Have you ever had a major medical event using your health insurance in America?
"We have the best!". But like, so do dictators of 3rd world countries. Do you actually have access to the best care? Are you sure? Because about 1 in 10 Americans are uninsured[1] and a substantially larger percentage are underinsured[2].
Meanwhile Australian life expectancy is higher then America[3] (I mean let's be fair: most of the western world's life expectancy is higher then America...I wonder what common trait most of those places have...)
I don’t disagree about the overall healthcare system being broken in the US, but I find it pretty funny that you replied to that person with more arguments about how healthcare sucks for the average person… When they were discussing healthcare being excellent for folks with great insurance.
you two are talking past each other, and talking about two different cohorts of people.
The person talking about "good insurance" provided no examples of even what that statement is meant to mean, or what they actually expected to get from it.
Just "the best care ever", no qualifiers, examples and no indication of costs.
Just what does "good healthcare" in America get you, that you imagine people in other countries do not get?
"good" is a relative term. In health care insurance world, it's the expensive plans, with broad coverage, and the best facilities in network (who participate in research and are at the forefront of treatment - MD Anderson, Mayo, Cleveland, Sloan Kettering etc). You get fast access to the best facilities with the best doctors and best treatments.
Maybe look at the rankings of best treatment facilities globally. Here is the list for oncology. Choose any dropdown you like. You are going to see a lot of "US" at the top.
Good question. I actually think the US should have a healthcare system more like other countries, don’t get me wrong. But I can directly answer your question, as someone who lives in the U.S. and is very happy with the care i receive.
In the U.S. i’d consider good health insurance to be:
- low monthly premiums (majority of cost is covered by a generous employer). Say $30-50 per paycheck for a single adult.
- A PPO plan, not an HMO (HMO limits your options when picking doctors).
- A plan that does NOT require pre-authorizations for most procedures and tests. They are a pain in the butt. And many crappy insurance companies like United Healthcare tend to auto-deny many things as “not medically necessary”.
- A medical plan that covers almost every non-experimental drug prescription, at low cost ($30 or less). Including antibiotics, EpiPen, GLP-1 (Ozempic), inhalers, etc.
- A reasonably low annual out-of-pocket max, say $2,500 or less? ALL costs after that max are fully covered by insurance. So you have peace of mind if something really bad happens.
- $0 or very low deductible for seeing your doctor. Also a very low coinsurance rate, say 20% or less. Coinsurance is the % of the bill you pay before your insurance covers the remainder.
All the above basically means, “low stress” when you get sick or into an accident, or get pregnant.
What does good “care” look like? I think we all know. In the U.S. this is _very_ region dependent. Most people don’t consider this when buying a home for some reason lol.
There are many cities with excellent hospitals and medical centers and also some top notch hospitals GLOBALLY. And then there are many “medical deserts”, typically cheaper areas to live, where care is harder to come by.
Examples of good care:
- QUICK access to your primary doctor/PCP (within 1-2 weeks)
- ability to get care urgently, within a days notice, from another doctor. urgent care, etc.
- ability to see a specialist within 3 months, ideally less than 1 month. Yes this is possible in some parts of the U.S. believe it or not.
- Living near (45 min or less) a major, well-rated hospital, in case you have a heart attack, get into a nasty car accident, etc.
The unfortunate truth is a LOT of americans are in a “healthcare desert”, or they are poor and can’t afford care, or their employers are not generous and offer them crappy plans. For example where the out of pocket max is $15k lol. Or where monthly premiums for a single person are $400.
The US is not a fun place to live if you’re lower class or lower-middle class. And our healthcare system is a confusing mess. :)
This magical "good insurance" doesn't exist, because it's not up to the insurance company.
Scheduling is controlled by the hospital. Right now american hospitals are insanely booked out, and have been for many years. There's no magical insurance that bumps someone else out of the line.
If you aren't experiencing 3 month delays for non-emergency medicine, it's not that you have "good insurance", it's that you live in a place where the local medical infrastructure is seriously underutilized. This might mean you just live in a rich enough place where more hospitals than needed were built, or it could mean that a lot of your neighbors just aren't getting the healthcare the local hospitals were expecting to serve.
Or maybe what you are hinting at is that in your state, the affordable health insurance for most people doesn't actually get them any real treatment options, so only very wealthy people can afford to actually get treated, so hospitals around you don't do much healing.
And that's fucking ghastly and should be seen as the abhorrent thing it is. You have hospitals around you that are not treating people even though there are plenty of people needing healthcare. A lot of resources were already spent building that hospital and training doctors and we are not utilizing those resources because of some abhorrent "but then I might have to wait a month for a completely non-threatening medical concern" ideology. Yes, that's called efficient use of resources. Triage is a core part of healthcare. Sometimes that means someone else gets treated before you, and that's because they need it more than you do.
My Canadian father-in-law had to wait over a year before being able to see a neurologist about his suspected Parkinsons symptoms. Fortunately, he's well off enough that he was able to afford medical treatment in another country, but many people trapped in such systems are not.
Just to share a perspective from someone who used to live in New York… I had what I suspected was a mild concussion with some annoying symptoms at the time. I could see a neurologist within 3 days IF my schedule was flexible (it was not). I ended up getting seen 10 days later.
Half of my work colleagues received health care abroad. Wait times in Quebec are insane. Yes, constant joint pain may be not 'life threatening' yet degrades quality of life significantly. Basically if you are not actively dying you can't get access to healthcare in Quebec.
Universal healthcare doesn't change the overall cost. To a large degree, the ACA/Obamacare was a good stab at getting universal healthcare! The change in this article is about undoing universality, by changing the subsidies for those with lower income.
To structurally reduce the fraction of GDP devoted to healthcare, we need to make far bigger changes. A lot of the setup right now is to subsidize those on Medicare by those on private insurance programs. The cross-subsidization goes very deep, and anything that might reduce costs also has the risk of undoing cross-subsidization. With half the country refusing to reform health care for the past 30 years, and the other half having their hands tied behind their back on trying to improve health care, we have built a gigantic overly complex system that's very hard to unwind.
Surely the complete removal of insurance and advertising from the US healthcare system would have an impact on the overall cost. Not to mention the amount of early preventative care that could be carried out instead of people waiting until it was really serious due to fear of medical bills.
Yes, the problem is insurance, not who pays for healthcare. There's not universal government funded car maintenance and it works just fine for the most part. Insuring predictable, recurring costs is a scam.
There's room, either private or public, to backstop catastrophes, but not the rest.
We are about twice as expensive as healthcare system from other similar countries. Eliminating all administrative fees from insurance, all advertising, does not close that gap. There's a lot more going on!
> Universal healthcare doesn't change the overall cost.
It can, at least to some degree. Every doctor's office has people who run through the insurance maze, trying to get services paid for. And every insurance company has people on the other side, trying to find ways to not pay for stuff. Having only one organization to deal with would simplify that; having one organization with clear, transparent rules would simplify it more.
> Universal healthcare doesn't change the overall cost.
Something like 15% of US healthcare spending goes towards administrative fees just around insurance. That's order of $800 billion annually, roughly $1,500 per American, that does not contribute in any way to improving health. This is roughly the size of the US defense budget that we spend on gating healthcare.
There are knock-on effects of our system that increase some costs, such as people skipping preventative care or medications due to high costs or lack of insurance and then ending up in higher-cost emergency care. Or see the recent trend of physicians documenting how much of their time spent arguing with insurance companies on behalf of patients, time not spent providing medical care (and thereby increasing costs).
> Universal healthcare doesn't change the overall cost
I get the sense I'm probably preaching to the choir here. But, the U.S. spends almost 2x what comparable countries (with universal healthcare) spend on healthcare. And we get worse than average results on virtually every measure.
This, of course, makes sense. When you're running healthcare as a for-profit business, part of our expenses are... profit to pay out shareholders. And advertisement budgets. And middlemen (insurance). And employees to do things like decline coverage. Medical employees to deal with insurance companies declining coverage. Etc. etc. There's a whole industry that only exists to support our private healthcare system that would cease to exist in a universal healthcare system.
Whatever the problem with health care in America is, the solution is not more money. We already spend double what all other countries spend as a percent of GDP and we have worse outcomes.
There are a lot of similar mysteries in America. For example, why does it cost a billion dollars a mile to do subways which is 20x almost everywhere else.
The US system is so dumb not to mention inefficient.