Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation.
But not only would it not happen at that price, but as the article says, it wouldn't happen period--even though I'm a healthy, nonsmoking, active 26-year-old male, I've had cubital tunnel problems in the past (typing) and surgery on my wrist (badly broken in an accident). If I applied, I would surely be denied--and again, as the article states, if you're denied once, your chances of being accepted in the future just dropped by a big percentage.
It literally makes more financial sense for me to pay minor expenses out of pocket and declare bankruptcy in the chance of crippling bills than to be insured.
Healthcare in America is utterly, utterly broken; it's damaging poor, middle-class, and rich people alike, and stifling innovation. I have the ability to innovate with my company because I'm young, single, and healthy; but many smart people have existing medical problems, families, or other factors that make them indentured servants to the company that pays their healthcare. As a nation we're under the thumb of the insurance companies, and instead of doing anything serious about it, we've done almost the worst possible option: require every one of us to be a customer of these monstrous companies, with little regulation on cost or other government oversight. I'm the first person to back health insurance reform, but we've reformed it in the name of shoveling more money into the pockets of industry instead of for regular people needing real care.
It's crap like this that's compelling me to make my current expat lifestyle permanent. America might still get the tax dollars my business generates (the only country to still tax you if you live abroad) but it won't get my brain or my talent within its borders.
A close read of your first three grafs --- the only ones that respond to the article --- suggests that you wish you could get something better than "car-crash-emergency" insurance for 50-100. Well. Let's unpack what you're missing here.
(1) The author of this article, like my own family, can't get "car-crash-emergency" insurance for 50, 100, or 500 dollars a month. Never mind the deductable. If your records include a shred of evidence of 150+ seemingly-random conditions†, you're an automatic decline. That's the problem the article is bringing up.
(2) A system in which only "car-crash-emergency" care was automatically covered would be workable; a vast improvement over what we have today! Outside of car crashes and appendicitis††, you in fact don't spend $1200/year on health care. We're a family of four, and we don't spend $1200/year on health care, let alone $4800/year or (gak) the significantly greater amount we really spend on the low-deductable group coverage we set up for Matasano.
A $5k deductable would suit us just fine; we'd save, significantly, simply by plowing the money we would have spent on crazy bullshit low-deductable insurance into an interest-bearing vehicle and shelling out from it when we actually needed care, all the while secure in the knowledge that when someone ends up in the ICU, our liability is capped. Not for nothing, but this is a scheme that both Dems and Republicans buy into.
Health care in America is broken. But it's not "utterly, utterly" broken. Whatever the number of random medical bk's we have in the US, it's too high. But we don't need to transform our health insurance system into the National Health or the French system. We are epsilon away from a Swiss-style system of mandatory and guaranteed-issue private insurance.
† http://www.thecasongroup.com/forms/enrollment/Humana/H1%20Un... .
†† Many tens of thousands of dollars. Happened to a friend.
"$499 for a 50 year old subscriber in San Francisco"
Looking at other states, there are premiums as low as $172/month.
It would surely be much cheaper for you as a 26-year-old. Not quite the $50-100 you're looking for but I'd bet you could afford it.
Things are bad but maybe not as bad for you as you think.
Right now my current location is Monterrey, Mexico, so again, doctor visits are cheaper to simply pay out of pocket. As an example, my uninsured girlfriend had to visit a doctor last week--a walk in appointment at the major Monterrey hospital plus lab test, technician, and prescription medication: 800 pesos, or about $66. And this is in a modern hospital in the most expensive city in Mexico.
You can see these plans for yourself by checking our Blue Cross or Humana in Florida, among others.
Fat chance of that happening. And if it did, the deductible would be so high as to make the plan worthless for anything short of a car-crash-emergency-type-situation.
Actually, that's exactly the policy you want as a healthy 26 year old: $5,000 deductible catastrophic coverage, and nothing more. It'll cost you $86 per month from Blue Shield.
Health insurance, in the sense that you see it in group policies from your employer, is not worth the cost if you're buying it yourself. It will be 15 years before you get to the point where a $50 copay and low deductible make sense. Think about it. How often are you at the doctor? Once a year? Once every 3 years? And it costs you a hundred bucks or so. That's not something you need to be insuring yourself against.
The key is to keep a bit of insurance just in case you get in that car crash and need new hip joints, or if you suddenly develop bone cancer and are looking at $10k/month health care bills. Those things are crazy rare, and the policy that protects you against them is priced accordingly.
Needless to say, I never came close to hitting my $5k deductible. (or even my $250 annual deductible in the years when I had company-sponsored insurance).
This fits a fair number of cost complaints I hear over healthcare. Who wouldn't like to pay $50-100/month to have something better than emergency healthcare support? But think about the costs of such a system, regardless of inefficiencies / the problems of the current system that make things cost hundreds of thousands:
Doctors and nurses and supporting staff must exist. So must hospitals. They are highly trained, and will be expensive - period. They also have to keep learning, so they can't be busy making money all the time. And they must have such people available all the time, or people die.
Given that, and the equipment and check-up and hospital time, how much should a minor surgery cost? Not in cost to you, in cost. If the cost to you is mitigated in any way, it's extracted another way (taxes). I'd have trouble seeing it cost less than a few thousand dollars in the best, highly-used system. That's a lot of training and a lot of supporting necessities for any random surgery.
At $50-100/month, they would have to sap you for nearly a decade to make up a single surgery. It might even out for the insurance company if that was it - but certainly not when you get older, and not with any kind of routine, preventative care. Scale that up to emergency situations where major surgery and years of rehab for even 0.1% of the people they're covering - how many hundreds of years does that cost everyone on the plan?
Cataclysmic health insurance is cheap because it only covers cataclysms. Because one in a hundred lives cost an utterly enormous amount more than a single person generates.
None of this is to say that I think the healthcare system is efficient by any means, nor not full of corruption, waste, frivolous lawsuits, or damaging dogma. Merely that there is simply a bottom limit that the prices that people want to pay will never be able to support, unless all cataclysmic protection is dropped. And would you rather die from a car crash, or be rehab'd for a couple years and continue your life for another 60 years? So people choose the cataclysmic protection, and prices jump.
edit: because this seems it will come up often, some evidence for my claim based on Canada's setup, copied from another comment I made below: http://en.wikipedia.org/wiki/Health_care_in_Canada
>In 2009, the government funded about 70% of Canadians' health care costs.
>Per capita expenditure in 2009: 3,895
$227 per month, per person, comes from the government, which means it comes from taxes. And an additional $100 per person is spent per month on average ($324.58 per month). Far in excess of $50-$100.
And, if you want to talk care and outcomes, let's pick the most grim of diagnostics: Cancer. Japan's 5-year survival rates are among the highest in the world, and the highest in particular cancers such as colon and rectal cancer. And, FYI, the US isn't #1 in survival rates for all cancers. It's spread evenly through the G8.
And, the most free of supposed free markets and tax-friendly wonderlands, Singapore, also puts price controls on procedures, with similarly successful outcomes. So it isn't a cultural or "economic" thing, it's a government thing. It always will be. An adult just needs to come in, put their foot down similar to what Tommy Douglas did in Canada, and declare either we all buy in to a government-run healthcare system, or we buy in to the government completely regulating the market much like it does the stock market or agricultural industry. States will have no say, no quarter, or feedback. They can choose to secede from the union to opt-out of the program.
And, while I love me some comment karma, I know that my position is tantamount to heresy on this board, so, get your dismissive hand cocked and ready to wave me away :D
What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty.
Because of that, some sort of non-market intervention is simply unavoidable. As are the inefficiencies that go along with price controls and other similar endeavors. Ugly stuff, this healthcare business.
Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your doctor is known. And he knows he's got by the genitalia and will charge accordingly since with even a thousand unknown providers, your real choices are very limited.
Just as much. Presently, no American hospital publishes its price list. I believe there's no regulation about this. Why hasn't "the market" impelled these providers to publish their prices.
Almost every American hospital publishes its price list to its primary customers: the insurance companies. The problem as I see it is that the insurance companies are the only entities that can get fair prices for health care, and they want to keep it that way. A potential solution would be to ban insurance discounts; a health-care provider could charge any price it wants, but it would be required to charge all customers the same price. Insurance companies would still negotiate for lower prices, so it would benefit all of us.
For instance, a podiatrist I know charges $350 to the insurance company (which shows this as the discounted, negotiated rate) but $150 cash to remove an ingrown toenail.
I'm sure there are exceptions.
This "retail rate" mentioned in the article is crap.
This was in Texas, so maybe someone that understands the laws can chime in and comment on that.
Medicare is the largest payer of insurance claims by far. Medicare also has a lot of rules. One of these rules is that, in order to prevent providers from shortchanging Medicare, they have to charge everyone the same price (otherwise medicare would be overpaying....). Medicare will then pay 80% of the indicated amount and the rest is covered by medigap insurance, Medicaid, or by the patient.
As you might imagine, the lack of ability to price discriminate, even to patients, hugely distorts the market.
However, private insurers have gotten around this (how I don't totally understand), by using what is called the contractually "allowed amount". This is an agreement that the provider will write off the variance between the allowed amount and the billed amount. This results in de facto price discrimination for large insurers while getting around the medicare law. Patient's don't have this kind of gig.
Of course, there are tons of other corruptions and inefficiencies in the system. I could tell you a story about a friend who once worked for NY Medicaid who was actively prevented from working to prevent the state from going bankrupt by paying claims.
I don't have the answers, but there is serious distortion of the market ATM.
I hope I never have to use this information, but it's out there.
1. the medical industries/professions work very hard at discouraging price competition.
2. price competition is not sufficient to create a healthcare marketplace that works well for society. I'd like to see people without means have at least some access to medical technology/services, even at the cost of inefficiency. But that's just me.
Like I said - it's a beast.
you don't have time to shop around for services while unconscious in the back of an ambulance.
It is true that some people will choose badly when left to their own devices, but that's better than forcing the same dumb rule on everyone. Each of us is an end in ourselves. So long as we do not violate the negative rights of others, we are responsible only for our own lives, not the lives of our brothers.
No man is an island. Neither you, nor anything you create is created in isolation.
Dependencies are ever-present and failing to understand this leads to failed ideas such as "true free market" not unlike the idea of "true communism".
In reality the very fact that you are alive to write your words is a testament of other peoples effort including your parents to guard you against the many many dangers in this world.
Ultimately you don't own the right to anything, not even yourself.
It's an agreed upon right not a natural law.
I agree that there are some times too many regulations. But claiming what you do here is simply wrong in a very unfortunate Ayn Rand way.
I can forgive Jefferson for living in different times, but Ayn Rand should have known better.
The Founding Fathers declaration doesn't apply to the 5.8 billion people who lives outside the US.
And even if it did it would not by any metrics be a natural law. Property rights is a human construct nothing else.
Elasticity in economics describes the relationship between two variables (normally price and demand which is price elasticity [of demand] but by no means exclusively).
But unless you define your variables (or state what sort of elasticity) it's not a useful term and certainly not something I'd be bandying about while suggesting that someone else didn't have a clue.
Nonsensical. What kind of market theory are you following that doesn't factor in market elasticity? Rush Limbaugh eco 101?
As I said the term elasticity isn't meaningless, but without defining the variables you are defining as elastic (or inelastic) it doesn't make sense, at least not without assumptions which obviously may or may be wrong.
Personally by default I'd assume that you were referring to price elasticity of demand - that is the relationship between changes in price and the resulting change in demand, however there are many other types of elasticity (see http://en.wikipedia.org/wiki/Elasticity_(economics)).
So if you want to explain exactly which variables "market elasticity" refers to then that would be great, but as "market" is a very loose term, on it's own it's not very useful.
You pulled someone up for not knowing what they were talking about ("For someone who puts so much faith in free markets you don't appear to understand how they work. In your studies, look up "market elasticity" for a clue."), when it seems the same accusation could be levelled at you.
But, I never really meant it to become a big deal so I apologise for being picky and I'll move on to answering your question.
Broadly I agree with you but I think it's slightly more complex than that a straight forward "it doesn't work" and for me the issue is how you factor in the failures which in healthcare tend to result in injury or death. For instance, would a law covering corporate homicide (that is an organisation causing the death of someone in the course of their work due to incompetence or carelessness) count as market regulation? Or even manslaughter if a doctor acting alone did the same? Would that be regulation?
Because of this I think any civilized society wouldn't accept the possibility of severe injury or death without significant consequence, so even if it might work in theory (more below), we'll never know in practice as it would never be allowed to come about.
More generally though my view is that markets of any sort only work well when you've got a few factors at play:
(1) the deals and decisions are being made directly by those they impact - that is the patients so the deal genuinely reflects the will and interest of the patients (as opposed to them being one step removed as with insurance companies where their interests muddy things)
(2) the system has to be such that there is a financial consequence to the patient of the decision they make (that is they see the benefit of getting a deal which is good value as well as good medicine otherwise why would they look for value)
(3) there has to be as close to perfect information as possible to allow these decisions to be made on a true and fair basis - and when you look at the PR machines we see today exist, you've got to think that's not going to happen without regulation.
My issue is I don't see how you'd consistently get those factors without regulation. I couldn't say it's impossible but it certainly seems highly improbable, certainly in the culture we have now (point 3 being the one I can't ever see coming about without enforcement).
As an aside - I live in the UK where we have nationalised healthcare and it's frankly great. The market reforms over here terrify me because they're ideologically driven by people who seem to want to drive us towards an American system so in theory while I'm not intrinsically against the market playing a greater role in health provision, in practice I'll tend to fight it on the grounds that it looks like they're going to the whole thing up a treat.
Which isn't to say either (1) that they actually do work well in, say, the USA, or (2) that some less free-market-based system mightn't work better. (I'm in the UK; the situation in the US looks absolutely horrifying to me. I don't know what an ideal healthcare system looks like, but it surely can't be that.)
You turned cause and effect upside down. You think the free market for food "works" because food supply is "abundant"? Think again. The supply is high because it's market is "free" (not really but fairly) globally and (sorta) works.
And of course, they will grow better if they eat their carrots ;-)
Healthcare can be broken up into a lot of smaller markets, and for a lot of those the free market works just fine. The market for coffee in the cafeteria of the hospital works fine as a free market. Do you know what percentage of healthcare cost pertain to the cost of the actual treatment itself? (hint: it's a very small part)
Basically everyone has to maintain a fund (the government pay into it for the poorest) for healthcare. This is what they spend when they have healthcare needs.
Because the people are making the purchasing decisions themselves (as opposed to the insurance company doing it) they have a far stronger incentive to demand value and to be informed, and you get genuine competition between providers (as if you don't like them this time you'll go elsewhere next time with no insurance company mandating who you can see).
The government then picks up the few areas that aren't well catered for by this system.
I think it costs about 40% of what the US system costs (possibly even less) and Singapore has a typical life expectancy of 80.
... has a price- and service-controlled market, set not by the healthcare industry but by the Singaporean government (you know, the guys that cane graffiti artists and banned gum-chewing?) They also provide government subsidies to citizens as well as permanent residents (though not as much) for their compulsory Medisave program. So, their invisible hand is very visible and it's called "their government regulates or pays for alot of their care".
And with that, you're no longer in a free market.
The Japanese system is not without its problems. More importantly, the "price fixing" approach to health insurance simply isn't going to happen in the US. What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat.
Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund?
The more important question is: Why hasn't that happened worldwide, in places where there truly _is_ universal/free/government healthcare?
"What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat."
And, nobody but the rich and upper-middle class will be able to afford healthcare by Market. We can already see that today, with over 50 million uninsured Americans, up from 37 million just two years ago. How many will it be next year?
My objection to your point is twofold:
(1) It is total wishful thinking.
(2) It's wishful thinking in the face of pragmatic solutions that could resolve the problems we have now without utterly restructuring the market for health care.†
I'd also appreciate it if you wouldn't attempt to frame any critique of your comments in terms of "you're either with me or against health care reform". As you can see from a casual glance at this vast, Reddit-like thread, few opponents of health care reform would dare poke their head up on HN these days. I'm not an opponent of reform.
† Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance, an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today), and broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics.
Guaranteed-issue meaning "you have to get it, but we [the insurer] can charge whatever the hell we want. So, you, small biz of 10 employees with one person who had cancer, you premium is now more money than the GDP of Haiti, per month. Thanks and come again!"
That kind of practice can be fixed by either 1) price-fixing or 2) subsidies forever, the latter of which is really, REALLY expensive.
"an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today)"
The one that the Obama administration just gave $240 million to 7 states (Kansas $31.5 million, Maryland $6.2 million, Massachusetts $35.6 million, New York $27.4 million, Oklahoma $54.6 million, Oregon $48.1 million and Wisconsin $37.8 million) to implement as part of the healthcare overhaul passed last year? I think it'll work, too. Funny how that needs federal dollars, though. Shouldn't the free market sort this stuff out without the magic hand of socialism?
"Broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics."
That I'll agree with, big time along with EMR mandates. That with HIPAA are a big step toward alleviating alot of the administrative burdens in healthcare management, especially tracking and billing.
I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat. So, first, you attempt to paint me as against all reform and in favor of people dying instead of companies going into debt. Now, you've tried to reframe the discussion so that you're either in favor of market-based approaches or a "socialist".
And, after you've done your level best to suck all the oxygen out of the conversation, it turns out... you agree with me.
Please stop writing like this on HN.
I didn't say they did. I said 10-person startup. And, regardless of the existence of an "exchange" or not, policies of that size will still be meted out case-by-case, and those little start-ups will get squeezed, especially if they have someone on board with a pre-existing condition.
There's no getting around that problem unless each state acts as a group insurance pool. You will ALWAYS run into the small business, part-timer, or self-employed worker problem. Full stop. No arguments.
"it turns out... you agree with me."
Let's get this out of the way from square one: I don't agree. At all. In principle or in general. I may agree in some finer details, but my ultimate pie-in-the-sky wish for America is for us to implement a mandatory system in which every man, woman, and child, regardless of age or infirmity can get covered for a nominal price, unless they are a religious or conscientious objector and chooses to opt-out, but must themselves still pay, like we do with defense.
"I disagreed with you that what we need is the Department of Health and Human Services to set prices for health care by fiat."
And, I disagreed that the free market cannot correct what is here _in practice_. Not some theoretical America where we didn't have a glacially large government or a sedentary populace with 50 Million uninsured that didn't eat Cheetos and Mountain Dew for dinner. I'm talking about the reality of the situation and how it will take more than EMR and telemedicine changes to close that 50 Million (and counting) gap, though I do agree that technology can play a non-trivial role in cutting administrative costs.
See, I have wiggle room and patience for negotiation.
"Please stop writing like this on HN."
You, I can see, don't.
Government-dictated pricing wouldn't necessarily violate the Constitution, it's been done several times throughout American history.
Funny mental picture though :D In my head they're wearing those stereotypical nurse hats and brought their own stretchers to carry off the wounded / exhausted / weaponry.
I can imagine a scenario where the age for Medicare was lowered slowly over time to cover more and more people. (Unlikely, but not beyond the realm of possibility).
The government is getting a pat on the back for removing essential services because the masses aren't taking notice; we've fanboy-ed our system while ignoring its degradation of the fundamentals. Our current system is not a positive guideline to success.
A Macleans article about the state of our system: http://www2.macleans.ca/2011/01/25/our-health-care-delusion/
Everything has a price, but that seems a little lopsided.
That was happening anyway, if it weren't for Medicaid, that is. There was a definite brain drain of doctors (especially specialists) who choose to go to affluent suburbs and urban areas simply because they get more (and better quality, AKA rich) patients. You think if we _further_ privatized the market, those in rural areas would be _better_ served? Isn't that the opposite of what the free market would actually do? In fact, take a look at this study about physicians in rural America. It's eye opening how they advocate federal and state intervention (read Medicaid and Medicare) as one of the solutions (along with opening training up to more potential candidates, which even I as a liberal elitist supports).
I generally trust a self-correcting free market over a government bureaucracy to solve such problems, but in this case it seems the fundamental problem is that there just isn't enough margin for for-profit insurance companies to prosper without turning the screws on either doctors & staff, patients, and/or taxpayers.
Bulk billing is so much more convenient for everyone that you'll see signs advertising it on the outside of doctors surgeries, thus the cost of care is kept down. On the other hand, the doctors are free to charge what they want. Sounds like a fair way to do it.
And the funny thing is, Singapore and Japan both are rather well-off nations, not much different wage and price wise than the US. Biggest difference is medical cost...
In fact, forcing US hospitals and doctors to publish a price of any kind would be a simple improvement.
It is amazing with all the other twiddling that this approach never appears - at least not much.
The problem with comparing global stats like cancer survival rates is their weak correlation with the health care system. For example, the reason why colon/rectal cancer survival rate is high is because Japan is basically the only rich country where those cancers are the most common one (in other rich countries, prostate, breast, lungs usuallly come first for the concerned sex). There is also the issue of "free-ride", where most western countries benefit from research being done in the US and a couple other countries - which is not so easy to quantify either.
Designing good indicators is incredibly hard, and for that reason alone I think it will always be a political question first, and an economical one second (i.e. economics can help making a decision, but it won't give you the decision).
Hospitals are private, and both they and doctors negotiate every two years to set prices for everything from MRIs to stitches. The insurance industry is also private, but they have a public-run insurer for Japanese poor. AFAIK, taxes are taken just for the public-run insurance, to which only a small percentage of Japanese apply, but for private insurance (which the rest are mandated to have), it's paid through premiums per month, which is on average about $250/mo per family (and employers pay for almost all of that).
Incidentally, as near as I can tell, a hospital in Japan is equivalent to a clinic or doctor's office in the US. They also seem to be open weird hours. (example http://www.youtube.com/watch?v=Mi31MJrRjhE)
So as a matter of priority versus other spending outlays, we're way out of line.
Here's per capita GDP:
Spitballing from these numbers, it looks like we spend about as much in absolute terms as Switzerland, with everyone else way, way far behind.
Here's another interesting graph, since I seem to be on a roll here:
The degree to which our government is in the red is in no small part a result of the degree to which we're invested in the health care money pit.
The amount of money that is going to health care should blow your mind. People go bankrupt every day due to health care expenses, and even if you don't go bankrupt your tax dollars are supporting this nonsense.
I was talking to a gentleman the other day who works for a medical hardware company. He said they had a radiation treatment device that costs one hundred million dollars. A tenth of a billion dollars for one machine! "Jeez," I said, "How long does it take to pay off such a thing?"
About a year.
There is, of course, a debate on how to fix health care. Is there really a debate on whether it's broken?
I'll be reading through the links, I can always use more detailed info for future debates. Thanks!
edit for repliers: before stating that location X has 100 or less per month, how much do your taxes cost for this? That counts too, ya know.
I know that smug Canadians are a cliche in any discussion of health care, but we are an existence proof that acabal's expectations are totally reasonable.
edit: answered for you:
$227 per month, per person, comes from the government, which gets its funding from your taxes. So you're paying $801/month for that plan (three people). Significantly less than many Americans, there's no debating that, but $120/month isn't anywhere near correct.
Point two - and this isn't a rebuttal of any kind against your claims, just an observation - that same graph shows that Canada spends a lower portion of government revenue on health care than we do. And we don't even have universal coverage!
That is a massively incorrect statement, which pops up every time government-mandated healthcare debates appear, which I wish to squash ASAP: http://en.wikipedia.org/wiki/Socialism
Universal healthcare != socialism. Not even remotely. It's a political mud-slinging attempt to equate healthcare changes with the historical fear of the USSR that seems to have infected far more people than it should even have reached. Yes, fear the Reds, they'll lob bombs at you now that the cold war is over. They've just been waiting.
At the absolute closest would be if the government were to run all the healthcare directly (it's not - there are and will be many private healthcare markets), and then it would be a socialist action, not socialism (a socialist government).
To make matters worse for this use, any form of taxation can be described as a socialist action. That doesn't make any government that taxes its citizens a socialist government.
Of course I don't think it's socialism - but everybody around me in Indiana damn well thinks so. Not that they know what socialism is, mind you - but they know it's really Evil, and it's something liberal people on the East Coast force down our throats in order to pay for all the welfare queens in the cities.... ah, hell, there's that pounding in my temple again.
Thanks for the catch, everyone-else, my bad!
I think most here know nationalize health isn't socialism.
It can be carried further: money they get refunded comes out of other areas' funding, as the difference gets made up somehow. Their property taxes go up, the cost of food goes up because others are carrying a heavier burden, jobs across the board pay less / hire fewer, everything always costs something, even refunds. Less in some situations, but not zero. And we're still not reaching $50-$100.
Let's hypothesize that all the engineers working in SV get an AIDS-like illness caused by spending too much time on news.yc.
If there was a health care solution that would make sure that all the employees of Google, Intel, HP, etc. continued to function as usual by caring for those engineers, then even an extremely high up-front cost for that care would result in a net-win for the budget/economy/country.
Of course, that's silly as it won't happen to that extreme. But, I don't think the downward-spiral of more-cuts-here-and-there that you describe is the only possible outcome. A positive virtuous-cycle of increased wealth production is also possible.
The only ways that increased healthcare spending can increase productivity are through effective preventive measures and corrective treatments that return the patient to sufficient health to be productive, but that's not where our super-high healthcare costs come from.
They come from the consequences of delayed care (eg. using only emergency rooms when you're uninsured, necessitating more risky treatments for more advanced problems, which means higher malpractice premiums) and from end-of-life care.
Nice reply, btw :)
If you instead look at all government spending as economic stimulus, and all taxation as a factor in inflation management, you get quite a different picture.
Most plans are around A$100/month or less
First, it's a complimentary insurance meaning that it's for extras that people otherwise pay out of pocket or go without like dental, private hospital rooms, etc. It doesn't cover the really expensive unpredictable things like major surgery, cancer treatment. The basics (eg GP visits) and the big expenses are covered by medicare.
Second, it is subsidized from both ends. The insurance companies get paid by the commonwealth and the expense is mostly tax deductible.
You really can't use the cost to us as a measure of what it costs to run.
The graphs comparing total healthcare spending of various countries put Australia's at close to $3500 per capita, so medicare must only be part of the total.
There are some funds going into health in one off ways like states funding hospitals, donations, people paying above medicare rebate amounts (usually about 30% more for GPs in my experience). There's drugs, some of which are subsidized. Then of course there's private insurance which a substantial portion of people have.
I had private insurance for foreign students for a few years. From what I understood it's basically a tax administered by an insurance agency.
Basically it's complicated and subsidized in all sorts of ways. It's like that in The States too. You can't just look at a doctor's bill or insurance premium in one place and assume that it's representing cost in some meaningful way.
That wasn't intended to argue the point either way, though, I was just saying :)
$70, Basic hospital, extras like dental work and optical ($300 / yr... Two new pairs of glasses, effectively, or the year's supply of contact lenses), private rooms.
I got a $800 bill for 10 minutes doctor visit (swollen toe). Not exaggerating a tiny bit. No insurance company involved. "Must exist" is not an argument. Something is broken in the system where a doctor charges you $4,800 per hour. Insurance companies, obesity, poor lifestyle choices (all usual BS reasons I hear on TV) do not explain why this particular ####le charged me $4,800 per hour.
This saddens me hearing that most discussions about healthcare are circling around the question of "how?" instead of asking ourselves "why so much?".
That's about right. A few years ago, I thought I had food poisoning and 40 uninsured minutes in the ER set me back $3800. But I was "lucky." I've had friends who were in bicycle accidents and ended up with $13,000 and $37,000 hospital bills.
The ones who really catch it in the shorts are people who have never been unable to pay off an obligation before: their credit and hard-earned reputations are probably ruined (the first for however long a bankruptcy takes to go off the books, the second possibly forever), their day-to-day lives will become a gigantic burden since a bankruptcy will demolish any accumulated wealth/assets, and that's not even considering what it will do to their self-image for them to feel like they aren't living up to their personal standard.
Just so we're clear: I think this system is terrible, and desperately hope that something is done to fix it. I'm not sure what the right fix is, but I hope somebody out there finds it.
If I had some rare disease but still wanted to do a startup, I think I would just work for Starbucks for 20 hours a week or something, simply for the health insurance.
Unless I've totally missed it, there's certainly no hipmunk for medicine, where I can put in that I want X service, and get a list of doctors and prices within a 50-mile radius.
I'm with Aetna and I can get lists of MDs within a 10 mile radius and I can get a price list of common procedures.
note to self: build a startup that's HipMunk for medicine
If you're happy about a 10% discount for being uninsured, the scam is working.
I stopped getting insurance because as a self-employed person it was expensive and rising. I played the odds and won. Sure doesn't make me feel happy.
Also, even if there is a case for antibiotics, there still isn't any case for 95% of medications.
The WHO and various countries including the US say there is an association with antibiotics in animal feeds and an increase in antibiotic resistance in human diseases. This has nothing to do with "doctors pushing antibodies."
Drug resistant staph was first found in the UK. Do doctors in the UK face the same pressure to justify their so-called offensive office visit fees?
Welcome to the Netherlands...
(and yes, we have waiting lists, and other issues with healthcare, but atleast it's affordable)
Anyway, this isn't the place to get in a discussion about how to fix the system. But as it stands now, it's just a fact that my bank account is better served by not being insured, having minor procedures done in another country, and declaring bankruptcy in the event of a cataclysm. That's not what the system in the richest and most powerful country in the world should look like.
How do they achieve what you call impossible?
It just so happens that more health care doesn't necessarily translate to measurably better outcomes (e.g. cancer screening helps reduce mortality for some cancers but not others).
It also just so happens that it's very rare to study whether a particular care regimen actually improves overall outcomes as opposed to just the thing it's ostensibly aimed at treating. Continuing our cancer example, cancer screening helps reduce mortality from _cancer_ for almost all if not all cancers, but for some the increased mortality from operations and other cancer therapies cancels out the improvement.
That's not to mention the fact that people in the US prefer to get care even if they know it'll likely make them worse than not getting care. I'll dig up the reference for this; I don't have it offhand.
But as examples:
http://www.ncbi.nlm.nih.gov/pubmed/2268793 (2.5x more coronary artery bypasses per capita in the US than in Canada in 1988; admittedly somewhat dated).
I realize that's pretty weak support; I don't have anything better off the top of my head, unfortunately.
How do you defined "more health care?"
> Could we save money and get the same outcomes?
That seems like an obvious corollary of the above... But yes, I think we could.
> And since we get worse outcomes then they do
Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our outcomes are not clearly better than theirs".
> could we spend less and still get better outcomes?
This question is based on a premise which doesn't seem to be true, so probably no.
> How do you defined "more health care?"
Number of procedures per capita per year for various procedures is a reasonable measurement (where procedures can be MRIs, surgeries of various sorts, etc, etc). Usually people focus on the expensive end of this, by the way; having more physical checkups won't necessarily blow up your healthcare costs the way that more invasive cancer surgeries will.
"Number of procedures per capita per year" is a horrible measure. It assumes that procedures done is a good proxy for overall health, which it isn't. Public health (clean food and water, trash pickup, promoting exercise and outside activities, cutting down on smoking, etc) is also important.
Here's a scenario. Country A and B are identical except that country A has pushed for potable water and B has not. As a result, 10% of the procedures in country B are from dysentery, cholera, and other water-borne diseases which are relatively cheap to treat (keep hydrated with a solution of salts and sugar). As a result, country B has more doctor visits per capita, and on average these costs are cheaper than in country A. Country B also has lower life-expectancy, more days sick per year, and other measurable outcomes.
By your definition, country B has the better health care system but I think most people would prefer the overall health of country A. Therefore your measurement is not so useful as an indicator of overall health outcomes.
My whole point is that it's not a good proxy for overall health. However it _is_ a good proxy for amount of money spent on the system. Which is how you can end up spending more but not getting better overall health.
Do read what I said again. You're arguing against a strawman.
Reference for this, too, please.
I say it because many many many other places subsidize healthcare at least as much as America does. And people don't seem to count the taxes they pay as part of the monthly cost.
edit: edited my top comment, sources are there. Canadians, famous for cheap healthcare, pay $324 per month per person for healthcare. The government covers $227 of that, which means $227 per person per month comes from taxes.
We beat Japan on life expectancy, provided you restrict the comparison to people of Japanese descent. Japanese Americans live 84.5 years on average, Japanese only 82.6.
(Would love to see data doing similar comparisons to other G8 nations.)
That's despite people of Asian descent in the US having higher income and education than the average, both of which are positively correlated with life expectancy.
Even if it is true, I'm not sure what the significance would be. I would be surprised if you couldn't pick out many subgroups in the US which do better in the US than in their places of origin, without it supporting an argument about the quality of the overall system.
Very true. To actually make the argument you are trying to make, you'd actually need to do a carefully controlled study. But most such studies (which include ethnicity, rural living, diet, etc as predictors) actually show no significant relationship between marginal changes in health care and health outcomes.
Some procedures are not covered in your scenario depending on your state. Organ Transplants in Arizona etc.
How many surgeries per decade do you think typical healthy nonsmoking twenty-somethings are having?
But nobody claimed he in particular should have the same policy or the same rate for the rest of his life. The point of insurance is to aggregate risk over large populations.
Perhaps I'm mistaken, but I thought that the reason his age was brought up was to justify giving him a lower premium. The principle behind social security (or at least the variation where I live) is that everyone pays, and everyone gets healthcare. His age and his health don't come into it.
£12k (grad student, trainee) - £62 per month
£24k (young professional) - £114 per month
£60k (moderately wealthy) - £318 per month
The average price is probably near your lower bound but the fact that it scales with income means that you aren't a slave to your workplace. You can quit your job and start a business without fear of crippling medical costs.
(Source is http://wheredoesmymoneygo.org/)
At $50-100/month, they would have to sap you for nearly a
decade to make up a single surgery.
Which brings up one of the biggest red herrings in this whole debate - the notion that the U.S. has a "market-based" system. The next time you go to the doctor, ask someone what it's going to cost. Guess what? No one outside the two people working in the basement billing office have the slightest clue, because it's all paid for by the insurance fairies. There's nothing even remotely resembling an efficient market for healthcare in the U.S., but the insurance companies like to spout otherwise, because it's entirely to their advantage.
Drug companies will charge US customers more, because health insurers will pay. Good luck importing drugs from ebay - it's not legal!
Doctors, and hospital managers charge more, because health insurers pay. Good luck getting an unqualified doctor to prescribe penicillin - it's not legal!
If the government was paying for more of it, they would train more doctors, and force drug companies to lower prices (as they do in most countries). Removing the profit motive in public hospitals makes them focus on better care, not more expensive care. Then the private sector has some real competition (Australia and Canada both have private health ... it's better than the US for most people).
Invisible cost: Medicare/medicaid. You pay into it regardless of whether or not you use it - how much medicare/medicaid withholdings are in your paycheck?
Add that onto your actual private monthly premiums to get the real cost of health care.
I don't know about you, but mine works out to be considerably more expensive than $325 a month. And in the Canadian case I can be a bit happier knowing that everyone is covered.
The cost of actual medical care for a 20-50 something is a fraction of that if you were buying insurance purely for your likely illnesses. If you are comparing what a critical illness cost/month would be for a healthy young adult you could half this figure
Still, $324 is a pretty nice average, when you weigh in the mix of young and elderly, and of course if it comes out of taxes, presumably someone who is only able to afford $100 a month is going to have a lower tax burden as well.
That's why Germany has a social system where people pay in a fixed percentage (15,5%) of their income. That way, everybody pays the same percentage and everybody gets the same service.
If I wasn't self-employed, my employer would have to pay 50% of these costs, so it would be about 8% of my income.
The nice thing: this gets automatically deducted from an employees pay, so if he gets a raise or a cut, the percentage always stays the same.
The downside of it: I make decent money at the moment and have to pay 600-700 euros/month for healthcare.
If you make over a certain amount of money or are self-employed, you can opt-out of this system and move to a cheaper and better private one.
I won't work for long because of demographic change, but it's an ok starting point
Health care might have cost thirty years ago but not the same degree.
Further, Health care is approaching twenty percent of GDP where once is was less than five. Wouldn't that be large factor in costs? And doesn't that seem a tad less than necessary?
Would you rather go back to colloidal silver someone sold you as a wonder-drug out of the back of their wagon? Or use the significantly more tested drugs the (fairly problematic and corrupt) FDA lets through? Antidepression drugs, for all their overprescribing (IMO, that's a debate for elsewhere), didn't exist before, and psychotherapy was largely viewed as in the realm of quackery and going to one was considered shameful (still is, but not as much).
Not that it accounts for all of the change. Or even a large portion. Just that the rise isn't entirely due to waste.
Then what is your argument??
Just that the rise isn't entirely due to waste.
No one argued that.
Even the most egregious health insurance policy abuses are generally something more than waste. Often, there's been an effort to enhance "choice" and "responsibility" but generally without understand that the average person simply has limited horizon for navigating such things.
It's not mere waste, it's mere corruption but a combination of multiple "perverse incentives" - effort to fuse government and private industry which aim for the best of all possible worlds but end in the worst.
"It begins with a blessing, it ends with a curse. Making life easy by making it worse 'My mask is my master', the trumpeter weeps But his voice is so weak, as he speaks from his sleep" Soft Machine
We face a challenging world today...
Not that 10% is the best it can be, but I find it unlikely to go significantly lower as long as people refuse to do what's best for themselves, health-wise. ie, ever. (maybe Americans are worse at preventing health problems? no idea, just musing)
Not that it has anything to do with the main subject, but that is not true. Other countries tax their expat citizens.
Insurance company profits are not the problem.
The West Coast, by the way, is beautiful. Vancouver BC and Seattle WA are practically sibling cities.
Apply for citizenship. We'd love to have you!
Over-regulation, high cost, and impossible to get without an employer or some other kind of large group.
The American system benefits only one group: insurance companies.
This is a common misunderstanding of the economics of this situation. The principle involved here is "Adverse Selection".
To illustrate, let's look at automobile liability insurance. The reason this insurance is so affordable for most americans is that 1) everyone with a car must pay it and 2) there is price competition among insurers.
Imagine for a moment that automobile liability insurance was optional. Who would benefit the most from having this insurance? Accident-prone drivers or non-accident-prone drivers?
That's right - the accident-prone drivers.
And since accident-prone drivers have the most incentive to have liability insurance, you would see the customer pool of the insurance start skewing heavily towards these high-risk drivers.
Then, since it's mostly the high-risk drivers in the customer pool, the number of claim payouts would go dramatically up along with the average payout per claim.
In order for the insurance company to remain in business they would be forced to raise their rates OR to be super strict about not insuring customers that seem risky.
Naturally, the insurance business only works if you have more money coming in than going out. And in order for the insurance to be "affordable" to most people, then the risk needs to be spread amongst most people (not just the more risky ones).
So, while I understand and share your frustration at the current state of health care in the U.S. - it's important to point out "why" everyone needs to be insured in order for the rates to be "affordable".
Of course there are other important variables affecting health insurance premium rates (rising health care costs is a major one), but the "Adverse Selection" issue is probably the most important.
Another point to consider is that the current big health insurance companies have focused their skill on just a couple things:
1. Avoiding risky customers (by denying them or offering only super-high premiums)
2. Paying out as little as possible (by reducing health care costs and denying claims)
The dynamics of the health insurance market are about to be dramatically changed. #1 will no longer be nearly as important and there will be a huge jump in the size of the market. This will be a huge opportunity for disruption in the industry.
The old health care companies are extremely slow, bloated, and resistant to change. It's easy to see that new entrants will be able to grab significant market share from them and initiate some real price competition.
It's frustrating to have to wait the few years until this happens, but I'm very optimistic about the future (assuming the recent health care reforms won't be diluted before they can be enacted).
All that space for a fallacious argument.
1) Do you really think only sick people want health insurance?
2) Not everyone has to buy car insurance. Only people who drive. High rates will force people not to drive. There's nothing people can do against high mandatory health insurance premiums.
3) We've tried incentivizing people to be healthier seven ways from Sunday but somehow they getting sick. So, like Bullwinkle said to Rocky, "this time fur-sure".
-- The beatings will continue until morale improves.
One must understand the reality of the variables involved in order to come up with solutions of value.
Emotional outbursts have rarely solved any important complex problems. See Hacker Code 11.3.7 ;)
I'm going to go out on a limb and say money is not an issue for Donna, yet she still can't even buy insurance if she wants to. I've always thought healthcare access was a bigger hurdle for entrepreneurs than tax rates. If I make a lot of money with my startup, great, I really could care less if I pay 15% or 40% of that to the gov't, because it will be a whole lot more than I make now. But not having health care insurance (or worse, having crappy insurance that denies you all the time like most individual plans do) is so damn risky it makes me afraid to step out on my own.
That said, that's roughly what the ACA ("ObamaCare") will likely end up with, if it doesn't get derailed, except that it'll take a few years to get there because 50 states is more complicated than one.
Actually, it could scale reasonably well, but for political reasons wasn't set up that way. So instead, each state will set up its own exchange; I suspect some will be MA-quality, some will be better, some will be poorer.
Note that the reason you can apply for it right away, unlike other state "benefits", is that it's not really a benefit - there's no subsidy (at least, not for self- or startup-employed folks like me who very well can afford it), so there's no real cost to the state of letting 1, 2, or 17000 more people buy in (and in fact there's an advantage, because you increase the risk pool).
I've thought about this a lot because I could easily be in this situation. If I did anything on my own I would need a group plan quickly. You only need 2 people to create a group.
So you can buy insurance its expensive, here is how you do it.
1) Start a company.
2) Hire another employee (this costs a lot)
3) Make a group health insurance policy for the company.
There you bought insurance.
I know this is stupid, but I'm just the kind of person that when someone says "You can't do XXX" I automatically have to see if I can do it.
Also, if you have a group of 2,5,10 or 20, the insurance company has an easier time denying you because if you get pissed and drop them, its not a big loss for them. In contrast, if you deny the right person at a 10,000 person company, they lose a big account.
Another idea I've kicked around: Create a sort-of incubator where, on paper, all of the startup founders and employees are employees of the incubator group. Then the incubator can handle the whole mess of both insurance and income taxes. (Bonus: Since the "incubator" now has a ton of developers on tap, it could double as a consulting agency.)
We do try to take on companies of a minimum size (10+ employees) but sometimes end up taking on companies with 2 or 3 employees because the owner forecasts explosive growth -- which never happens. All that said, it's a freaking battle with the carriers every year to try to keep the increases at a lower rate. Also, we have "rate buckets" where we place clients according to risk and past medical history of its employees. It still tends to work out better than if they would attempt to get insurance on their own.
shudder This is the part where a small employer can basically be forced to find an excuse to dismiss anyone with a serious illness, who is then doubly screwed. A public option would have been so much more humane.
Also, there are HR-outsourcing companies like TriNet that negotiate as a group for smaller/startup companies.
I think a startup that can help tackle this issue would create tremendous value in the payor / consumer market, but the field is extraordinarly complicated and requires a very rare multi-disciplinary background in individual state law (CA's system alone is very different from, say, MA's bc CA is HMO-based and MA has a public option), behavioral economics, gov't regulation, insurance underwriting methods, insurance administrative practices. Oh, and if it's a tech startup, the team would obviously need web dev / product skills as well.
The problem is, developing a basic mastery of all these subjects takes a lot of time -- reading, thinking, and experiencing to understand the pain points deeply. That tends to cut against the stereotypical startup team of two young twenty-somethings hacking away and living on ramen, who have never studied the insurance industry or directly experienced the pain of searching for or relying heavily on health insurance (bc young 20 somethings tend not to have major health problems). I think that's a key reason why startups haven't done much innovation in the insurance payer market.
My latest line of thinking is about whether there are hacks around the problem that can incrementally chip away at and disintermediate insurance payers as the sole gateway to affordable healthcare.
although this is true, the leverage gained through group is different for other services, where a bulk order is much cheaper.
Assuming everyone's making rational decisions, the only people that would want insurance would be the high risk ones. Insurance companies would loss money regardless of the rates they charge because the only rational people that would pay it would be the ones that think they would likely benefit from it, since they have additional information (eating habit, risk level, etc ) over the insurance company. By putting a lot of people (high risk and low risk) in a group, the insurance company can balance out the group and make a small gain on top of the expected payout.
My auto insurance company also runs a savings bank for its members and offers loans at markedly better rates than retail banks.
Consumer cooperatives would seem the simplest way to alleviate this issue--no need for additional legislation. To confirm, I live in the US.
If the Republicans are serious about an economic recovery and want startups to flourish, then universal healthcare is a cornerstone of such an effort. I know of other people too who are afraid of leaving their (big-company) positions because they have a wife + young kids, and lack of health insurance terrifies them.
In California you need at least 2 employees to qualify for group coverage. So you start an actual company, perform business (presumably turning in some money to cover your costs), and also get coverage for your dependents. There's one caveat that the coverage does not start until your company has been around for 6 months (unrelated to the pre-existing 6 months figure above.)
Or was the author's post related to (presumably) retiring earlier and specifically not wanting to start a company again?
You can be young, fit and healthy, but get hit by a car and your life is over. Once you're bankrupted by medical fees, you'll never have good credit again - and in the US, this is like the mark of the beast.
It's no wonder that American streets are filled by the homeless and disabled. This is a great country, with wonderful people, but in some ways it's medieval.
Of course, that presupposes you don't need to pay out-of-pocket for major medical care more than once every 5-10 years.
Neither can those of us who live here.
I mean, I can kind of understand the series of historical accidents of how we got here. What I can't understand are the politicians promising to fight tooth and nail to roll back the very minor reforms just enacted, and all of the people who enthusiastically just voted them into office last election, based on that platform.
So what? We live in a litigious society, laws are verbose because they have to be. Make it too vague and you just force the issues to be resolved in the courts making it even more confusing because the rules become written in case law.
Call me an idealist, but I think that's bad.
Like a tax code, usually these kinds of things end up working out mostly to the benefit of the larger parties who pay the most lawyers and professional staff to find and execute on the loopholes.
I do engineering for government contracts. The spec for the system I work on covers thousands of pages. I've read about 6" thick worth of it and that is less than 10%. But they detail down to the most minute thing what you are allowed to do and not allowed to do. The big picture stuff fits on the first 10 pages, and then they drill down into exactly what kind of thread you can have on a fastener and exactly how you are allowed to stress a weld for the next 1,000 pages. But it stems from previous experiences and errors, and it leads to a better product (though a more expensive one).
So I don't think "# of pages" should ever be a metric for judging a law.
Yeah, well what you said is just a tactic to try and sway people to think what you believe. See where that line of reasoning goes?
I do engineering for government contracts. The spec for the system I work on covers thousands of pages. I've read about 6" thick worth of it
I've read and implemented big specs too and I know how much work they take to produce. And I know darn well it wasn't some committee of smart and well-intentioned elected representatives that wrote it.
then they drill down into exactly what kind of thread you can have on a fastener and exactly how you are allowed to stress a weld for the next 1,000 pages. But it stems from previous experiences and errors, and it leads to a better product (though a more expensive one).
Are you seriously claiming the health care bill is so big because it's a precise engineering document which "stems from previous experiences and errors, and it leads to a better product"?
If so, how much does 10,000 pages of high-quality engineering documentation cost to produce?
Who do you think paid for it?
I think you're just imagining that it's what you want it to be.
But the bigger reason is probably that ultimately they know the key to maximizing their long-term profitability is to funnel as much money into Washington DC as they possibly can.
There will be more laws regulating healthcare in the future.
Baby boomers are going to be using a lot of healthcare in the coming decades and retired people vote. The debates will be no less political.
In my opinion, the "very minor reforms" you mentioned will probably accelerate health cost inflation by subsidizing more consumption of health care goods and offering no incentive for offsetting conservation. They may ease the symptoms for a time, but they will exacerbate the underlying illness.
The vast majority of costs borne by and in the US healthcare system are the results of overeating, oversmoking, and underexercising. Period. Heart disease, many forms of cancer, diabetes, most forms of pancreatic, gallbladder, and adrenal conditions, are largely the result of personal choice.
Setting aside for a moment the fact that congenital defects, hereditary disorders, infections, and accidents are no fault of the victim/patient, it should be important to note that a system that REQUIRES those who take care of their health by eating and exercising properly to subsidize the consequences of the choices of those who do not, is taken by many Americans to be fundamentally unfair.
If legislative initiative were taken to find a way to exclude universal coverage of lifestyle diseases, while still permitting universal coverage of non-lifestyle conditions, many people would not have such a viscerally negative reaction to the notion of universal health care.
The US health care system is melange of many complex and perverse incentives. I recall a study saying unhealthy behavior adds at most 50% to costs but costs have increased many more times than that in the last thirty years. The billing system, medical education system, end-of-life-care, the health insurance system, ad-nauseum. It takes a LOT of crazy schemes to eat up 20% of the GDP of the once-most-prosperous country in the world.
That played no small part in getting me back in shape.
A single-payer/public system has a strong incentive to preventatively fight lifestyle diseases in a way that bickering insurance companies simply do not.
Placing a tax on fat content would increase the proportion of earnings used for the NHS by those who would use it the most. It would also provide a disincentive to eat unhealthy in the first place. Of course, many many people think this smells a lot like social engineering (what isn't at government level?), so this wouldn't pass in the UK, let alone the US.
Lots of good background on Fat Tax in the References at http://en.wikipedia.org/wiki/Fat_tax
Insurance (which is a horrible system for health care, since insurance depends on people who buy it not to use it, and all of us need health care, usually multiple times per year) and government programs merely mask the root of all of this, which is that health care is completely and utterly unsustainable at its current rates. Something has to change about the way we administer medicine because nobody can afford it.
Everyone outside of the US has seen that people can't afford it and instead of fixing it, they've just said "the government will pay whatever it costs, don't worry any more, peasants!" In the US the problem has existed so long because we've covered it with insurance companies, but that system is crumbling as it gets harder for anyone without a job at BigCo to get reasonable care.
Our options are to figure out how to make health care cost a reasonable and affordable amount of money or let the government print money to fix it all for all of us (in the short term, ignoring the consequences of printing a bunch of money to keep an unsustainable system alive).
The current plan to force everyone in the United States onto an insurance policy with minimal modifications from existing policies is a pretty bad plan imo. The rates will be about the same and I'm sure the insurance companies are going to be thrilled to get tens of millions of new customers to suck dry by legal mandate. The people that will qualify for state subsidized insurance rates are only a handful more than the people that currently qualify for state medical programs like Medicaid anyway.
Simply because the insurance and billing drive costs so much higher
It's simply that some people make irrational, bad choices, and the incentives on the whole make no difference.
Such as the choice to smoke, or over-eat. Yes, they can be addictive, but there are supports and cures for both, and involve willpower and sacrifice, but they're there.
I say this as a fatarse who has lost 20Kg by eating less (The Horror!) and doesn't blame anyone except himself.
If the potential future cost of dying of lung cancer doesn't deter people from smoking, then the potential future cost of bankruptcy from paying for lung cancer treatment isn't going to, either.
It's about the mispricing of future risk rather than moral hazard. If you brought the cost up-front, by giving them health insurance but charging additional risk premiums to smokers, then you would likely find more rational decision-making around smoking.
It's the Republican Party. They serve a certain set of masters. This set of masters is not the everyday Joe. This should be old news. Unfortunately it is not. And yes some folks vote for them that probably should not, but we have a sort of Bell Curve of intelligence and education out there -- though everyone's vote counts exactly the same -- combined with a variety of different levels of empathy for others, combined with a propaganda-rich media environment. This is what happens under those conditions. Ideally, we want to change these underlying conditions.
In the US you can't leave your job to start your own business because your children might get sick and die. Even leaving for another employer is tricky because there is often a 6-12month gap before the new health coverage kicks in and anything you had treated in the past (like a broken leg in a childhood cycling accident) becomes a pre-existing condition and the new place denies you coverage.
This very effectively reduces wage costs since the whole 'importing people from africa' thing was banned.
As a relatively well-paid (when I wasn't working for myself) Canadian, it just never occurred to me that I might need to stick with a job just for the benefits. I had the freedom to move.
A six or twelve month wait is also unusual on switching jobs. Generally it will take ~60 days from hire for the new insurance to kick in, but rarely more than 90.
Instead I've only had to pay a nominal fee every time I need medication. Surgery, over a dozen MRI scans and visits to specialists over the years plus other tests and whatever else have all been paid for at no cost to me.
It scares the crap out of me to think what would have happened to me if I was in the USA.
To be able to see specialists or have expensive tests at times when I've been lucky to have $5 to my name is something I feel enormous gratitude for. I can't imagine the hardship having to pay for all this out of pocket would cause.
The problem is the government is broke and the health care bill was so bad that many supporters already have exemptions (including a few unions that backed the bill). Worse it really didn't address the big problem of why health care costs so much. It also had unwarranted optimism on cost savings.
At some point, I hope that the government will address: tort reform, drug trial costs, cost of medical training, bulk drug purchasing, "catastrophic" government backed insurance, and better medical savings accounts. I really expect more talking heads yelling at each other first.
"In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States."
I saw 3 different doctors, including seeking multiple opinions from 2 different knee specialists. I decided not to have surgery right away, and got a brace.
A few years later, my preferred leisure activities changed, so I decided to have surgery done. It took 11 weeks to get an appointment (as it was elective surgery at that point). The surgery was done by an experienced surgeon (a few hundred ACLs under his belt), and he met with me 4 times himself during the following year to follow up on my recovery progress.
Total out of pocket cost was ~$300 for a couple optional recovery devices (icing machine, etc.).
Physiotherapy appointments were, however, covered by my employer's extended medical at the time. That was about $1-2k that I would have had to pay had I been completely uninsured. I probably would have elected for less and cheaper physio care in that case though.
Short version: after reading this article/thread, I'd honestly be scared to join YC in SV, especially now that I have a daughter.
(Side note, I tore my ACL in Ontario and had an initial appt there, but ended up getting treatment in BC. It seems a lot of posts here talk about which state you have coverage in? Is the paid-for insurance not country-wide either??)
There's the separate concept of in-network and out-of-network doctors, of course....
I've been self-employed since 2003 and I've never paid a cent in health insurance, I just pay the Medicare levy like everyone else. I didn't pay any money at all for this stay or surgery, and also received free pain medication (endone, oxycontin etc.) upon release.
The surgery was successful and although I still have some pain sometimes, I can walk, run, play sport and do anything else I like.
If only the U.S healthcare system were my broken calcaneus :)
The MRI was on the order of $1200, and another appointment later (this time with a knee specialist), it turned out that I did, in fact, have a torn ACL. By now, however, it had happened nearly a month prior, and the doctor recommended waiting at least two more months for the swelling to fully subside.
Reluctant to make such a big investment and being fearful of such a major surgery, I waited about 9 more months before I finally had the surgery. Since I didn't go to a hospital, the costs were actually reasonably low: ~$2500 each for the facilities, the anesthesiologist, and the surgeon. From diagnosis through final checkup, the cost was about $10K, and I was fortunate enough to have my doctor advise me on personal rehabilitation (I didn't go to a single session of rehab).
So I was lucky to get into a good facility with a good doctor and get reasonably-priced care, and now I'm stuck in a job I don't like with high credit card bills in order to pay off a large cost for a fluke basketball accident. Call me crazy, but I'd be interested in taking my chances in Canada or the UK. I've only just now (a year later) paid off the anesthesia, and I'm halfway done paying off the surgeon.