Whatever it is the US does, it costs 2x as much as the second most expensive country. This indicates to me that the system is so bad that it needs to be scratched and rebuilt entirely ... this level of inefficiency can't be patched up. It's fundamentally broken.
(Must likely due to a combination of frivolous lawsuits + a belief in drugs and technology.)
TL;DR - I don't care that the US is the leading nation in MRI machines per capita. I'd pretty much take any random health care system of the next ten countries over that of the US.
It's a travesty.
It's indeed a case of not acknowledging that trying to socialize health care by using corporate subsidies and forcing people into private insures is a stupid idea to begin with. It's like insisting that a car must have three wheels because a car with four wheels does not conform to the prevailing ideology even if four wheels makes more sense.
Bias disclaimer: I consider myself somewhat of a [progressive] libertarian, but I think health care is close to national defense in that it's a public issue (because diseases are transmittable ... consider it national defense against microbes ...) and thus should be a national matter.
Obamacare R.I.P.
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secretwealth
- Posts: 1948
- Joined: Mon Jun 27, 2011 3:31 am
I can probably answer for Jacob, since I could also live in a few other countries and was given the opportunity to live elsewhere for higher pay: the U.S. is still a fascinating place with a compelling culture and a lot of perks that counterbalance the health care issue. I did consider leaving America permanently and actually cancelled my plans after Obamacare passed. With the promise that all Americans would have affordable healthcare by 2014, I finally accepted that the biggest barrier to a good life in America was finally gone.
Somewhere, either here or in the blog, Jacob analogously compared modern America with imperial Rome in terms of being the "seat of civilisation", which makes up for other major and minor inconveniences, therefore making him stay (for now).
He also expressed caveat that he is known to pack up bags and leave in the past.
He also expressed caveat that he is known to pack up bags and leave in the past.
@Jacob
Yes, nationalized health care is national defense against microbes. Nationalized agriculture and food distribution is national defense against hunger. Nationalization of the printing press and media is national defense against treasonous and subversive ideas.
In a country where the majority of people die from non-contagious degenerative (largely self-imposed) diseases.
Yes, nationalized health care is national defense against microbes. Nationalized agriculture and food distribution is national defense against hunger. Nationalization of the printing press and media is national defense against treasonous and subversive ideas.
In a country where the majority of people die from non-contagious degenerative (largely self-imposed) diseases.
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jennypenny
- Posts: 6910
- Joined: Sun Jul 03, 2011 2:20 pm
"It is impossible to have a free market for healthcare"
It can be a free market as much as banking or housing is in this country. Even the automotive industry is subsidized right now, but no one is complaining about paying $30K for a Silverado. Why is healthcare different?
You don't have to change the whole system, or limit everyone to one system with a universal plan to fix things (I agree it needs fixing). Push it closer to a free market system. Insurance should be available to everyone (no pre-existing clauses), it should be required, and it shouldn't be tied to employment. It could be structured like auto insurance. And those of us who are high risk could be treated like assigned risk drivers. And we could all pay a small amount into an uninsured/underinsured pool. End of.
I agree that a healthy population is in the national interest like defense and education. But those two things are under government control, and people do nothing but bitch about how expensive and inefficient they are. How do people like Ritholz (who I think is a smart guy) post charts showing how much we spend on the DoD to highlight how poorly the government spends money, and then argue for a government mandated healthcare system? You'd be handing our health care over to the same bunch of idiots who've run the rest of the government into the ground financially.
It can be a free market as much as banking or housing is in this country. Even the automotive industry is subsidized right now, but no one is complaining about paying $30K for a Silverado. Why is healthcare different?
You don't have to change the whole system, or limit everyone to one system with a universal plan to fix things (I agree it needs fixing). Push it closer to a free market system. Insurance should be available to everyone (no pre-existing clauses), it should be required, and it shouldn't be tied to employment. It could be structured like auto insurance. And those of us who are high risk could be treated like assigned risk drivers. And we could all pay a small amount into an uninsured/underinsured pool. End of.
I agree that a healthy population is in the national interest like defense and education. But those two things are under government control, and people do nothing but bitch about how expensive and inefficient they are. How do people like Ritholz (who I think is a smart guy) post charts showing how much we spend on the DoD to highlight how poorly the government spends money, and then argue for a government mandated healthcare system? You'd be handing our health care over to the same bunch of idiots who've run the rest of the government into the ground financially.
I have my part-time, full-benefitted job with a university specifically for the benefits. We're a family of 5; four of us have chronic conditions that are NOT expensive if managed properly. (Our conditions are not "lifestyle" conditions, either -- autoimmune or genetic), but that would be a disaster if they got out of control, so we need good health insurance.
To replace our insurance -- the existing HMO -- costs $2100 per month (yep -- twenty one hundred) for our family as private insurance as part of a small business alliance here in MA. If our business income replaces our current wage income, we wouldn't qualify for subsidized plans. So we need to earn an extra $1700/month (we pay $400 right now through my employer) before thinking about going out on our own, and we'd have to stay in MA, where pre-existing conditions cant dq you.
We don't qualify for a LOT of the cheaper plans because of our conditions. The 2014 change was going to be huge for us.
I love my job, and realize I'm fortunate to work half time and get great benefits for $400/month. If my health insurance weren't tied to employment, though, and we could get private insurance in the $400/month range, we'd go for building our small business, which would -- at a minimum -- allow us to create 3-4 new jobs for other people right off the bat.
Tying health insurance to employment really hurts growth.
And ERE!
To replace our insurance -- the existing HMO -- costs $2100 per month (yep -- twenty one hundred) for our family as private insurance as part of a small business alliance here in MA. If our business income replaces our current wage income, we wouldn't qualify for subsidized plans. So we need to earn an extra $1700/month (we pay $400 right now through my employer) before thinking about going out on our own, and we'd have to stay in MA, where pre-existing conditions cant dq you.
We don't qualify for a LOT of the cheaper plans because of our conditions. The 2014 change was going to be huge for us.
I love my job, and realize I'm fortunate to work half time and get great benefits for $400/month. If my health insurance weren't tied to employment, though, and we could get private insurance in the $400/month range, we'd go for building our small business, which would -- at a minimum -- allow us to create 3-4 new jobs for other people right off the bat.
Tying health insurance to employment really hurts growth.
And ERE!
@JohnnyH
I expressed myself poorly in my previous post. Of course, it is possible to tweak the system. My point is that you can "free market" tweak it all you want. You can completely destroy the system and go 100% cash, zero insurance (not even medicare), and you still won't have a free market healthcare system (see previous post with abbreviated problems for a free market).
@Roark
"What moral right do any of you have to force me, by the point of a gun, to pay for your health care? Am I your slave?"
Dude, you already pay for it (see my first post). You just pay for it very inefficiently now.
@JennyPenny
First, I have worked for small businesses, Fortune 500 companies, and the government. The idea that the government is vastly more inefficient than these businesses is a false meme perpetrated on us since we were kids (note this is coming from someone who considered himself a Republican until about 12 years ago and who had enjoyed Ann Rand).
The majority of what the government does (defense, scientific research, safety nets, etc.) is all magnitudes harder than what most companies do. Building widget A (even if it's an iPad) and shipping it to store B is pretty easy compared to deciding how much defense is needed, where basic research dollars should go, how to screen people for inclusion in safety nets, etc.
I'm not suggesting that the government doesn't waste a lot politically and operationally, but that operationally they aren't nearly as bad as we have been led to believe. Same thing occurs in business. It's why when Citibank cuts 20,000 jobs no one notices a drop in service.
The idea that government is useless is a useless meme in this day and age.
Ok, let's assume you are able to make the changes for a supposed "free market" healthcare system. How would you do it? And, why would it work? I have yet to see any suggestions anywhere from advocates of a free market.
I don't see how it can when even small cities only have 1-2 legit hospitals. I use Erie, PA as an example because I lived there for a time and there were only 2 legit hospitals in the 4th largest city in Pennsylvania. There just isn't enough choice or the ability to evaluate how good medical care is to have a free market.
I expressed myself poorly in my previous post. Of course, it is possible to tweak the system. My point is that you can "free market" tweak it all you want. You can completely destroy the system and go 100% cash, zero insurance (not even medicare), and you still won't have a free market healthcare system (see previous post with abbreviated problems for a free market).
@Roark
"What moral right do any of you have to force me, by the point of a gun, to pay for your health care? Am I your slave?"
Dude, you already pay for it (see my first post). You just pay for it very inefficiently now.
@JennyPenny
First, I have worked for small businesses, Fortune 500 companies, and the government. The idea that the government is vastly more inefficient than these businesses is a false meme perpetrated on us since we were kids (note this is coming from someone who considered himself a Republican until about 12 years ago and who had enjoyed Ann Rand).
The majority of what the government does (defense, scientific research, safety nets, etc.) is all magnitudes harder than what most companies do. Building widget A (even if it's an iPad) and shipping it to store B is pretty easy compared to deciding how much defense is needed, where basic research dollars should go, how to screen people for inclusion in safety nets, etc.
I'm not suggesting that the government doesn't waste a lot politically and operationally, but that operationally they aren't nearly as bad as we have been led to believe. Same thing occurs in business. It's why when Citibank cuts 20,000 jobs no one notices a drop in service.
The idea that government is useless is a useless meme in this day and age.
Ok, let's assume you are able to make the changes for a supposed "free market" healthcare system. How would you do it? And, why would it work? I have yet to see any suggestions anywhere from advocates of a free market.
I don't see how it can when even small cities only have 1-2 legit hospitals. I use Erie, PA as an example because I lived there for a time and there were only 2 legit hospitals in the 4th largest city in Pennsylvania. There just isn't enough choice or the ability to evaluate how good medical care is to have a free market.
@JasonR
"America serves as a brain magnet."
Yet, we still have worse results than the European countries and Canada? And, it's more expensive? Your argument about Ecuador having poor reporting might be possible, but it isn't with the Europeans and Canada.
"We already have free healthcare."
Already covered this in previous posts and how it is inefficient and more costly than actually having universal healthcare.
Your 2nd paragraph about non-payers is mostly true in my experience (talking with my mother who is a CFO of hospital system). Though, my mother's hospital often doesn't bother to sue, as most of these people can't pay and legal fees end up being more than they are worth. So, we just pay for them in our fees.
"America serves as a brain magnet."
Yet, we still have worse results than the European countries and Canada? And, it's more expensive? Your argument about Ecuador having poor reporting might be possible, but it isn't with the Europeans and Canada.
"We already have free healthcare."
Already covered this in previous posts and how it is inefficient and more costly than actually having universal healthcare.
Your 2nd paragraph about non-payers is mostly true in my experience (talking with my mother who is a CFO of hospital system). Though, my mother's hospital often doesn't bother to sue, as most of these people can't pay and legal fees end up being more than they are worth. So, we just pay for them in our fees.
Before I say this: I have a pre-existing condition that has prevented me from accessing insurance in the past. This is not a theoretical discussion for me.
I am in favor of a baseline level of quality, affordable health care being available to all by law. I am NOT in favor of requiring insurance.
If one doesn't want to pay for car insurance there are other transportation options available... one is not required to own and operate a car in order to be an American. If one doesn't want to pay homeowner's insurance or property taxes, one can rent. Neither of those options are 100% ideal but if you truly want to opt out of "the system," for whatever reason, it IS possible.
Requiring health insurance, however, backs EVERYONE into a corner financially. And that's wrong. It's fundamentally undemocratic to force people to buy a product they don't believe that they need, and it's completely disingenuous to do it when the underlying rationale is "so it's cheaper for other people." That's not a health care plan, it's involuntary wealth redistribution. Also wrong.
The real problem here is that the health care companies (pharmaceuticals, insurance, etc.) have manipulated this nation's health care pricing through price fixing, patents and lobbyists, to the point that the free market system -- which would normally address this problem -- isn't operating at all.
I wish our lawmakers would stop trying to decide which handful of unlucky souls should be paying these outrageous prices and focus on the fact that they've been artificially inflated.
I am in favor of a baseline level of quality, affordable health care being available to all by law. I am NOT in favor of requiring insurance.
If one doesn't want to pay for car insurance there are other transportation options available... one is not required to own and operate a car in order to be an American. If one doesn't want to pay homeowner's insurance or property taxes, one can rent. Neither of those options are 100% ideal but if you truly want to opt out of "the system," for whatever reason, it IS possible.
Requiring health insurance, however, backs EVERYONE into a corner financially. And that's wrong. It's fundamentally undemocratic to force people to buy a product they don't believe that they need, and it's completely disingenuous to do it when the underlying rationale is "so it's cheaper for other people." That's not a health care plan, it's involuntary wealth redistribution. Also wrong.
The real problem here is that the health care companies (pharmaceuticals, insurance, etc.) have manipulated this nation's health care pricing through price fixing, patents and lobbyists, to the point that the free market system -- which would normally address this problem -- isn't operating at all.
I wish our lawmakers would stop trying to decide which handful of unlucky souls should be paying these outrageous prices and focus on the fact that they've been artificially inflated.
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jennypenny
- Posts: 6910
- Joined: Sun Jul 03, 2011 2:20 pm
@Secretwealth,
"You don't address the fact that the insured currently pay for others' medical care, since they subsume the costs of the uninsured receiving emergency care and not paying their bills."
I know. I was trying to make a different point with my comment. Here's another try:
What struck me was your comment that you find $400/mo to cover you and your wife "unacceptable". Including my employer's contribution, I pay $1472.21/mo to cover me,wife, and child. It's a group policy. I estimate that I pay about $1000/mo to medicare and medicaid-- it's a long discussion as to how I get to that number, but what I was hoping is that other folks might think about how much they pay per month to medicare and medicaid, and what number would be considered acceptable, or reasonable.
I know people will suggest different limits to this question based on their own beliefs and opinions. You have set a limit on what you think is reasonable for your private insurance, but what should the limit be for my contribution to public insurance that benefits others? Until we (not just you and I, but the country we) come to the realization that there should be a limit, I think the problem with costs will persist-- both for the private and public sector.
Without dragging this out any longer, I'll cut straight to the ending: $400/mo to cover two of you, unless you have a low max lifetime benefit, is probably an outstandingly low price considering the coverage and access you likely have.
Lastly, "the insured currently pay for others' medical care"-- well only kind of, right? Are we neglecting the uninsured, but also paying a good deal for their care? I don't dispute that a portion of what privately insured individuals pay for healthcare provides benefit for the uninsured, but it doesn't happen on a 1:1, dollar for dollar ratio.
"You don't address the fact that the insured currently pay for others' medical care, since they subsume the costs of the uninsured receiving emergency care and not paying their bills."
I know. I was trying to make a different point with my comment. Here's another try:
What struck me was your comment that you find $400/mo to cover you and your wife "unacceptable". Including my employer's contribution, I pay $1472.21/mo to cover me,wife, and child. It's a group policy. I estimate that I pay about $1000/mo to medicare and medicaid-- it's a long discussion as to how I get to that number, but what I was hoping is that other folks might think about how much they pay per month to medicare and medicaid, and what number would be considered acceptable, or reasonable.
I know people will suggest different limits to this question based on their own beliefs and opinions. You have set a limit on what you think is reasonable for your private insurance, but what should the limit be for my contribution to public insurance that benefits others? Until we (not just you and I, but the country we) come to the realization that there should be a limit, I think the problem with costs will persist-- both for the private and public sector.
Without dragging this out any longer, I'll cut straight to the ending: $400/mo to cover two of you, unless you have a low max lifetime benefit, is probably an outstandingly low price considering the coverage and access you likely have.
Lastly, "the insured currently pay for others' medical care"-- well only kind of, right? Are we neglecting the uninsured, but also paying a good deal for their care? I don't dispute that a portion of what privately insured individuals pay for healthcare provides benefit for the uninsured, but it doesn't happen on a 1:1, dollar for dollar ratio.
@Chad, "Yet, we still have worse results than the European countries and Canada?"
For certain metrics, yes. For others, no.
How do we rank on breast cancer survival? US is number 1, right? OECD 2011.
How'd the Canadians do on surgical wait time? Dead last.
We are just about average for heart attack survival, which could be viewed as surprising given our rates of obesity and diabetes. We have more diabetics (as a percentage) than any country, and we are much better at keeping them out of the hospital than most, if not all, countries.
The different health systems, and different cultures, have different advantages and disadvantages. The quality metrics have some serious limitations. Does it really mean you're providing higher quality care because you send a woman home sooner after childbirth?
For certain metrics, yes. For others, no.
How do we rank on breast cancer survival? US is number 1, right? OECD 2011.
How'd the Canadians do on surgical wait time? Dead last.
We are just about average for heart attack survival, which could be viewed as surprising given our rates of obesity and diabetes. We have more diabetics (as a percentage) than any country, and we are much better at keeping them out of the hospital than most, if not all, countries.
The different health systems, and different cultures, have different advantages and disadvantages. The quality metrics have some serious limitations. Does it really mean you're providing higher quality care because you send a woman home sooner after childbirth?
@Mo
It's not just about quality, which I stated in my previous post. Don't cherry pick the numbers. It is always about quality and cost...together. No matter how you look at the numbers our system fails when these two variables are put up against other first world countries.
I would point out that those in support of universal healthcare have numerous first world examples to suggest, but no one on the free market side can ever put forth a legit plan. Just let the free market do it is not a good answer for such a strange business.
Here is a good article discussing how most MRI's are useless and could actually be harmful because they spark unnecessary surgery. This article wasn't really talking about the economics of healthcare, but you can see how this kind of abuses the free market when doctors are scheduling unnecessary tests just to make money off of them.
http://www.mensjournal.com/the-downside-of-mris
@JasonR
I'm still not sure what argument you are making with 1% students from 3rd world countries staying here. That could have absolutely nothing to do with the medical system and everything to do with:
"America with imperial Rome in terms of being the "seat of civilisation", which makes up for other major and minor inconveniences, therefore making him stay (for now)."
That happens in the U.S. with top students in rural areas. Most leave and move to more happening major population centers because of more opportunity.
It's not just about quality, which I stated in my previous post. Don't cherry pick the numbers. It is always about quality and cost...together. No matter how you look at the numbers our system fails when these two variables are put up against other first world countries.
I would point out that those in support of universal healthcare have numerous first world examples to suggest, but no one on the free market side can ever put forth a legit plan. Just let the free market do it is not a good answer for such a strange business.
Here is a good article discussing how most MRI's are useless and could actually be harmful because they spark unnecessary surgery. This article wasn't really talking about the economics of healthcare, but you can see how this kind of abuses the free market when doctors are scheduling unnecessary tests just to make money off of them.
http://www.mensjournal.com/the-downside-of-mris
@JasonR
I'm still not sure what argument you are making with 1% students from 3rd world countries staying here. That could have absolutely nothing to do with the medical system and everything to do with:
"America with imperial Rome in terms of being the "seat of civilisation", which makes up for other major and minor inconveniences, therefore making him stay (for now)."
That happens in the U.S. with top students in rural areas. Most leave and move to more happening major population centers because of more opportunity.
@JasonR
Ah, no wonder I couldn't find the argument.
I doubt the 1% being skimmed does much to general services. These are probably the theoretical guys and not necessarily all medical. What they develop eventually makes it's way back via new procedures or equipment.
"...then maybe the sick don't go to the hospital to die?" Possible. This is also why universal healthcare is better. They are much better at encouraging people not to do useless expensive and life impairing procedures, as they don't make any more money either way. While our doctors do. I still remember my 82 year old grandfather coming out of open heart surgery and saying, "I'm never going to do that again."
Ah, no wonder I couldn't find the argument.
I doubt the 1% being skimmed does much to general services. These are probably the theoretical guys and not necessarily all medical. What they develop eventually makes it's way back via new procedures or equipment.
"...then maybe the sick don't go to the hospital to die?" Possible. This is also why universal healthcare is better. They are much better at encouraging people not to do useless expensive and life impairing procedures, as they don't make any more money either way. While our doctors do. I still remember my 82 year old grandfather coming out of open heart surgery and saying, "I'm never going to do that again."
@Chad, Cherry-picking the data isn't necessary, there is an overwhelming amount of comparative data available. The US loses out on cost per capita, always, but it isn't true that we always lose out on quality.
I'm with you on the idea that we spend too much for our health care. I don't think that we will see cost reduction by implementing a system similar to the NHS, for example. I think we'd actually see cost increases because I don't think our government is able to control any costs of significance.
I disagree with you that our budget is an easy fix. "A few more taxes and a few cuts with defense being cut the most." You could get rid of the entire military and we'd still be in the red by $600billion last year. The problem with any situation of overspending isn't the math behind it-- the math is easy. The problem is getting people to actually agree to the cuts.
In the past 50 years we've run a surplus 5 times. 90% of the time we run a debt. We're like a drunk who can't stop drinking.
I'm with you on the idea that we spend too much for our health care. I don't think that we will see cost reduction by implementing a system similar to the NHS, for example. I think we'd actually see cost increases because I don't think our government is able to control any costs of significance.
I disagree with you that our budget is an easy fix. "A few more taxes and a few cuts with defense being cut the most." You could get rid of the entire military and we'd still be in the red by $600billion last year. The problem with any situation of overspending isn't the math behind it-- the math is easy. The problem is getting people to actually agree to the cuts.
In the past 50 years we've run a surplus 5 times. 90% of the time we run a debt. We're like a drunk who can't stop drinking.