Healthcare costs

Recent figures put the US economy at $20.5 Trillion. Of that, we apparently spend 17.1% on healthcare. A quick scan of comparable percentages shows us that nations like France, Germany, Sweden, etc. spend around 11%. If the US was to move to a system like theirs at even half the savings (3% of GDP) we'd save $615 billion dollars per year.

Can someone tell me why we can't deliver health care at those European levels (which are quite good) for less than we spend now? If we manage to strip healthcare out of employment costs we liberate potential entrepreneurs and also cut out a big fixed cost for many corporations (which inhibits hiring and flexible work arrangements).

Look, I get that it won't be all peaches and cream, and that unlike promises made by Republican Politicians perhaps everybody won't be better taken care of than they are now. Certainly those CEO's in the health insurance industry won't be taken care of as well. But can't we do a lot better than we are now? Has socialized medicine really hurt Canada, Germany, the UK, France, Norway, Japan, Belgium, Sweden, The Netherlands, Australia, Switzerland, Israel, etc.? They all have higher life expectancy than we do. I know that isn't the only stat that matters, but we also are worse than all of them in infant mortality.

Every year I have to pick between various plans my employer offers (and my employer has to take the time to negotiate them and explain them) and every year they are a little worse. My contribution goes up, or my co-pay goes up, or my deductible goes up, or usually some combination of those. And it isn't a small company with no bargaining power. Fortune 400.

We see better ways all over the developed world, but somehow can't get it done. We appear to have a better way here in this country with Medicare. It costs less than private insurance and would likely only get cheaper with increased buying power. And for those who want more, those other countries with socialized medicine offer supplemental private insurance, so that could still be an option. Rich people would still get better healthcare if they wanted to pay for it.

It's tough to make international comparisons on the basis of output alone.

We need to take other qualitative factors into consideration, and attempt to quantify them before any such analysis can be made.

American's tend to have a much larger body mass index. American's tend to smoke more. Americans are more likely to get injured via weapons and violence. Americans are more likely to be involved in automobile accidents. Americans are more likely to develop diabeetes, kidney disease, heart disease, etc....

You get the point.

Can we shave off a few percentage points as a representation of GDP by having a public health care guarantee? Sure... it will necessarily take the most risky people off of private risk pools, while simultaneously removing the inefficiencies of improper health care channeling, e.g. going to ER for a cold.

Journeyman said:

Can someone tell me why we can't deliver health care at those European levels (which are quite good) for less than we spend now? If we manage to strip healthcare out of employment costs we liberate potential entrepreneurs and also cut out a big fixed cost for many corporations (which inhibits hiring and flexible work arrangements).

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I for one am not sure cost should be that big an issue at all. Whenever the GOP wants something - military hardware, foreign wars, tax cuts for the rich, trade wars and embargoes, propping up coal - it's worth the cost. The Dems ask for healthcare and suddenly it's too expensive. Yes it is expensive which means cuts elsewhere, perhaps to those pet projects above. But what price do you put on the health of the nation when literally millions have no cover and will get sick and die needlessly?

An expensive system that covers everyone is better than none at all.

Kushinator said:

It's tough to make international comparisons on the basis of output alone.

We need to take other qualitative factors into consideration, and attempt to quantify them before any such analysis can be made.

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No, not really.

American's tend to have a much larger body mass index.

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Not really.. The differences are not that big. Yes the US is a fat nation, but Germany, Greece and others are not that far behind. However there are nations ahead of the US as well.. oh and most have universal healthcare and pay wayyyyy less than the US.

American's tend to smoke more.

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The US consumes about 1016.6 cigs per person. France 1089.9, Netherlands 1459.9, Spain 1499 (can confirm this big time), Denmark 1298, Austria 1927, Belgium 2440.9...

List of countries by cigarette consumption per capita - Wikipedia

In other words.. no, wrong and false.

Americans are more likely to get injured via weapons and violence.

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Yes, here you are nr. 1. Regardless of all the violence in the US, it is still relatively "small" part of the overall health picture.

Americans are more likely to be involved in automobile accidents.

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Seriously? The European average is 9.3 deaths per 100k population. The US is 10.9. China is 18.9...So again no.

Americans are more likely to develop diabeetes, kidney disease, heart disease, etc....

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No real evidence of this. Lots of myth and stuff, but actual evidence no. Take diabetes..

Countries ranked by Diabetes prevalence (% of population ages 20 to 79)

US is nr 43.

The differences in cost comes down to a broken US greed system where the consumer has zero power and the providers jack up prices as much as they want and can.

Money, it's all about profit and the average person can take a running leap off a cliff if they don't like the system. Money is put ahead of almost everything, unless of course it's something the republicans want, more tax cuts for the top ten percent. One day the average republican will wake up and realize their support of the ten percent, keeps them from living a decent life in the richest country in the world. Money.

Kushinator said:

It's tough to make international comparisons on the basis of output alone.

We need to take other qualitative factors into consideration, and attempt to quantify them before any such analysis can be made.

American's tend to have a much larger body mass index. American's tend to smoke more. Americans are more likely to get injured via weapons and violence. Americans are more likely to be involved in automobile accidents. Americans are more likely to develop diabeetes, kidney disease, heart disease, etc....

You get the point.

Can we shave off a few percentage points as a representation of GDP by having a public health care guarantee? Sure... it will necessarily take the most risky people off of private risk pools, while simultaneously removing the inefficiencies of improper health care channeling, e.g. going to ER for a cold.

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Thanks for a respectful response. I take your points, though Pete rebuts them to some extent below. Even if we can say that environmental factors are why the US is worse on various health metrics, we certainly can't say that we'd be way better without those factors.

Still, you agree that we can make things better (saving money and getting more coverage), so props to you.

PeteEU said:

No, not really.

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Yes really.

Not really.. The differences are not that big. Yes the US is a fat nation, but Germany, Greece and others are not that far behind. However there are nations ahead of the US as well.. oh and most have universal healthcare and pay wayyyyy less than the US.

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We are comparing the U.S. to developed nations, not the likes of China, India, Angola, or Russia for that matter.

The US consumes about 1016.6 cigs per person. France 1089.9, Netherlands 1459.9, Spain 1499 (can confirm this big time), Denmark 1298, Austria 1927, Belgium 2440.9...

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But you're forgetting Ireland, UK, Sweden, Norway, etc....

List of countries by cigarette consumption per capita - Wikipedia

In other words.. no, wrong and false.

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Did you see what i wrote? When i said "tends to smoke more", that's what the data shows.

The word tends has meaning in this context, so please try not to ignore it.

Seriously? The European average is 9.3 deaths per 100k population. The US is 10.9. China is 18.9...So again no.

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I'm very confused. I could have swore the words you quoted all contained the verb TENDS.

No real evidence of this. Lots of myth and stuff, but actual evidence no. Take diabetes..

Countries ranked by Diabetes prevalence (% of population ages 20 to 79)

US is nr 43.

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What is their place among developed nations? The rate of diabetes diagnosis in Saudi Arabia or French Polynesia is entirely irrelevant to the point. When we compare the most developed countries, the U.S. has a combination of high risk factors that necessarily increase the cost of care, just as the inability to afford preventative treatment tends to increase the cost of treating an illness.

I notice you skipped over the other aspects of my post in order to attack a straw man. Not once did i claim U.S. is the global leader or has more exogenous health care risk factors than EVERY developed country. You're putting your agenda before the data.

Journeyman said:

Thanks for a respectful response. I take your points, though Pete rebuts them to some extent below.

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Pete Cherry picked to push his agenda. I am in agreement that we need to reform our health care system. But i will continue to remain objective.

Journeyman said:

Recent figures put the US economy at $20.5 Trillion. Of that, we apparently spend 17.1% on healthcare. A quick scan of comparable percentages shows us that nations like France, Germany, Sweden, etc. spend around 11%. If the US was to move to a system like theirs at even half the savings (3% of GDP) we'd save $615 billion dollars per year.

Can someone tell me why we can't deliver health care at those European levels (which are quite good) for less than we spend now? If we manage to strip healthcare out of employment costs we liberate potential entrepreneurs and also cut out a big fixed cost for many corporations (which inhibits hiring and flexible work arrangements).

Look, I get that it won't be all peaches and cream, and that unlike promises made by Republican Politicians perhaps everybody won't be better taken care of than they are now. Certainly those CEO's in the health insurance industry won't be taken care of as well. But can't we do a lot better than we are now? Has socialized medicine really hurt Canada, Germany, the UK, France, Norway, Japan, Belgium, Sweden, The Netherlands, Australia, Switzerland, Israel, etc.? They all have higher life expectancy than we do. I know that isn't the only stat that matters, but we also are worse than all of them in infant mortality.

Every year I have to pick between various plans my employer offers (and my employer has to take the time to negotiate them and explain them) and every year they are a little worse. My contribution goes up, or my co-pay goes up, or my deductible goes up, or usually some combination of those. And it isn't a small company with no bargaining power. Fortune 400.

We see better ways all over the developed world, but somehow can't get it done. We appear to have a better way here in this country with Medicare. It costs less than private insurance and would likely only get cheaper with increased buying power. And for those who want more, those other countries with socialized medicine offer supplemental private insurance, so that could still be an option. Rich people would still get better healthcare if they wanted to pay for it.

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Well,.. there is a lot here that has already been discussed in the healthcare forum.. but.. lets since this is government spending and debt forum.. lets just throw this out there:

If the US was to move to a system like theirs at even half the savings (3% of GDP) we'd save $615 billion dollars per year.

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no.. you would not save this money.. you would LOSE this money. You would reduce our GDP by 3%.. The great recession that we just went through? Reduced GDP by 4 percent. And if we tried to go to the full savings.. it would be roughly 6-7 percent of gdp,

That represents thousands upon thousands of jobs.. it represents a huge amount of wages.. that go to middle class folks that are nurses, lab tech.. etc.

Because one of the major reasons that healthcare costs more in this country? WE pay much better wages.

I just throw it out there because healthcare is one if not THE primary growth in employment in this country.

And why? Because of demand for services.

Journeyman said:

Can someone tell me why we can't deliver health care at those European levels (which are quite good) for less than we spend now?

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Well, we can start with some of the reasons we don't now.

We pay people too much.

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And we're paying too many people.

In the last quarter, the healthcare industry surpassed manufacturing and retail for the first time in history to become the nation's largest employer, according to The Atlantic.

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We've got too many hospitals.

The smaller average size of US hospitals and relatively lower hospital utilization also play a role in driving up US inpatient costs. The United States has 23 percent fewer beds per hospital than the OECD average, reflecting the fact that capacity is distributed over more hospitals in the United States than it is in other countries. Because many fixed costs, such as high-cost machinery and administrative functions, must be incurred in each hospital regardless of size, being subscale increases US fixed costs per bed.

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We deliver too many services.

Compared with the average OECD country, the U.S. delivers (population adjusted) almost three times as many mammograms, two-and-a-half times the number of MRI scans, and 31 percent more C-sections. Also, the U.S. has more stand-by equipment, for example, 1.66 MRI machines per 6,000 annual scans vs. 1.06 machines. The extra machines provide easier access for Americans, but add to cost. Similarly, occupancy rates in U.S. acute care hospitals are much lower than in OECD countries, reducing the likelihood of delays in admissions, but building that extra capacity adds to cost. Aggressive treatment of very sick elderly also makes the mix expensive. In the U.S. many elderly patients are treated in intensive care units (ICUs), but in other countries they would receive only palliative care. More amenities such as privacy and space in hospitals and more attractive clinics also add to U.S. costs.

While the U.S. mix of services is disproportionately tilted toward more expensive interventions, the other OECD countries emphasize a “plain vanilla” mix. Compared with the U.S., the average OECD country has 30 percent more physician visits and more than 30 percent more hospital days per capita.

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We use too many medicines and get access to them too quickly.

Overall, Americans use more medicines than people in other developed countries. They rank first for their use of antipsychotics as well as drugs for dementia, respiratory problems and rheumatoid arthritis. This is partly explained by medical needs: The burden of disease in the U.S. — as measured in “years of life lost” — is higher than in many OECD countries for the most common forms of heart disease, chronic obstructive pulmonary diseases, diabetes, and Alzheimer’s. Several factors may explain this, including high levels of obesity and high rates of diagnosis.

Americans also have faster access to new drugs than patients in many other countries. That’s in part because the U.S. has always been a very attractive market for pharmaceutical companies: It’s big, accounting for 34 percent of the world market; has low levels of price regulation; and offers few barriers to market entry once FDA approval has been secured. (By contrast, in some other countries there may be a time lag between clinical approval of a drug and the point when it is added to official lists of reimbursable drugs.)

The result is that companies often choose the U.S. to launch new products. And, because the US market is so big and profitable, investments in research and development have long been steered towards meeting its clinical needs.

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"Too much/many" here just means to too much/many to hit an arbitrary OECD-inspired health spending target. In terms of whether Americans actually generally think we ought to slash wages and jobs, close hospitals, scale back capacity and reduce the amount of services and medicines we get, or slow down access, or reduce innovation--well, you can probably start to appreciate why actually reducing health spending is so difficult.

Greenbeard said:

And we're paying too many people.


We've got too many hospitals.


We deliver too many services.

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Just one side question about this that may explain the disparity: how much of that is due to the US having far lower population densities than most other OECD nations?

phattonez said:

Just one side question about this that may explain the disparity: how much of that is due to the US having far lower population densities than most other OECD nations?

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The hospital beds point, certainly. We've got a huge issue right now with financing rural hospitals and there are very real questions about whether those communities can and should sustain a local hospital--at least one with the services they're accustomed to. It's much easier on the finances of the overall health system to have fewer hospitals with more beds than the reverse.

Greenbeard said:

The hospital beds point, certainly. We've got a huge issue right now with financing rural hospitals and there are very real questions about whether those communities can and should sustain a local hospital--at least one with the services they're accustomed to. It's much easier on the finances of the overall health system to have fewer hospitals with more beds than the reverse.

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I've heard a lot about this, and your post made me immediately think about this. Many of these rural hospitals have closed, without significant gains in cost or outcomes.

jaeger19 said:

Well,.. there is a lot here that has already been discussed in the healthcare forum.. but.. lets since this is government spending and debt forum.. lets just throw this out there:



no.. you would not save this money.. you would LOSE this money. You would reduce our GDP by 3%.. The great recession that we just went through? Reduced GDP by 4 percent. And if we tried to go to the full savings.. it would be roughly 6-7 percent of gdp,

That represents thousands upon thousands of jobs.. it represents a huge amount of wages.. that go to middle class folks that are nurses, lab tech.. etc.

Because one of the major reasons that healthcare costs more in this country? WE pay much better wages.

I just throw it out there because healthcare is one if not THE primary growth in employment in this country.

And why? Because of demand for services.

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Okay, first, thank you for a thoughtful reply.

Now, I see what you are saying, but I think it smacks of the broken window fallacy. We are wasting that money as a society. Yes, if we were to be able to throw a switch and transition our economy would be that much smaller, but 1, that's not how it would work, and 2, we could still put that money to a different, presumably better use. That savings will accrue to people, companies, and governments who can turn that money to more productive uses. If I pay less for healthcare, I can spend more on new furniture. That increases demand for furniture builders, so new jobs come in there to replace a healthcare job lost. Of course it isn't one-to-one and any disruption of an industry is going to be messy and painful. One approach would be to try to lessen that pain, provide re-training, provide support, etc. Another would be to say, "Tough, them's the breaks." People differ philosophically on which way is better.

As I see what you are saying it looks like the argument of someone hooked on a bad drug who is arguing that withdraw is too painful to try and stop taking it. I can see the same argument being made against making the tax code simpler. Think of the accountants! Another example would be the disruption caused by the invention of the mechanical reaper. It made farming more efficient, but did it hurt GDP from lost farm hand jobs? Certainly plenty of people lost jobs, but they found other employment.

Greenbeard said:

Well, we can start with some of the reasons we don't now.

...

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All very good points, thank you.

I do have to wonder at what point it stops being sustainable. I note the 30% fewer doctor visits and have to think that is impacting our heath negatively. I also suspect that it is cost driven, at least in part. When enough people start suffering enough from not being able to afford to go to the doctor when they should, will that cause appetite for a change? I know people making 6 figures who aren't happy with the level of health care they get for the price. How long can that go on as each year gets worse and worse (higher healthcare inflation vs. wage growth).

Journeyman said:

Okay, first, thank you for a thoughtful reply.

Now, I see what you are saying, but I think it smacks of the broken window fallacy. We are wasting that money as a society. Yes, if we were to be able to throw a switch and transition our economy would be that much smaller, but 1, that's not how it would work, and 2, we could still put that money to a different, presumably better use. That savings will accrue to people, companies, and governments who can turn that money to more productive uses. .

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Yeah.. lets think about that.. whats more productive than keeping people healthy? Sure the we pay more... but one of the reasons we pay more is because of demand. More people demand our services. So.. that fellow that would have to stop working at 45 and go on disability? He now is back to work.. courtesy of me. How valuable is that? Or all those people that would have to be in long term care.. that are living independently because of the healthcare industry. How productive is that making people have better quality of life?

You think buying more furniture from china is actually more productive? Think about it.. If you spend on healthcare.. not only does it make YOU more productive because you maintain or improve your health.. but those dollars you spend? They go to the US.. because we don't really outsource our healthcare. That money is going to a physician and a nurse, and a x ray tech.. that spends that money in your community. Maybe for your services. And their better wages.. prop up YOUR wages.. because it creates wage pressure. And heck.. a lot of providers work in NON PROFITS.. which means that any "profit" is turned right back into the community and doesn't end up offshore in an account in Ireland or the Caymans.

but when you purchase that furniture.. with the made in china, or "hencho in mexico".. sign on it? Not nearly the economic effect as much as healthcare.

I can see the same argument being made against making the tax code simpler. Think of the accountants! Another example would be the disruption caused by the invention of the mechanical reaper. It made farming more efficient, but did it hurt GDP from lost farm hand jobs? Certainly plenty of people lost jobs, but they found other employment.

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Nope.. not the same argument. Because in both of those scenarios you are reducing the demand for those services.. tax accountants, and farm hand jobs.. by meeting the demand in another way.

With healthcare.. you are talking about artificially simply deciding to 1. pay people less..
2. Stop providing certain levels of care
3. Decrease access to medical technology and hospital beds etc. especially in rural areas.


Imaging what would have happened if.. there was no invention of the mechanical reaper... but someone said... "gee.. we are paying way to much money for food.. so to reduce the price of food.. we are going to drastically reduce what we pay farmers.. (but not reduce those farmers costs.. in fact.. in some ways increase them)....

Well.. what do you think would happen? Farmers WOULD switch to other postions.. fields would go untended.. and the supply of food would diminish...

Journeyman said:

All very good points, thank you.

I do have to wonder at what point it stops being sustainable. I note the 30% fewer doctor visits and have to think that is impacting our heath negatively. .

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OR.. its a sign that because doctors have more access to say getting a person an MRI.. or doing a pap smear, or ordering a mammogram or biopsy.. that doctors take less visits to provide care. The end result may be that more people have what eventually is deemed unnecessary.. but the people that are diagnosed with whatever, get diagnosed faster, and get better care...

Perhaps that's why the US does better on cancer survival rates than Britain does.

Journeyman said:

All very good points, thank you.

I do have to wonder at what point it stops being sustainable. I note the 30% fewer doctor visits and have to think that is impacting our heath negatively. I also suspect that it is cost driven, at least in part. When enough people start suffering enough from not being able to afford to go to the doctor when they should, will that cause appetite for a change? I know people making 6 figures who aren't happy with the level of health care they get for the price. How long can that go on as each year gets worse and worse (higher healthcare inflation vs. wage growth).

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Just to point out by the way.. most people don't pay for healthcare.. they pay for healthcare insurance.

The cost of healthcare in this country has been controlled for decades.. starting with the balance budget act and most recently with Obamacare. And who benefits the most? The insurance companies that pay the hospital. not you. Because you pay for health insurance.

Take a look at one of your bills.. and see what the doctor charged.. and then see what the insurance paid him. Why the large disparity do you think?

jaeger19 said:

Yeah.. lets think about that.. whats more productive than keeping people healthy? Sure the we pay more... but one of the reasons we pay more is because of demand. More people demand our services. So.. that fellow that would have to stop working at 45 and go on disability? He now is back to work.. courtesy of me. How valuable is that? Or all those people that would have to be in long term care.. that are living independently because of the healthcare industry. How productive is that making people have better quality of life?

You think buying more furniture from china is actually more productive? Think about it.. If you spend on healthcare.. not only does it make YOU more productive because you maintain or improve your health.. but those dollars you spend? They go to the US.. because we don't really outsource our healthcare. That money is going to a physician and a nurse, and a x ray tech.. that spends that money in your community. Maybe for your services. And their better wages.. prop up YOUR wages.. because it creates wage pressure. And heck.. a lot of providers work in NON PROFITS.. which means that any "profit" is turned right back into the community and doesn't end up offshore in an account in Ireland or the Caymans.

but when you purchase that furniture.. with the made in china, or "hencho in mexico".. sign on it? Not nearly the economic effect as much as healthcare.



Nope.. not the same argument. Because in both of those scenarios you are reducing the demand for those services.. tax accountants, and farm hand jobs.. by meeting the demand in another way.

With healthcare.. you are talking about artificially simply deciding to 1. pay people less..
2. Stop providing certain levels of care
3. Decrease access to medical technology and hospital beds etc. especially in rural areas.


Imaging what would have happened if.. there was no invention of the mechanical reaper... but someone said... "gee.. we are paying way to much money for food.. so to reduce the price of food.. we are going to drastically reduce what we pay farmers.. (but not reduce those farmers costs.. in fact.. in some ways increase them)....

Well.. what do you think would happen? Farmers WOULD switch to other postions.. fields would go untended.. and the supply of food would diminish...

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A lot of this boils down to whether or not we agree that the US healthcare system is providing better results. You bring up some interesting points, but I'm not certain that it is producing better results. You would be right if we aren't talking about efficiency gains. Cutting a big piece of the private insurance industry out of the process would represent a big gain in efficiency. As for reducing pay, that depends on who, how much, and what effect it has. Cut the pay of the $15 an hour bedpan changer and you don't get much savings, hurt direct spending in the economy, and incent that person to find a different job, thus causing a new problem. But what about if doctors in the top half of doctor pay made 10% less? Are they going to switch jobs? Sure some will, but will the aggregate impact be better or worse? Hard to answer for sure, but I'll still go back to basic premise that we are paying more and not getting more (or at least not 'more enough').

Journeyman said:

A lot of this boils down to whether or not we agree that the US healthcare system is providing better results. ).

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Not really. Not from an economic standpoint...

You would be right if we aren't talking about efficiency gains.

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Well.. okay.. lets talk about efficiency gains. Greenbeard presented a bunch things were we are less efficient. Which adds to cost. For example. we have way more hospitals and hospital beds. So.. yep.. we could decide that those rural hospitals need to close.. or that their services need to be reduced so that they become more efficient. BUT.. is that something that the US wants to do? Would you be content.. that you have to drive 3 hours for a service that your local hospital used to provide 15 minutes away?

Cutting a big piece of the private insurance industry out of the process would represent a big gain in efficiency

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Or not. right now.. the Medicaid and Medicare.. and other public insurance.. represent about 60% of the money that private insurance companies make. Because the private insurance industry administers these public insurances. SO.. why do you think that when we go to a government single payer.. we will suddenly get rid of those private insurance companies.. when now they are administering the government insurances? You think there is going to be stomach to create a whole new government agency to administer the public insurance? What assurance do you have that it will be more efficient.

AND

Right now.. the worst insurances for me to deal with.. are government insurances.. they decrease my efficiency and increase my cost over almost all other private plans. So when you say.. "well the government plan will be more efficient".. I have a lot of experience that tells me that it won't be.

Cut the pay of the $15 an hour bedpan changer and you don't get much savings, hurt direct spending in the economy, and incent that person to find a different job, thus causing a new problem. But what about if doctors in the top half of doctor pay made 10% less? Are they going to switch jobs? Sure some will, but will the aggregate impact be better or worse?

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Well.. We can argue the who what when and where.. but lets think on this... what do you THINK would happen.. based on past economic history? Do you think that your are going to be able to selectively "lower the top half of doctor pay 10%".. without effects lower down the line? We have already reducing the cost of healthcare.. and the result is that you don't see a physician anymore,, more likely a PA or nurse practitioner. And you spend less time with the provider.. etc.

At the end of the day.. as Greenbeard has shown.. there is no magical free lunch here.

I'll still go back to basic premise that we are paying more and not getting more (or at least not 'more enough').

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Well.. It would depend on what you value. and what you consider more.

So a few things for you to consider and research.

1. Look at countries that have similar systems of single payer healthcare... and you will find that when you compare THEM to each other.. they have wide variations in cost and care. Yet they have the same system... which means that variations of cost are due to things OTHER than whether you have single payer or not.

now. I can hear some of the folks on this board running to say "yes but the US is higher than everyone"... yep... but the fact that there is wide variations in costs among single payer.. means that the reason that the US pays more for healthcare.. may be more due to other factors.. and NOT do to the fact we don't have single payer government healthcare.

things like 1. Shifted costs.. other countries pay for their physicians education.. so it ends up in their education expenses.... we do not.. and so our healthcare costs have to absorb that cost of education.
2. Demographics.. such as smoking rates, sedentary rates, obesity rates.. repetitive injury rates, work hours, and vacation time and stress. Americans are generally fatter, more sedentary, work more hours, have more stress, and take less vacations than other countries. And that has an effect on our cost of healthcare.

If you look at quality of care, effectiveness of care.. the US scores in the top 5 of countries.. or better.. if you look at timeliness of care.. we score in the top as well.. as well as in many other categories... and THATS despite the fact that we don't have our whole population covered in insurance. Which creates outliers that would hurt those scores.

Its factors like "equity of care".. that hurt us healthcare ratings.. because they are most effected by not having our whole population covered by insurance.

the fact is that when you consider the factors the US deals when it comes to our demographics, and not having our whole population covered... we probably score substantially higher than other countries...

The higher cost of healthcare in the US is easy to explain.
First of all, we provide free healthcare to anyone in need. In every other country I have been in the healthcare you receive is paid for in advance if you are not a resident of that country. The credit limit on your credit card will determine how much healthcare you will get.
Second, there are no limits on liability in this country. In all other countries liability limits are capped.
Third, people in this country have extremely unhealthy lifestyles. The number of obese people in the US is far higher than anywhere else in the world.
Fourth, in the US medical procedures are performed on the elderly that would be denied in most other countries.
Fifth, medical procedures are carried out in a much more timely manner. In most of the world you will wait months or even years for many procedures.
Sixth, the US has become a society of pill poppers. They want a pill for every tiny ache or condition.

Journeyman said:

Recent figures put the US economy at $20.5 Trillion. Of that, we apparently spend 17.1% on healthcare. A quick scan of comparable percentages shows us that nations like France, Germany, Sweden, etc. spend around 11%. If the US was to move to a system like theirs at even half the savings (3% of GDP) we'd save $615 billion dollars per year.

Can someone tell me why we can't deliver health care at those European levels (which are quite good) for less than we spend now? If we manage to strip healthcare out of employment costs we liberate potential entrepreneurs and also cut out a big fixed cost for many corporations (which inhibits hiring and flexible work arrangements).

Look, I get that it won't be all peaches and cream, and that unlike promises made by Republican Politicians perhaps everybody won't be better taken care of than they are now. Certainly those CEO's in the health insurance industry won't be taken care of as well. But can't we do a lot better than we are now? Has socialized medicine really hurt Canada, Germany, the UK, France, Norway, Japan, Belgium, Sweden, The Netherlands, Australia, Switzerland, Israel, etc.? They all have higher life expectancy than we do. I know that isn't the only stat that matters, but we also are worse than all of them in infant mortality.

Every year I have to pick between various plans my employer offers (and my employer has to take the time to negotiate them and explain them) and every year they are a little worse. My contribution goes up, or my co-pay goes up, or my deductible goes up, or usually some combination of those. And it isn't a small company with no bargaining power. Fortune 400.

We see better ways all over the developed world, but somehow can't get it done. We appear to have a better way here in this country with Medicare. It costs less than private insurance and would likely only get cheaper with increased buying power. And for those who want more, those other countries with socialized medicine offer supplemental private insurance, so that could still be an option. Rich people would still get better healthcare if they wanted to pay for it.

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I'm basically with you on this, but I will add...

I don't think America can match the per capita costs experienced by Europe, though we can come in better than we are doing now. The reason is that Americans are not as stingy with their health care dollars. But, given that Europe's cost are 50% compared to America, there's a lot of headroom there, and even if it winds up being the same costs as it does now, the fact that everyone is covered and you don't have to worry about deductibles and copays, it would be the more moral course of action to take and there would be a lot less stress in America for this reason.

Two worthwhile objectives, and if it is cheaper, all the more reason to do it. There is no indication it will be an add on cost. Studies which ignore the fact that it is replacing something, and posit that they are adding onto something, are flawed.

Some very interesting comments on this thread. I'd like to add an element that hasn't been discussed: the drag of healthcare on trade competition. For many major companies in the United States, health insurance benefits are a major cost - over $12,000 per employee. A cost not borne by most industrialized competitors.

Journeyman said:

Recent figures put the US economy at $20.5 Trillion. Of that, we apparently spend 17.1% on healthcare. A quick scan of comparable percentages shows us that nations like France, Germany, Sweden, etc. spend around 11%. If the US was to move to a system like theirs at even half the savings (3% of GDP) we'd save $615 billion dollars per year.

Can someone tell me why we can't deliver health care at those European levels (which are quite good) for less than we spend now? If we manage to strip healthcare out of employment costs we liberate potential entrepreneurs and also cut out a big fixed cost for many corporations (which inhibits hiring and flexible work arrangements).

Look, I get that it won't be all peaches and cream, and that unlike promises made by Republican Politicians perhaps everybody won't be better taken care of than they are now. Certainly those CEO's in the health insurance industry won't be taken care of as well. But can't we do a lot better than we are now? Has socialized medicine really hurt Canada, Germany, the UK, France, Norway, Japan, Belgium, Sweden, The Netherlands, Australia, Switzerland, Israel, etc.? They all have higher life expectancy than we do. I know that isn't the only stat that matters, but we also are worse than all of them in infant mortality.

Every year I have to pick between various plans my employer offers (and my employer has to take the time to negotiate them and explain them) and every year they are a little worse. My contribution goes up, or my co-pay goes up, or my deductible goes up, or usually some combination of those. And it isn't a small company with no bargaining power. Fortune 400.

We see better ways all over the developed world, but somehow can't get it done. We appear to have a better way here in this country with Medicare. It costs less than private insurance and would likely only get cheaper with increased buying power. And for those who want more, those other countries with socialized medicine offer supplemental private insurance, so that could still be an option. Rich people would still get better healthcare if they wanted to pay for it.

Click to expand...

Ever been to Europe? Very few FAT people. Americans, on the other hand, are just about the fattest people on Earth, and eat the worst diet. My doctor told me obesity is the real driver of health care costs. that and drug abuse.

NWRatCon said:

Some very interesting comments on this thread. I'd like to add an element that hasn't been discussed: the drag of healthcare on trade competition. For many major companies in the United States, health insurance benefits are a major cost - over $12,000 per employee. A cost not borne by most industrialized competitors.

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They are borne by those competitors. In the form of taxes and VAT taxes etc.


The only industrialized countries that do not.. like China.. also pay so much less in wages as well.