British National Healthcare System holds top spot in worldwide healthcare survey

joG said:

Of course it's cool to free ride the system. At least you say you like doing it. But I think it terrible that my PA had to pay your kids' education as she had to, when I had one in Paris.

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Would she of benefited from having her education paid for as well......

Lafayette said:

Nope, that comment shows you are blind to the facts.

From here: Insurance industry is the most at fault for high healthcare costs: poll
Excerpt:

Better yet, from someone who really knows about HealthCare costs: Why does health care cost so much in America? Ask Harvard’s David Cutler - excerpt:



For those who really care about cogent answers to the question, read the Cutler interview thoroughly ...

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OK, first off. Your poll says that most Americans blame insurance companies. That is because for most Americans, insurance companies serve as a proxy for their healthcare costs. They pay insurance premiums, not providers directly, and when they do pay providers, its their insurer's copays, thus they blame the insurer for the high costs rather than what the provider is billing them. For example, Americans tend to think that prescription drugs are one of the biggest drivers of healthcare costs. They think this because its one of the costs they have to personally shoulder the most. However, pharma, even with all its abuses, is only about 10% of over all healthcare costs in this country.

Now, lets just look at a typical premium for a family a year if they are on the individual market and not getting subsidies. It runs about 20 to 22k a year depending on the market. If you took every cent of the costs of high executive salaries and excessive insurer administrative costs, you are down to about 19k a year in premiums. Now, lets take the excessive provider administrative costs out and get them down to what is comparable to the rest of the world, now you are down to a little over 18k a year premiums. That is not exactly affordable. It's still 18k a year in premiums for a family's health coverage and that doesn't even include deductibles and copays.

See people are under the illusion that if you just got ride of insurance companies, our healthcare would all of a sudden become magically affordable. It wouldn't though. The reason why healthcare is much less expensive in other industrialize nations is in those nations they limit the amount of money providers can charge for care. Providers earn less money across the board in other countries, particularly specialists. Insurers are not why have orthopedic surgeons earning 800k a year or more here. They are not why oncologists often slow down the rate of chemo infusions just to increase their billing. They are not why hospitals will often bill over 400 dollars for a 20 dollar metabolic panel. They are not why anesthesiologists often double bill for their nurses. Insurers are not why half of all markets in the United States are provider monopolies where one health system owns all the hospitals, all the labs and imaging, employs all the specialists, and most of the GPs - and thus can set pricing like a monopoly. Moreover, much of our "administrative costs" are providers paying billing consultants to tell them how to maximize billing all the way to the legal line of fraud.

My wife has worked for insurance defense firms for years. She pulls medical records and billing all the time, you would not believe the crap she sees on a daily basis. We are never going to get healthcare costs under control in this country until we move away from fee for service.

You should read An American Sickness. https://www.amazon.com/American-Sickness-Healthcare-Became-Business/dp/1594206759

I am not saying that doctors are all greedy or insurers have no blame, I am saying that the entire system has all the wrong incentives in it in terms of controlling costs. As a side note though, if Americans would just eat a good diet, exercise regularly, not smoke, wear their seat belts in the car and helmets when on a bike or motorcycle, healthcare spending would be cut in half overnight.

joG said:

But social medicine is not the panacea it is made out to be by social populists. But.

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Only because you don't have any? You are writing like someone who's never even seen one.

Moreover, you are obfuscating the debate with your usual disinformation.

The infographic I put up (here) is one of the most professional examinations of health-care systems on this planet. There is no other, and if there were anyone would find it easily on the Internet.

It just aint there. Moreover, there was a previous study by the World Health Organization (2000) produced this ranking here. The result was a momentous brouhaha heard round the world. Many countries were indignant that they were not in the top-ten. (And the US was 12th!)

The US was somewhere in the mid-thirties, and the report itself explained why. Because the healthcare given per se was very good, but there were 16% of the American population was unable to obtain it because of its high-cost! (These American victims of Unaffordable Healthcare are the people who made "ER" a bestselling Hollywood TV series!)

As far as America is concerned, ObamaCare is that best that healthcare ever got in the US - and Donald Dork has just (yesterday) caused a major upheaval in its financing. And why?

Because he hates Barack Obama and is consummately jealous of him. Three and half more years of this narcissistic idiot.

God bless America, cuz no one else will whilst he is PotUS ...

Lovebug said:

All insurance coverage must be across state lines and allow for preexisting conditions without cap. It is an absolute must.

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I can agree to that. Screwing the insurance companies would most likely help America in the long run. They are inhuman giants that use bureaucracy to take money and never give it back.


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holbritter said:

That's not all they make 'gobs' of money from, and you know that. How about reducing the costs for THIS nation.

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Ok. They will do that by making gobs of money on gobs of generic pharmaceuticals. You know. What they do now. You realize we are largest producer of generic medication world wide? And that those generics are dirt cheap and help REDUCE healthcare cost right? Including here in America. As well as foreign nations that then use our generic medicine without having to pay for research.


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blackjack50 said:

I can help America get a reduced cost health care plan. Force competition in the health insurance industry. Allow insurance coverage across state lines. Mandate and reduce deductible/copay prices. Perhaps increase the amount of GP visits so that people actually go see the doctor and not the ER.


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Allow people to choose from a menu of coverage options that fit their particular needs and budgets rather than force everyone to accept a one-size-fits-all plan.

joG said:

Sort of like food or clothes, eh?

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If dozens of other countries could feed and clothe their citizens for half the cost, why would we not emulate that model? Instead of bowing to the market gods, let's look at what actually works, and, right now, the way we do health care isn't working.

Fletch said:

Allow people to choose from a menu of coverage options that fit their particular needs and budgets rather than force everyone to accept a one-size-fits-all plan.

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No. It's single-payer time. No more discussions and tweaks and GOP BS. Your approach has failed.

joG said:

Also nhs is only part of total public health care spending in the U.K. but is being compared with total US spending by public and private sectors. Most of the professionals in our offices in London, Paris and Frankfurt were either privately insured or had taken out additional policies to cover private treatment costs for obvious reasons. Also the nhs seems to be facing severe financial challenges that will have to be met in some way. In Germany the services have been cut considerably to include closing hospital departments, restricting medication or reducing dental beyond recognition.

This is not to say that the US doesn't spend too much. It does. But social medicine is not the panacea it is made out to be by social populists. But a question that always strikes me is why twenty percent of GDP should not be spent on medical services, if that is the way citizens spend. Risk pooling is really very easy given today's technologies and look what folks pay for other consumer goods that are much less important, one might think.

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The charts make no distinction in a like for like comparison. The NHS isn't the sole provider

GhostlyJoe said:

No. It's single-payer time. No more discussions and tweaks and GOP BS. Your approach has failed.

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I'm sorry, when was my approach tried?

blackjack50 said:

Ok. They will do that by making gobs of money on gobs of generic pharmaceuticals. You know. What they do now. You realize we are largest producer of generic medication world wide? And that those generics are dirt cheap and help REDUCE healthcare cost right? Including here in America. As well as foreign nations that then use our generic medicine without having to pay for research.


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So Big Pharma can sell to other nations, but we citizens cannot buy from other nations?

Fletch said:

Allow people to choose from a menu of coverage options that fit their particular needs and budgets rather than force everyone to accept a one-size-fits-all plan.

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Well, if we could know when we'll get cancer, diabetes, mental illness, our wife have a baby with severe birth defects or born prematurely, etc. then that's a great plan. Otherwise we have no idea what our "needs" are until we're already sick and then it's too late to get that cancer coverage that will blow through the $100k lifetime limit (which is all you "needed" last year) in a few months leaving you uninsurable forever after that.

Or, if we CAN freely switch from a mini-me plan with laughably low lifetime limits, no hospitalization, cancer coverage, small list of covered drugs, to insurance with full coverage, then full insurance becomes a dumping ground for high risk patients and those wealthy enough to afford full coverage even when they are relatively healthy.

Fletch said:

I'm sorry, when was my approach tried?

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So tell us about your approach, then.

JasperL said:

Well, if we could know when we'll get cancer, diabetes, mental illness, our wife have a baby with severe birth defects or born prematurely, etc. then that's a great plan. Otherwise we have no idea what our "needs" are until we're already sick and then it's too late to get that cancer coverage that will blow through the $100k lifetime limit (which is all you "needed" last year) in a few months leaving you uninsurable forever after that.

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Bull****. I don't need prescription drug coverage, dental or optical. I don't need co-pays for doctor visits or maternity coverage. I need coverage for major illness. Everything else I can pay out of pocket.

Or, if we CAN freely switch from a mini-me plan with laughably low lifetime limits, no hospitalization, cancer coverage, small list of covered drugs, to insurance with full coverage, then full insurance becomes a dumping ground for high risk patients and those wealthy enough to afford full coverage even when they are relatively healthy.

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We already have such a dumping ground. Its called Medicare/Medicaid.

GhostlyJoe said:

So tell us about your approach, then.

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???? You said my approach was tied and failed. Now you ask me for my approach. Perhaps you should have asked that question before declaring my approach a failure, no?

Fletch said:

Bull****. I don't need prescription drug coverage, dental or optical. I don't need co-pays for doctor visits or maternity coverage. I need coverage for major illness. Everything else I can pay out of pocket.

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So you can pay for $40,000/year in prescriptions? That's what mine cost per year as prescribed, and I'm otherwise healthy. If you can, that's great for you but most cannot. And when I was 41 I thought like you did that prescription drugs were no biggee for me - I had none. Then, in a week, mine went from $0.00 per year to (then) $24,000 per year. I'd love to know how to predict that in advance!

We already have such a dumping ground. Its called Medicare/Medicaid.

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Only if you're poor (and not even being poor works in Tennessee - also need to have kids) or disabled.

Fletch said:

???? You said my approach was tied and failed. Now you ask me for my approach. Perhaps you should have asked that question before declaring my approach a failure, no?

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I said the GOP approach was tried and failed. Your suggestion of a la carte service is a non-starter -- it's what led to Obamacare in the first place.

JasperL said:

So you can pay for $40,000/year in prescriptions? That's what mine cost per year as prescribed, and I'm otherwise healthy. If you can, that's great for you but most cannot. And when I was 41 I thought like you did that prescription drugs were no biggee for me - I had none. Then, in a week, mine went from $0.00 per year to (then) $24,000 per year. I'd love to know how to predict that in advance!

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I don't take prescriptions of any kind.

Only if you're poor (and not even being poor works in Tennessee - also need to have kids) or disabled.

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The government should handle only those things the free market cannot do itself. Pre-existing conditions might be one of those areas where the only solution is the state.

GhostlyJoe said:

I said the GOP approach was tried and failed. Your suggestion of a la carte service is a non-starter -- it's what led to Obamacare in the first place.

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Why is it a non-starter?

Fletch said:

Why is it a non-starter?

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Because it makes insurance pointless. If there is no pooling of risk, then insurance only represents an added cost. We might as well not have any insurance at all.

GhostlyJoe said:

Because it makes insurance pointless. If there is no pooling of risk, then insurance only represents an added cost. We might as well not have any insurance at all.

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Insurance is meant to cover only catastrophic risk. It is the fact that health insurance covers the everyday expense is why it is so expensive.

Fletch said:

I don't take prescriptions of any kind.

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You missed the point. I didn't either - none, $0.00 per year on prescription drugs - until I did and when I did my costs went to $24,000/year, overnight. At 54 I now take TWO drugs. One costs $40,000 per year, the other a generic that runs about $5/month as prescribed, no insurance (with insurance it cost me about $4 for a 90 day supply).

The point is you never know when you'll get sick and need expensive care, including expensive prescription drugs.

The government should handle only those things the free market cannot do itself. Pre-existing conditions might be one of those areas where the only solution is the state.

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It's not the place to go into it, but talking points like that are what the GOP have fed us for years now, and the stupid liberals kept saying, "it's not that simple, insurance doesn't work that way." Now the GOP is in control and we're finding out.... it's not that simple, insurance doesn't work that way.

It could work that way I guess - have a bailout option into a government funded high risk pool. But that's not a free market and we should be honest about that. It's instead a market where I get to make a bet, keep the winnings (low premiums) until I get sick and need expensive care, then the government pays for my losses.

Lafayette said:

Yes, unfortunately. It seems we Yanks are never ever going to learn.

I never tire of repeating the same facts:
*I live in France. I pay high taxes (compared to the US).
*I have put two kids through university (one a doctor) for a tuition fee of 800€ per year, plus, of course room 'n board.
*I have a national healthcare service (NHS) that costs me nothing, but pays only about 75% of any preliminary doctor's visit cost - but will pay 100% of further serious healthcare . I have a top-up insurance of 1200€ a year (whether I use it or not) that pays any additional hospitalization cost. (That same NHS in the UK is totally free, gratis and for nothing all services included. It began in the early 1950s.)
*Only Uncle Sam effs-around with both Health Care and and Tertiary Education, which are key to the lifestyle of any developed country.
*Europe learned early the virtue of providing key government-sponsored services after WW2, and rebuilt itself based upon those two ethics: Free Healthcare and Tertiary Education.
*Meanwhile, at first Uncle Sam went off on a anti-Communist frenzy, then fought pocket-wars in Central-america and the Middle-east Sandbox - in order to get value-for-money from an outrageous annual $534B DoD budget. (See here.)

When I show those details above info-graphically in France, the people just shake their heads in disbelief. The USA, nice place to visit, friendly people - but who in hell would ever want to live there ... ?

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I don't blame you for being tired of repeating facts; in fact, I have a set of my own that are in part counter-factual to yours. BUT here is the problem, 95 percent of the claims depend on fairy dust - in other words they assume correlation must be causation. After reading about the health-care debate for a decade I have decided that most folks just "assume" that OUTCOME Y is related to SYSTEM X, which may have nothing to do with it.

Among the many skeptical questions I have are:

How are health costs or outcomes surveyed, processed, and reported. Do countries vary on what they consider a health care cost and are all costs and outcome comparisons "normalized" to account for widely different data collection methods? How so?

Ignoring the US, why would Japan spend so little while major EU's spend more? Why is Switzerland higher than the rest?

Exactly HOW does an American hospital operating costs differ from that of Canada or Germany?

I have remain unconvinced that in America there is a clear and undisputed understanding of why US costs differ, nor a clear and convincing proof that for the US, any other system would be a vast improvement.

Fletch said:

Insurance is meant to cover only catastrophic risk. It is the fact that health insurance covers the everyday expense is why it is so expensive.

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That's at least in part true, but one big complaint in all these threads about the ACA is that the deductibles are so high that people can't use insurance and so it's no good. I can't recall if you've made that argument, but it's one made EVERY time the ACA is the topic in a thread. So it's a bit frustrating when you say that insurance is only meant to cover catastrophic risks, which implies policies like ACA bronze plans or plans with even HIGHER deductibles per year.

Those work pretty well, actually, unless:
1) you're like me with a chronic condition and will hit the deductible every year, which just means I have a very high annual healthcare cost and will forever, or
2) are poor and the deductibles are too high to be affordable.

So now you need government programs to at least partially address the poor and especially poor people who also fall into category 1), those with chronic conditions.

That's in short the head of the needle the ACA attempted to thread, with mixed results.

maxparrish said:

BUT here is the problem, 95 percent of the claims depend on fairy dust - in other words they assume correlation must be causation. After reading about the health-care debate for a decade I have decided that most folks just "assume" that OUTCOME Y is related to SYSTEM X, which may have nothing to do with it.

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Give us factual evidence of your claim from an independent body.

Ninety-percent! You live on Mars ... ?

maxparrish said:

How are health costs or outcomes surveyed, processed, and reported. Do countries vary on what they consider a health care cost and are all costs and outcome comparisons "normalized" to account for widely different data collection methods? How so?

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You don't understand that when there is a Central NHS-agency processing all claims, they know exactly who is submitting them. Moreover, we have in Europe something you are lacking in the US. It is called a National Identity Card (distinct from a passport). State officials know where you work, where you live and how much you earn. (Unless you are working "off record".)

A member of the EU carries that card with them (and renew it) all their life, so once identified claims to any official body (NHS, welfare, Educational Tuition repayment) are clearly identified on that Big Monster of a State Computer in the sky.

Of course, in the US, we could update the Social Security Card into a functionality for all national-services. Why not?

maxparrish said:

Ignoring the US, why would Japan spend so little while major EU's spend more? Why is Switzerland higher than the rest?

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Go ask them. More than likely it depends upon cost of coverage for whatever healthcare is provided. These differ from country to country, which is why the Commonwealth Fund study is so important a reckoning factor in the debate.

maxparrish said:

Exactly HOW does an American hospital operating costs differ from that of Canada or Germany?

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Your GP earns $200K a year and most of it comes from Insurance Companies who take their cut off the top? There is effectively no competition whatsoever within geographies because only two or three companies own all the hospitals. In Europe, those hospitals are run by government Civil-Servants (at much lower costs but a lifetime guaranty of their jobs.)

maxparrish said:

I have remain unconvinced that in America there is a clear and undisputed understanding of why US costs differ, nor a clear and convincing proof that for the US, any other system would be a vast improvement.

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Bollocks.

The Commonwealth Fund maintains an in-depth understanding of healthcare costs across all nations covered in its study. Its ranked results are accusatory:


In the US, you have one of the worst healthcare system of any developed nation, and IT IS THE ONLY ONE BASED UPON PRIVATIZED INSURANCE ..