How can medical care costs be reduced in the US?

Single payer 100% universal guaranteed coverage. Eliminate private health insurance, and have wealthy pay for it. That would be a good start.

And if you’re concerned about the commodification of something as basic as health care, we can discuss taking this from the private sector altogether and eliminating the profit motive.

ACA was just a gift to the private healthcare industry.

There are countries that offer this. Why not take a leaf out of their book and learn what works well in moving towards a national healthcare program?

1. Cut out the middle man where possible.

2. Cap profits (we already have gouging laws I think we should apply them to medical care).

3. Ideally socialized medicine where everyone is paying into the system, but even if we don’t get a socialized system we can still address points one and two that I made.

I agree that ACA did not address costs enough and I personally was caught in a trap of being right the borderline of income that I had to pay a fortune my last year on ACA for health insurance (was in the ACA system for 3 years) while my insurance company had huge profits. That means tax money and out of pocket is just lining the pockets of insurance companies and stock holders.

Keep in mind the best medical institutions in America salary their doctors. Johns Hopkins, Mayo, and others. It’s a good salary, but not as much as they could earn in the own practice. I know a lot of doctors who trained as military doctors and then went out into the private sector, and all of them say they miss being able to be good doctors without money as part of the equation. Even the military doctors deal with certain drugs being encouraged over other for cost issues, and it is not like they do whatever they want altogether, there are still standards of care, but scheduling an ultrasound for someone with a high risk for uterine cancer, but no symptoms is free. The tech is there, the machine is there, you just pay for the little bit of electricity and whatever to sanitize.

I grew up in military health and it was great, although there are still things that can be improved. I know people in the VA system, and most are very happy. These are all socialized medicine. My uncle, who is a retired doctor and very politically conservative on every other issue, he uses the VA now that there is a clinic closer to him, and he thinks we definitely should have socialized medicine for the country. Once he started using the VA he changed his mind on this issue.

Competition does not work well in health care. People have no power, there is too often no competition, and worse there is often time collusion. We already have proven it doesn’t work, ACA is only 10 years old. We have many years of leaving medical care to the free market.

@hmmmmmm You make national health seem like a magic wand. Keep in mind there are deeply entrenched special interests that will fight tooth and nail for whatever they have clawed, connived or plain fought for over the years. Other than tearing down the present system and starting with a blank sheet of paper, I am not sure what you are advocating can possibly happen. And starting with a blank sheet of paper is problematic in the field of health care.

@Pied_Pfeffer The main problem is the US’s litigious society. What works in other countries will NOT work here. I’ll give you just one example.

Suppose A has a very rare cancer, and so does B. The difference is that B belongs to the top 0.1% for whom paying a million is not much of a problem. So he is able to pay for this horrendously expensive chemotherapy drug, and lives. Poor A is covered by national health which specifically excludes costly chemotherapy drugs. How long before the national health list of exclusions is modified?

Make people responsible for things they can control.
some examples: If you are obese and it is causing other problems you will be required to lose weight or you will be responsible for a percentage of the cost. 5%? 10%?
Everyone needs to pay something to get service. It might only be $10 but you must pay something. The emergency room shold not be a place for people to go if they are bored and think they have a cold.
If this is the 3rd time you have been admitted to the emergency room for a drug overdose, you will automatically be put into mandatory rehab in a prison-like setting A year in prison costs $40,000, an emergency room visit for a drug overdose can run to over $100,000 or more if there are serious complications. A 3–6 month timeout would be ¼ of that.
I can think of many more “draconian” measures that would work. ”

@crazyguy: “The main problem is the US’s litigious society. What works in other countries will NOT work here.”

Sounds like you already have the answers, and they just happen to be the textbook right-wing propaganda that was pushed for decades. Note: even the right has given up on the “litigious culture” nonsense.

Anyway, you seem dedicated to keeping healthcare a commodity, yet you (disingenuously) ask how we can reduce costs. Good luck.

Also… @crazyguy: “You make national health seem like a magic wand.”

No, I don’t. And it isn’t. But it’s the fact that the US doesn’t have single payer is an embarrassment and one of the most obvious examples that the US is a failed state. Any state that doesn’t do the functions of as state has no business existing.

@JLeslie I said you were active, and now I see one reason why. You are logical and have a lot of knowledge!

1. Cutting out the middle man is easier said than done. For instance, if a patient goes directly to a doctor, can you see the doctor charging whatever s/he thinks the patient can afford to pay?

2. The trouble with stopping gouging is the matter of definition. To me personally, gouging is charging more than the market will bear. For instance, UBER’s surge pricing may be considered gouging; as could be $8 for freshly squeezed lemonade on a superhot day.

My wife spent her 65th year on Obamacare. She has never needed medical care all her life, but there was no option for a high deductible low cost plan for her at that age. That option is reserved for younger people. The CHEAPEST plan for her was a bronze plan and cost $10G’s for the year! I would have gladly paid for her regular physical checkup out of pocket, but I had to have insurance, just in case…

That is the big problem with government-prescribed medical insurance. They are so concerned about protecting the idiots from greedy insurance companies, they forget the guys who can!

My medical care provider in California is Kaiser Permanente. They have doctors on salary; but the salaries are somehow tied to what a doctor can make in private practice. They do, by and large, have their own thinking, and rarely have to bow to corporate governance. Ordering even expensive tests is left almost entirely up to the doctor, although I am certain there are some incentives to minimize the cost. By the way, your statement “The tech is there, the machine is there, you just pay for the little bit of electricity and whatever to sanitize.” is not quite correct. Because it ignores the capital cost of buying another machine if the first one is over-utilized.

@LuckyGuy I agree 100%. A co-pay of some sort is absolutely mandatory to make a prospective patient think about going to the doctor. For instance, a patient with a cold or a flu cannot possibly benefit from his/her visit to the doctor. A prescription for antibiotics is not only useless, but also, it causes harm in the sense it increases the chances of bugs becoming resistant to antibiotics.

@hmmmmmm The US does not have single payer. But would it be acceptable to you if you were required to pay $20 for each visit to the doctor and $50 for each visit to the ER, with the single payer (the Government) picking up the balance? No? I thought so. You are confusing single payer with “free”.

@hmmmmmm Sorry I missed your earlier response. No, I do not have all the answers, and no, I do not regurgitate stuff. I do have a rather active mind and I like to address problems. The biggest one we are facing right now is that a large percentage of our population expects freebies; we have to wean them from this desire.

@crazyguy True about the over-utilization of a diagnostic machine can mean purchasing another expensive machine. Take where my dad gets his healthcare—Walter Reed/Bethesda Naval. He needed a non urgent MRI. He can get an appointment quicker if he goes at night when the regular 8:00–5:00 patients aren’t using the clinic. Walter Reed is a campus that includes a hospital and also regular doctors‘ offices. They don’t have extra machines I don’t think, but they probably do have 24 hour diagnostics for the hospital that regular clinic people can also use so they utilize it well.

Gouging is usually defined as a certain percentage over cost of over regular retail. Many states have gouging laws that apply to natural disasters, but I argue a health problem is a natural disaster for an individual. Here is a Wikipedia link about gouging. https://en.m.wikipedia.org/wiki/Price_gouging#United_States

It’s unethical to gouge, and one of the biggest problems in American business today is the lack of integrity, the lack of the golden rule. Not all companies of course, but public companies especially are pushed to grow profit, squeeze employees, and push prices to the hilt of what the market will bear, but in our society many Americans will buy on credit, so basically they often can’t really afford what they are buying. Bad for our well being in the country.

I’m not saying companies can’t make a profit, I’m a capitalist, but when they take advantage and cross the line on making huge profits that hurt the public well being it’s destructive in many ways including it creates a prime situation for a backlash and each action tends to get an opposite and equal reaction.

Under ACA my husband and I paid $13,000 a year with a $12,000 deductible.

Kaiser Permanente is generally thought to be a good system.

I don’t like systems where I have to go to a primary first and then get referred. HMO’s were like that and I got out as fast as I could.

I see things that are billed when medical treatment is needed, and they make no sense to me. I know when my boys were born (that was several decades ago), we arrived in the parking lot at 03:10 and they were born by 04:30. The anesthesiologist stood against the far wall of the delivery room yawning. He never did anything. He didn’t administer any drugs and wasn’t asked for any consultations. He was there less than 1 hour. He was paid $500 for his time. With no liability and no actual work…pay him $50 for his time and give him a thank you. But beyond that, I took my son to the ER when he was about 10. Cut his head open. I got the bills after the visit. I had to pay the hospital for the Emergency Room. I had to pay for the Emergency room staff. I had to pay for the Emergency Room supplies (bandage/sutures). I had to pay for the Emergency room doctor. I had to pay for the anesthetic they gave him. They took x-rays to make sure no other injuries existed and I got to pay for the radiology staff, the x-rays, and the radiologist to look at them. It seems like there is a lot of overlap here. If I am paying for the ER, why am I also paying for the staff, the supplies, the doctor, the drugs, etc?
I think there are a couple things going on that need to be looked at. First is malpractice lawsuits. I think there ought to be a way for them to be tossed out as frivolous if they are. That might cut down on malpractice insurance costs that are transmitted right to the end user. Another thing to look at is the administrative end. What costs are being driven by that? Who makes those decisions? And I think we need to look at things from a realistic view point. As with the anesthesiologist at my boys’ birth, if he doesn’t do anything, isn’t asked to do anything, and isn’t responsible for anything, he shouldn’t be able to charge an exorbitant rate for doing nothing.

@seawulf575: Why was the anesthesiologist in the room if he didn’t do anything, when your son was born?

When I had a baby, 13 years ago, the anesthesiologist only came into the birthing room if he needed to give anesthesia. He came in, did it and left. During the day, he went from room to room. Then in the evening, when I was ready to push the baby out, the anesthesiologist came from his house because I remember I needed the epidural and the doctor told me the anesthesiologist was on his way, and I was frantically asking “where is he now?” The doctor told me “he’s on North Broadway” and I said “Oh my god tell him to hurry up.” I don’t think it would be worth it for an anesthesiologist to come out of his house and drive to the hospital for $50. The maintenance guys at my job get more than that, being on call and having a “call back” – they get a four hour minimum plus travel, which definitely comes to more than $50 because their base salary is at least 60k.

@jca2 it was twins. Maybe that had something to do with it. But there was no time for an epidural, a shot of Demerol….nothing. I guess they wanted him there “in case”. And I don’t think he had to drive from home or anything…he was already on site as far as I know. As I said, we were inside the hospital just over an hour before both boys were born…period. If he came from home, he must have driven like a maniac when he got the call.

First you need to answer why our expenses exceed by far those in the rest of the first world nations. Then we should enact the same methods if we expect the same results. Since, for instance, you can fill a prescription in both Canada and Mexico for one half or one third the price as here, what should that tell you?

@seawulf575 For twins, she had regular delivery and not C-section?

@jca2 Yup. No time or need for Cesarean. When we got to the hospital she was already like 8 cm dilated. They had to tell her not to push just to give the doctor and staff time to get everything lined up.

Socialize medicine. Make all medical personnel government employees.

@JLeslie The Primary Care Provider that a patient selects and can change as often as desired in the Kaiser system acts as the “gatekeeper”. S/he will examine the patient, take a medical history, and refer to specialists if needed. I do not see how medical costs can ever be contained if patients can select who they wish to see, based on their own analysis of their problems.

The problem with defining “gouging” for medical services is that each provider can claim to have a different level of service and facilities.Generally that claim is true.

You, like many other people, are okay with companies making profits, as long as the profits are not “huge” or “obscene”. However, i say to you and others that all society can do is define the rules and allow ALL participants to make as much profit as they can while playing by the rules. So if a medical practitioner spends 60 hours a week seeing patients and makes a million dollars per year, that works out to a pay rate of $1 million/(60*52) = $320 per hour. Is that excessive? Keep in mind the practitioner spent a minimum of 7–8 years AFTER COLLEGE getting his/her education and training.

@seawulf575: A medical doctor performs “hospital rounds” at least once a day. For each patient, the doctor spends even a minute with, the insurance company pays $25—$35. If a doctor has 20 patients in two hospitals, s/he can make $5–700 in a couple of hours, So I am not at all surprised to read that an anesthesiologist charged you $500 for his time. Just estimate the opportunity cost of his hour.

Your second example is something we can all relate to – the nickel and dime billings from every person who said hello to you during your son’s treatment. That is annoying; but it will not go away with nationalized health; you just won’t see the bills – they will go directly to the payer.

@stanleybmanly I agree with you 100%. For far too long we have let the pharma companies, AMA, Hospital Associations, and medical service employee unions dictate to us. It is time for pushback. Once we get the ACTUAL COSTS down, we can figure out the best ways to pay the cost. It may or may not require a single payer. Just for your information, even the granddaddy of national health plans (in the UK) allows supplemental insurance for expenses of either jumping the queue for services or for services not covered by the government plan.

@kritiper I would be very careful with simplistic solutions. You do not gain ANY efficiency by increasing the size of government. What you do get is the ability to protest against a single entity.

@crazyguy I don’t want a gatekeeper. Waste of my time and money.

We were taught that insurance that requires you to see a gatekeeper is an inferior policy.

If I have a skin problem, I know enough to make an appointment with a dermatologist. If I had to go to a gatekeeper doctor, I’d have to wait to get that appointment, and then wait for the appointment for the dermatologist, and by then, it’s maybe weeks out. Plus, would I have to pay copays to both doctors? Probably. With my insurance (a premium policy), I call the dermatologist and make the appointment, or if I am in a big hurry, call multiple dermatologists and find one that can take me sooner.

@JLeslie Agreed. A gatekeeper is not free. However, the gatekeeper is your personal physician who knows a lot about you. Sometimes, s/he may be able to diagnose your problem better than you, an Internet doctor, can; those times the gatekeeper is worth his/her wight in gold.

If you are certain what specialist you need to say, you can have a telephone consultation with your primary doctor and get a referral. Saves BOTH time and money.

@jca2 While you are correct in saying that a skin problem requires a dermatologist, not all symptoms are as clear cut. In the cases that seem clear cut to you, you can schedule a telephone visit with your primary in order to get a referral to a specialist.

@crazyguy: To me, that’s more time and a waste of time, when I can just call the dermatologist directly, especially when many things (like a skin issue for example) require someone to actually see it. If I describe it, it’s not the same as the dermatologist looking, and he diagnoses it within about 30 seconds.

@crazyguy “That is annoying; but it will not go away with nationalized health; you just won’t see the bills – they will go directly to the payer.” So the cost won’t actually be reduced. It will likely go up since there won’t be an individual having to pay it. But making a change to the way things are billed would likely reduce the costs.

Note the ~ in front of the next sentence.

~Let Covid-19 spread to everyone so elderly, infirm, and immuno-compromised individuals die off quickly rather than sucking up medical costs for years. Think of it like a forest fire that cleans out the dead wood.

I half wonder if that’s what our leader is thinking. Was that ever discussed on Fox?

@seawulf575 I take issue with your last sentence: “But making a change to the way things are billed would likely reduce the costs.” The bureaucracy needed by insurance companies to handle medical bills will be bloated by a factor of 10 once the government takes over.

@crazyguy I’m with @jca2. When I KNOW the specialist I need I don’t want to see a GP first, I don’t want to be forced to see and spend money on a GP.

Sometimes, I have symptoms that I’m not sure what is going on, or I have a simple cut or illness that is for a GP, and that’s fine I go there. In the last 30 years I haven’t seen many GP’s who really care about knowing me better and coordinating my care. It’s not like the old days with longer appointments. HMO’s typically push shorter appointments.

Supposedly, The health system where I live in my community does provide longer GP appointments, but I’m also pretty sure they milk the Medicare system. Patients coming in every 2–3 months, sometimes just to discuss test results that have nothing very new. When I first moved here I called to use an endocrinologist and gastroenterologist there and they wouldn’t let me unless I saw a GP first. That is a waste of my time. I’ve been a thyroid patient for 15 years and had colon polyps for 20 years. I don’t need a GP for either. I also see a cardiologist for my heart, and a GYN for my girly parts. There isn’t much a GP needs to do for me.

Where I live now almost all the doctors want you to go to your GP regularly (2–6 times a year) and it’s fraud and incompetence in my opinion. My current cardiologist won’t test my thyroid. I need to switch cardiologist because of this, but haven’t gotten around to it, I think it is incompetence. My heart is very affected by my thyroid, every cardiologist I’ve had in every other city I’ve lived in tests my thyroid without me even asking. My cardiologist keeps telling me to go to my GP to test my thyroid. My GP is trying to milk the system making me have an appointment for a blood test.

One good thing about covid is phone and video doctor appointments commonplace and covered through insurance. Although, I pay everything I’m high deductible. Now, I can go back to using my endocrinologist in TN, I’m thinking about it. She gave me blood tests for a year (Usually about 3). I didn’t need to see her constantly. I could use the test when I wasn’t feeling right thyroid related and at the same time test my cholesterol, vitamin D, kidneys, iron, those are things I need to watch.

@seawulf575 I actually agree with you that when the patient doesn’t see the bills there is more possibility for costs escalating, unless there is truly a watchdog and a system to control costs. But also, free market doesn’t work well to control healthcare costs either.

@LuckyGuy I do not recall if that specific scenario was discussed on Fox. There have been discussions about the Swedish strategy, but not in terms of “a forest fire that cleans out the dead wood.” By the way Sweden had just 139 new cases yesterday and ZERO deaths.

@crazyguy Sometimes people tend to make things too complex. Simplicity is key. Unless you have a better idea, which you must not otherwise you wouldn’t have asked this question…

@crazyguy. You don’t seem to get it. Other countries offer national health care that make it simplistic. I’ve experienced this in the UK, both going with my partner and his parents and myself, a US citizen.

What is the UK doing that the US can’t do? What about the other countries that are successfully providing national health care? Can’t we learn from their progress?

@Pied_Pfeffer: On the other hand, I heard taxes in UK are way higher than US.

^ Private health insurance – or even employer-subsidized insurance – is a “tax” that US citizens pay. Add this to the fun of connecting health insurance to employment and the ability to lose everything you’ve worked for your entire life if you have the nerve to get sick doesn’t make a nation’s “taxes” an issue of “on the other hand”. We know the costs of healthcare. But US citizens somehow don’t consider something a “tax” if it’s being paid to a corporation.

@crazyguy Yeah, I went back and re-read my last sentence. It was supposed to be a throw-back thought to how we could reduce medical costs…not that it was a by-product of some sort of socialized medicine.

@Pied_Pfeffer But isn’t it also true that in the UK, the healthcare system doesn’t actually cover everything? And some of what it does cover has enormously long wait times? And isn’t it also true that many people buy private healthcare insurance (or get it as a perk from work) so that they can get the stuff not covered by NHS or so they don’t have to wait? wouldn’t that just put us back into the wealth division that is so popular to scream about?

@crazyguy “The bureaucracy needed by insurance companies to handle medical bills will be bloated by a factor of 10 once the government takes over.”

You don’t get it !

No insurance companies they are blown to smithereens! Don’t need no sticking insurance company

@seawolf575 and @jca, The cost isn’t much more than what we pay in the US. It doesn’t cover dental and there is a limited amount that covers visual, as far as I understand. The rest is fully covered.

As far as the wait, sure it happens in some areas. I’ve gone to appts. with the in-laws and non-emergency with both my partner and myself and the wait was not long. In my case, I wasn’t on NSA insurance, but had travel insurance. It ended up costing nothing, despite the excellent care.

Switch from treatment to prevention and education.

@Pied_Pfeffer

The problem with most government-paid health care is that it cannot possibly cover everything. For instance state-of-the-art new drugs are usually not covered. That is why most national health plans allow the existence of private health insurance. In fact the only country I know of that does NOT allow private health insurance is Canada. I wonder if the reason is that top-notch medical care is available to most Candians in the US, which, for most Canadians is just a few hours’ drive.

So yes, let’s learn from other countries and do the following:

1. Figure out exactly where our health care dollars go, and why there are more healthcare dollars than ALL the other western nations.

2. Figure out which of these dollars can be saved, and how.

Only then can we try and address the question of paying these costs. If you just expand Medicare to pay these bloated costs, you will not reduce your costs, you will increase them.

@Pied_Pfeffer

Travel insurance is private insurance and is usually excellent.

Both my parents lived in London for many years, and my younger brother and his family still live in London. They have all experienced LONG waits for elective procedures, so much so that my mother has, on several occasions, had the procedure done here on one of her annual visits to the US.

@RedDeerGuy1

Agreed. BUT that requires a complete change in the lifestyle of most of us. Do you really see that happening?

@Tropical_Willie

I say you are the one not getting it. I understand full well that the proposed solution would take insurance companies out of the business of providing coverage for basic health care. However, you still need some bureaucracy to monitor expenses; that is what I was talking about.

@seawulf575

Your response to Pied_Pfeffer hits the nail on the head. Well done!

@hmmmmmm

You say “We know the costs of healthcare.” I beg to differ. We think we know the costs. Let the government allocate a budget, and we’ll blow right through it in no more than 10–11 months.

@kritiper

You are perfectly correct – I do NOT have an answer. However, I do realize the problem is not as simple as some on this thread would have you believe.

@crazyguy My travel insurance was not used. The UK NSA put me on temporary NSA insurance and covered several appts. with my partner’s doctor.

@Pied_Pfeffer

Thanks for the correction to your earlier post. However, it does not make any difference to my response.

Remove the profit from the equation.

There is an inherent conflict of interest when for-profit corporations provide products in the healthcare field. A corporation, by law, is designed to provide maximum return to investors.

@crazyguy The thing is, London is a massive city. Where my partner lives, it is a town of ~25K. Getting medical service in a timely manner seems to move along well.

@Pied_Pfeffer: What I heard (from relative that lives in the UK) is that for something like approval for heart surgery or something major like that, it can be a two year wait.

@jca2 I can’t answer to that. The only major surgery cases I am familiar with are one of throat cancer and another of a potential aneurism(?). Both had surgery almost immediately.

@Strauss In response to

“Remove the profit from the equation.

There is an inherent conflict of interest when for-profit corporations provide products in the healthcare field. A corporation, by law, is designed to provide maximum return to investors.”

I disagree. Medical care is a service to the community. All providers, unless they are paid by the government, are entitled to charge reasonable prices, and make reasonable profits. If the government takes over health care, the quality will get worse, and costs will rise. The way to limit profits is to provide greater transparency.

@Pied_Pfeffer In response to

“The thing is, London is a massive city. Where my partner lives, it is a town of ~25K. Getting medical service in a timely manner seems to move along well.”

Even more important than one’s exact location, your assigned or selected gatekeeper, defines your experience. The gatekeeper has a difficult job; s/he has to keep the patients happy but not order tests and specialist consultations willy nilly.

@Pied_Pfeffer In response to

“I can’t answer to that. The only major surgery cases I am familiar with are one of throat cancer and another of a potential aneurism(?). Both had surgery almost immediately.”

I think witlisting is only for elective procedures. For instance my late mother was scheduled for a knee replacement about a year in the future.

IMO, this much is certain: People should not have to lose everything they own just because they got sick. All the more reason we need socialized medicine. It may not be perfect, but it may be as close as we can get.

In response to “reasonable” charges and “reasonable” profits, would that be your description of current conditions in the United States. Apply the term “reasonable” to the status quo and show us evidence of any incentive for improvement.

@kritiper Socialized medicine cannot possibly cover state-of-the-art treatments and drugs. If it does, it will go bankrupt faster than Medicare.

Therefore, getting sick may still wipe out people.

“Socialized medicine cannot possibly cover state-of-the-art treatments and drugs. If it does, it will go bankrupt faster than Medicare”

Sources Pleeze @crazyguy

You keep putting stuff out there like you are a “Stable Genius” ! ! !

@stanleybmanly

I have no idea what “reasonable” profits would be for any business. If you have a ground-breaking product or idea, you deserve to charge whatever the market will bear. For a commodity business like a doctor’s office or a lab, profits should be capped by competition since there is not much differentiation in the offerings. The reason it does not happen in the US is the fact that there is little or no transparency in medical billings. A second reason is that a patient has no reason to price shop because generally s/he is responsible for just a tiny co-pay (which can, in many cases, be “waived”). I would suggest two changes right away:

1. Make sure that every medical bill, whether the patient is responsible for any part of it or not, be shared with the patient. That way, the patient can protect against insurance fraud.

2. Increase the co-pay and set up severe penalties for waiving it.

@crazyguy: In some cases, the copay is set by the employer that provides the insurance (like mine).

That’s an interesting supposition. Are you saying the rest of the first world is slacking in their care?

@jca2 The employer chooses from a slate of options offered by insurance companies. So the co-pay is set by the insurance companies for the many plans offered to each employer. The employer selects a few of the offerings; the selections determine the co-pay.

@stanleybmanly I believe the US has the best medical care in the whole world. The reason the US trails in statistics like life expectancy and infant mortality is that not everybody in the US can afford top-notch medical care.

That’s a very accurate description of the facts. What have those nations with better outcomes over us? Are their citizens richer? What good is the best healthcare if none but the rich can afford it?

@crazyguy: That’s not correct. Our insurance company has not changed but the copay has gone up over the years. Our copay is determined by our union contract (collective bargaining agreement).

@crazyguy I believe the US has the best medical care in the whole world. The reason the US trails in statistics like life expectancy and infant mortality is that not everybody in the US can afford top-notch medical care.

In that case, it’s not “the US” who have the best medical care. Rather, it is “a few rich people who happen to live in the US”.

I think your claim is very interesting. I agree that the US is a leading power in science, medicine included. I’m not so sure that affects which procedures are available. Happy to be proven wrong, though. Can you tell me more about the procedures I don’t have access to, as a citizen of Germany?

@crazyguy When you have cancer how do you shop around? You need the cancer drug, take it or you die. Pay the $10,000 a month or you die. New drug comes out, they charge $15,000 a month, and are getting it. Old drug says, “hey the market will bear $15,000,” and they RAISE their price. This shit happens all the time. They collude.

You’re right that in most free markets knowing a price helps competition and will lower prices, but health is more of a disaster situation where you have either little or no choice, or not time to shop around, because you need treatment. The customer has very little power when the situation is most critical.

@stanleybmanly In response to

“That’s a very accurate description of the facts. What have those nations with better outcomes over us? Are their citizens richer? What good is the best healthcare if none but the rich can afford it?”

I did not say only the rich can afford it. What I said, and the exact words are extremely important, is “not everybody in the US can afford top-notch medical care.” EVERYBODY can afford basic coverage (ER’s are free to even illegal immigrants). Anything else you pay for. In other countries the definition of basic coverage is different. It is a question of degree.

@jca2 In response to

“That’s not correct. Our insurance company has not changed but the copay has gone up over the years. Our copay is determined by our union contract (collective bargaining agreement).”

what I said was “The employer chooses from a slate of options offered by insurance companies. So the co-pay is set by the insurance companies for the many plans offered to each employer. The employer selects a few of the offerings; the selections determine the co-pay.” If you substitute your union for employer, I think my statement is correct.

@JLeslie In response to

“When you have cancer how do you shop around? You need the cancer drug, take it or you die. Pay the $10,000 a month or you die. New drug comes out, they charge $15,000 a month, and are getting it. Old drug says, “hey the market will bear $15,000,” and they RAISE their price. This shit happens all the time. They collude.

You’re right that in most free markets knowing a price helps competition and will lower prices, but health is more of a disaster situation where you have either little or no choice, or not time to shop around, because you need treatment. The customer has very little power when the situation is most critical.”

let me say this: if national health covers these expensive drugs, the whole country will be bankrupt in months. Even the UK has limits on what is covered. They encourage supplemental insurance for what is excluded.

Note they can get away with it because their society is not as litigious as ours.

@longgone In response to

“In that case, it’s not “the US” who have the best medical care. Rather, it is “a few rich people who happen to live in the US”.

I think your claim is very interesting. I agree that the US is a leading power in science, medicine included. I’m not so sure that affects which procedures are available. Happy to be proven wrong, though. Can you tell me more about the procedures I don’t have access to, as a citizen of Germany?”

I do not have the time to research what exactly is excluded from Government coverage. However, in broad terms, here is a quote from Wikipedia: “Germany’s health care system was 77% government-funded and 23% privately funded as of 2004.” I have no idea how the percentages have shifted in recent years; however, I do know that there is private health insurance in Germany TO SUPPLEMENT Government insurance.

@crazyguy: According to what you wrote, if my job’s plan didn’t change then the copay shouldn’t change. My job’s plan didn’t change, but the copay has gone up.

Also, the union doesn’t choose our health care provider, the employer does.

@crazyguy The first, last and only objective of any corporation, by charter and by law, is to provide its investors with maximum return on the investment. Any decision that conflicts with this is poor corporate governance.

When a small rural hospital is constantly facing a deficit, the corporation that owns it is obligated to consider first and foremost the economic impact on the rest of the corporation. The effect of this decision in the community and the availability of health care to the community will always take a back seat to profitability without government intervention at some level.

@crazyguy Nope. In National Healthcare situations the drug companies don’t charge those outlandish prices for cancer treatment. We need to either regulate pricing with the system we have now or we need to go socialized. It can’t keep going how it is now, it is bankrupting the country. You have seen the stories, Epipen and an HIV drug that increased their prices by huge amounts purely for profit, those two stories are just a drop in the bucket. Do you get CBS All Access. Leslie Stahl did a great story on drug pricing a few years ago on 60 Minutes.

Combined reaponse for jca2, strauss, jLeslie:

jc: Just because the insurance company is the same and the plan name is the same, it does not mean the plan did not change.

Strauss: Agree 100%. Government’s role is to change the playing field and the rules. If either makes a profit impossible, the hospital will be shut down.

jL: I watched that 60 minutes episode, I remember being delighted by the spotlight. You are correct that other countries do not pay those outlandish prices. Because we Americans pay enough to enable Big Pharma to continue investing billions in new drug development. I am anxiously watching the impact of Trump’s executive order on drug prices.

@jca2 When you shop for insurance (any insurance) you have options. there is one cost for all coverage with no deductible. There is another if you bump up the deductible and still another if you crank it up even more. All three provide the exact same level of coverage, but your portion before it kicks in may change. The same applies to co-pay. The fact that you aren’t choosing the plan means you aren’t seeing what the costs are for each version. Your employer is seeing that. And they are making a decision based on what they can afford (or are willing) to pay. They are still providing insurance, but the plan co-pay is set by the insurance company as an option and that option was chosen by your employer.
If you ever looked at the healthcare.gov options for coverage, they were fairly similar. Premiums (cost of the plan) and the deductibles were mixed and matched. The insurance companies offered these plans, but you got to decide what fit in best with your situation. That was why I hated Obamacare so much. It did nothing to reel in insurance costs, it just spread them around. You might get a plan that had a low premium payment, but your deductible might be huge and there might be limited coverage after you met the deductible. It actually caused coverage cost to go up for many people. But they could say they had coverage so they didn’t have to pay a penalty.

@crazyguy Our federal government helps to fund a lot of pharma research. Look at stories like Gilead’s Hep C drug. $84,000 for treatment and they estimated they would make billions PROFIT. Not revenue, I’m talking profit. So that covers the expense of developing the drug and testing it. The hep c drug was actually first developed by another company and purchased by Gilead. When pressed about the price their response was it will be cheaper for the patient than current treatments. Remember that most of America is insured in some way so that means we all pay for that high price. It doesn’t matter if we pay through our taxes or through insurance premiums, we all pay for these gouging prices. Same with the epipen and the HIV drug and the cancer drugs.

@seawulf575 Most people who get their insurance through work get the choices their work decides to offer. For YEARS all that was offered to me was HMO garbage. Finally some companies added PPO’s. Now, a lot of companies don’t offer HMO’s at all.

Many companies (almost all large companies) are self insured and the insurance company is just the administrator. The company you work for decides what to offer in the plan. If the insurance company is challenging covering something it’s actually your own place of work that makes the decision in the end about coverage in those situations.

The ACA penalty was very low. The insurance under ACA has gone up and up, I agree it did not address costs enough. I wouldn’t say it spread the cost around more, I’d say it didn’t clamp down on the gouging in the system. It also allows millionaires to get subsidized health insurance as long as their Adjusted Gross Income is under $65k or whatever the limit was.

@seawulf575 Your answer reflects my thinking so much that I had to double check it to make sure I didn’t write the answer! Actually, under Obamacare the plan I really wanted for the one year my wife fell between my employer-sponsored plan and Medicare, was not available to her. It was ONLY available to younger people! I wanted a plan with a very high deductible and a lower premium because my wife does not need much medical care (fortunately) and has no pre-existing condition. So we settle for the Bronze plan and had to shell out over $9,000 to help out others (in addition to our higher tax rate imposed by Obama).

@JLeslie Big Pharma plays by the rules that they helped craft, and pay huge lobbying costs to keep in place. Did you happen to catch the 60 MINUTES story on how a minor label change by the FDA caused the opioid crisis – https://www.cbsnews.com/video/opioid-epidemic-did-the-fda-ignite-the-crisis-60-minutes/ Like all businesses, big Pharma is in business to make profits for their owners, the shareholders. Our only recourse is to craft rules and enforce them.

@crazyguy “I have no idea how the percentages have shifted in recent years; however, I do know that there is private health insurance in Germany TO SUPPLEMENT Government insurance.”

To supplement? How do you mean? Can you give me an example?

Longgone: My only source for info about the German healthcare ssytem is the Internet. So I cannot vouch for correctness. Here is what I found at https://www.iamexpat.de/expat-info/german-health-insurance/statutory-health-insurance-germany

Additional insurance (Zusatzverischerung)

It is also possible to purchase additional insurance (Zusatzversicherung) from health insurance providers, such as Deutsche Familienversicherung, to “top-up” the care you receive from your statutory insurance. This might include:

Foreign travel health insurance
Additional sickness benefit (your statutory health insurance already entitles you to some; see below)
Additional long-term care benefits
Better hospital treatment, including higher doctor’s fees and private hospital rooms
Additional dental care
Alternative medicine

Hope this helps. On another website I found out that everybody with a salary of about 62,000 euros per year is required to accept statutory healthcare. Anybody making more has a choice.

@crazyguy Thanks for taking the time to research some more. I still don’t fully understand your point about public health insurance being “supplemented” in Germany – and why that means the American system is superior.

The vast majority of Germans (89%) will never interact with a private health insurance company. We pay a monthly bill based on income, and from that point on everything is “free”. So, for those people (like me), I’d still like to understand why I’d be better off in America. I don’t necessarily need links, but I would love to understand what you’re thinking of when you make this claim. What scenario is going through your head?

@longgone It is simply a matter of choice. In Germany, you pay your national health dues (I believe the percentage is in the teens), and you make do with whatever medical care you need. If only the sick had the insurance, the rate of taxation would have to keep rising. However, NOBODY has a choice – like it or not, they have to participate. Therefore the tax rate can be kept reasonable because the vast majority of people paying the premium get NOTHING from the government in return. It is indeed the way insurance is supposed to work. But in the US, EVERY insurance we buy is our choice. The government cannot force us into it.

What you call ‘free’ is anything but. If you see a doctor once a year, and make 60,000 euros per year, that one visit to the doctor cost you about 10,000 euros!

The US has people go bankrupt instead. A week in the hospital for cardiac care can be $100,000 article is six years old so prices have only gone up.

@crazyguy you miss the crucial point of what the Germans get with their national healthcare “dues” is the guarantee that a medical diagnosis will not mean financial ruin. No German is a slave to his employer because he dare not leave his job and lose his health coverage. No German goes with shitty coverage due to a minimum wage job

@stanleybmanley No German is a slave to his employer

This is a sad but true assessment of the state if employment in the U.S., at least before the COVID lockdown. And now, when folks can least afford to be without it, even that “opportunity” is becoming less and less because of the failing economy and lack of any type of job.

@Tropical_Willie The US has free choice. You can choose to pay for health insurance or not. I honestly do not know which system is better. I do know one thing for sure: basic care in the US will grow to be all-inclusive over just a few years because of our litigious society.

@stanleybmanly You are right. Because of subsidies from the young and healthy, pre-existing conditions are covered. However, if you can afford it, private health insurance is better.

@Strauss In the US, you have freedom to leave your employment. If you are fortunate enough to have a job that provides healthcare, the onus is on you to seek alternative employment with health insurance before you leave your current job. BUT the choice is yours.

@crazyguy Of course the rich can afford and will receive better care than the rest of us in any country you care to name. That isn’t the issue here. The issue is what is best for the society at large. Must we allow healthcare expenses to gobble up an ever expanding crippling percentage of the working man’s paycheck? Why must there be the choice between the gun of financial ruin at our head from medical expenses and the extortion prices of insurance for inadequate coverage from the private sector? You’re broke either way. Obamacare and Medicare— government mandated and regulated healthcare are here to stay—SOCIALIZED medicine IS the answer simply because there is no other way out. This is the reason neither the Republicans nor God himself offers any alternative. The private sector will not rise to meet the requirement in any system such as capitalism where the market is footed on and dominated by greed.

@crazyguy: “In the US, you have freedom to leave your employment. If you are fortunate enough to have a job that provides healthcare, the onus is on you to seek alternative employment with health insurance before you leave your current job. BUT the choice is yours.”

I can’t tell if you’re being serious or not.

The scenario in which a basic need as healthcare is tied to employment means that employers have even greater power over workers. You spin this as a pro for workers.

Why don’t we tie things like fire services to employment as well? I currently don’t have a fire in my house, and since my next job doesn’t offer fire service insurance, I’ll take the chance and maybe buy a lower-tier fire services insurance at some point in the future.

It’s my choice! Since I don’t burn candles or smoke in the house, my fire services risk is low. Maybe I’ll choose tier D, which will guarantee that fire services will cover fires caused by outside event, such as fire pits or grills. This choice will save me a ton of money, and I love the freedom of choice!

1 month later, an electrical fire burns down your house. The fire department won’t come, and you watch your entire life savings, all of your belongings, and your housing go up in flames. Oh well, it was your choice. That’s the price of freedom, or some bullshit. You now have no home and are penniless.

Healthcare is a basic human necessity, and commodifying it obscene.

@stanleybmanly Greed = “intense and selfish desire for something, especially wealth, power, or food.” It is definitely “bad”. However, it is the natural instinct that capitalism is based on. When I was in college, eons ago, I had a friend who was an avowed marxist. My question to him always was: “Why would a member of a collective work hard when his/her reward has no connection to the effort?” He answered that everybody would work for the greater good. This was on 1969 when communism was an experiment. Well, 50 years later, communism is a failed experiment. It tried to go against a basic human instinct and it failed miserably. Capitalism allows greed and that is why it succeeds.

Healthcare is a hard “business”. “Business development” in healthcare requires a populace to submit to tests and treatments that may or may not be beneficial, and may or may not be necessary and may be painful and counter-productive. You may argue that every act of “persuading” a consumer to part with his/her hard-earned money to satisfy a corporation’s greed is damaging. However, the link between corporate “greed” and healthcare is more obvious.

So the temptation is to let the government take care of it. So you will have bureaucrats who have zero skin in the game, making decisions on what patient gets what treatment or test. How exactly do you control costs in that environment? Exactly like the rest of the world, you say. The problem is that we have a society run by lawyers, where every decision, every guideline will be brought up in court. For instance, exclusion of a state-of-the-art chemo drug that costs half a million per dose will have to be included because some poor slob’s life could have been saved by the wonder drug.

@stanleybmanly In response to

’“In the US, you have freedom to leave your employment. If you are fortunate enough to have a job that provides healthcare, the onus is on you to seek alternative employment with health insurance before you leave your current job. BUT the choice is yours.”

I can’t tell if you’re being serious or not.

“The scenario in which a basic need as healthcare is tied to employment means that employers have even greater power over workers. You spin this as a pro for workers.

Why don’t we tie things like fire services to employment as well? I currently don’t have a fire in my house, and since my next job doesn’t offer fire service insurance, I’ll take the chance and maybe buy a lower-tier fire services insurance at some point in the future.

It’s my choice! Since I don’t burn candles or smoke in the house, my fire services risk is low. Maybe I’ll choose tier D, which will guarantee that fire services will cover fires caused by outside event, such as fire pits or grills. This choice will save me a ton of money, and I love the freedom of choice!

1 month later, an electrical fire burns down your house. The fire department won’t come, and you watch your entire life savings, all of your belongings, and your housing go up in flames. Oh well, it was your choice. That’s the price of freedom, or some bullshit. You now have no home and are penniless.

Healthcare is a basic human necessity, and commodifying it obscene.’

here is my response.

You provide a good example. So, in that scenario, I guess you would require ALL homeowners’ policies to provide fire protection from all causes, am I correct? Would you allow premiums to be different for higher-risk properties like those surrounded by a forest?

If you would allow the premiums to be different would you also provide a choice to the homeowner to fly without a parachute? Obviously not.

To some extent, taking care of a person’s health is similar. Some patients require more care than others. However, the one difference that makes any logical discussion hard, is that everybody will need healthcare sooner or later, while fire insurance is a rarely-used protection. Since Obamacare made it illegal to offer policies with different rates for healthy people versus those with pre-existing conditions, and mad it illegal to limit the coverage, the only choices are the deductible and the co-pay. However, certain horrendously expensive tests and treatments are permitted to be excluded. Flying without a parachute was discouraged by the Individual Mandate – however, that has now gone away.

Let me run out hypothetical economics for an Obamacare insurance company:

Number of insured = 100,000
Split between Gold, Silver and Bronze: 20/60/20.
Premiums collected per year for the three tiers: 20K, 15K, 12K.
Total premiums collected = 400 million + 900 million + 240 million = say $1.5 billion.

Number of “massive” bills (over $10 million) = 100

Therefore, the probability that you pay out two/thirds of the premiums collected to 0.1% of the insured is fairly high. Now the insurance company has to provide coverage to the remaining 99.9% of the insured and make a profit out of one-third of the premiums collected. Yoou can argue about the specific numbers I used, but I think you can see the difficulties of forecasting.

OK. So let the government become the single payer. How do you build in some incentive for cost savings? Easy. Have gatekeepers. A gatekeeper is judged by his/her flexibility. Any flexibility s/he is given will invariably be used to benefit the patient. Fine, let’s not provide any flexibility. Then a few patients will die. That is what the lawyers are waiting for. Two years later, the gatekeepers still have no flexibility but the lack of coverage for the specific treatments that may have saved a few lives has been addressed. And government expenses just went up.

@crazyguy

“What you call ‘free’ is anything but. If you see a doctor once a year, and make 60,000 euros per year, that one visit to the doctor cost you about 10,000 euros!”

That’s not quite right. We pay 7.5% of our income, but there’s a cap – so the most any employee pays for a year of health insurance is 4200€. Still, you’re correct, for that one doctor visit that would be a lot.

However, I absolutely don’t agree that all you get is that one visit. You get:

1) a guarantee that you’ll be taken care of if you can’t work at any point in your life. You could lose your job for reasons outside of your control (like a pandemic), or you might have a car accident that renders you unable to work, or perhaps you just cannot deal with the horrible pay and demanding supervisor anymore. Whatever your reason, you will still not be required to live in your car because your child gets sick.

2) medical care for your entire family (spouse plus children under 25), including routine checkups, vaccinations, scans, physical therapy, dental work, and even things like “parent-child retreats” every few years, or paid rides to procedures

3) the knowledge that you can always call an ambulance, even for a homeless guy, and no-one will get a bill later on

4) medical care for those in our society who do not have enough money to get by. This includes students (a young married couple might pay 75€ per month for themselves and any children), unemployed people, anyone with (mental) health issues preventing them from working, any new arrivals like the refugees coming in at the moment. Personally, I think it’s ethically problematic to leave these people to fend for themselves. But also, selfishly, I just don’t want to be exposed to the suffering that medical bills can cause. I don’t want to see people living on the streets, especially knowing that before it came to that, they were bled dry by insurance premiums and deductibles, by drug prices, and by credit card companies making a fortune through their misfortune.

“So the temptation is to let the government take care of it. So you will have bureaucrats who have zero skin in the game, making decisions on what patient gets what treatment or test. How exactly do you control costs in that environment?”

Well, the bureaucrats should be subject to the same rules. If I can’t get the newest cancer drug, they can’t either. And you control costs by making sure insurance companies are not allowed to make a profit.

I really don’t want to sell you on anything here. Germany has its own problems, and health insurance could work better here, too. I am currently arguing with my insurance company. I just want to provide a perspective of how it can work. Because frankly, Americans too deserve to be taken care of when they’re sick.

@crazyguy: – You didn’t @ me, so I almost missed your response.

@crazyguy: “You provide a good example. So, in that scenario, I guess you would require ALL homeowners’ policies to provide fire protection from all causes, am I correct? Would you allow premiums to be different for higher-risk properties like those surrounded by a forest?”

The risk of using a hypothetical is that it’s possible it’s a bad example. The other risk is that the person just doesn’t understand the connection you’re making. In this case, the former could still be true, but the latter definitely is true.

No, I would not “require ALL homeowners’ policies to provide fire protection from all causes”. I’m saying that there shouldn’t be fire services insurance at all. Look at what we currently have. If a house in a city is on fire, the fire department arrives and puts out that fire. The cost of funding the fire department is a group effort, and everyone pays regardless of your risk of fire or use of services. The person whose house catches fire twice in one year pays the same amount as the person who hasn’t had to call on their services.

Much of your response and comments about Obamacare/ACA, which I’m completely opposed to, is irrelevant due to the above.