Understanding American Healthcare

[guerilla]

There was a thread on this but it has been polluted and I think these two videos from doctors present a very complete case for history and economics regarding the American health care system.

[ame=http://www.youtube.com/watch?v=v-TSn9wEHWg]Thinking About Medicine Outside the Statist Quo - YouTube[/ame]




[ame=http://www.youtube.com/watch?v=XjoSEkqO4_8]Elaina George, MD - Why Doctors Must Stand Up for Their Patients - YouTube[/ame]

 

[Pseudo Nym]

Are these problems with government-run healthcare in general, or just the way it's done in the US? The first guy has some some graphs he shows, but it's only US stats. It'd be interesting to see a comparison to other first-world countries.

One wonders why virtually every other first world county has some form of universal health coverage, yet the US spends 50% more (as a percent of GDP) than any of them and there are still millions without healthcare. It seems to me the problem is not government provided healthcare per se, but rather some aspects of American culture and politics that screws it up. Maybe the US should be spending more time looking at what other countries are doing to make their systems work instead of the endless ideological bickering that goes on, all the while real people are losing their health and livelihoods/lives.

The first guy mentions Hayek a few times, and - I mentioned this recently in another thread - Hayek explicitly supported the idea of state assisted healthcare in Road to Serfdom.

 

[pfgannon]

Very interesting to hear from the perspective of doctors, they seem to have surprisingly little voice in the public debate.

Pseudo, I often wonder this too. If we spend so much here, why aren't we getting the same results as other state-subsidized health care systems. However, on a fundamental level, I don't really think it matters because state-subsidized relief of pain and suffering through health care is paid for with the pain and suffering of others. Where's the trade off?

 

[Pseudo Nym]

Very interesting to hear from the perspective of doctors, they seem to have surprisingly little voice in the public debate.

I can appreciate the desire both speakers expressed for more autonomy in their practice. Overbearing bureaucratic beancounters can certainly cause harm in many cases. It's worth noting the second speaker mentions the hassle of dealing with insurance companies as well, not just government.

However, on a fundamental level, I don't really think it matters because state-subsidized relief of pain and suffering through health care is paid for with the pain and suffering of others. Where's the trade off?

What "pain and suffering of others" are you referring to?

 

[Falian]

I can appreciate the desire both speakers expressed for more autonomy in their practice. Overbearing bureaucratic beancounters can certainly cause harm in many cases. It's worth noting the second speaker mentions the hassle of dealing with insurance companies as well, not just government.



What "pain and suffering of others" are you referring to?

I think he's referring to the pain of paying more taxes, because I doubt the lower/middle class will be footing the bill.

Oh and you also got to keep in mind we can't even balance our current budget, or our current healthcare subsidies (medicare/medicaid), so it's not like we have a surplus of class floating around for all these social projects.

 

[Pseudo Nym]

I think he's referring to the pain of paying more taxes, because I doubt the lower/middle class will be footing the bill.

That's kind of what I figured, but I didn't want to presume. In response, I guess I would say most people consider taxes a relatively mild form of suffering compared with the suffering that can result from untreated illness.

Oh and you also got to keep in mind we can't even balance our current budget, or our current healthcare subsidies (medicare/medicaid), so it's not like we have a surplus of class floating around for all these social projects.

Not that it can't be done though, yeah? As was mentioned, the US spends a lot more than any other country and gets less for it. So it's clear there's a lot of room for improvement.

Worth pointing out the budget surplus that existed at the end of the '90s as well.

 

[pfgannon]

I think he's referring to the pain of paying more taxes, because I doubt the lower/middle class will be footing the bill.

Oh and you also got to keep in mind we can't even balance our current budget, or our current healthcare subsidies (medicare/medicaid), so it's not like we have a surplus of class floating around for all these social projects.

Yeah, for the most part. But also the wars our government gets us involved with to bolster the economy, the availability of drugs that never make it to market due to the increased cost of meeting regulations, and natural pain relievers like marijuana that people can't access due to the threat of violence.

All these things are made possible through taxes, so I suppose you hit the nail on the head.

EDIT: @Pseudo, so again where is the trade off? Who has the right to decide if one form of suffering is more acceptable than another?
As I pointed out earlier in this post, the suffering goes far beyond the violent taking of property through taxes.

 

[Falian]

That's kind of what I figured, but I didn't want to presume. In response, I guess I would say most people consider taxes a relatively mild form of suffering compared with the suffering that can result from untreated illness.



Not that it can't be done though, yeah? As was mentioned, the US spends a lot more than any other country and gets less for it. So it's clear there's a lot of room for improvement.

Worth pointing out the budget surplus that existed at the end of the '90s as well.

There's a lot of reasons that we spend more than any other country, and i'm not sure handing the reigns over to the inefficient government is going to help. In fact, the government's regulations, and lack there of, are a big reason why we spend more money. For example, we pay more for prescription drugs than any other country. We also have the worst (for those getting sued) malpractice laws in the world. See USPS, our government doesn't have a good track record.

As for the budget surplus, if we get back to that point then by all means spend all those greenbacks on healthcare for people. I don't want to have to pay a higher % in taxes.

Thanks to the internet, the world is changing. As more and more people telecommute to work, location will be less of a factor. If I can run my company anywhere in the world, then I have a lot of freedom as to where I live. I can live with paying 35% to live in the US. You start hiking up that number and I start getting antsy.

Some may argue that the wealthy paid as much as 94% in income tax in the past. Most of that was in the 40's-60's, when the rest of the developed world was still recovering from WW2. Times have changed now, there are more options and mobility is easier.

As I said earlier, I'm fine with paying 35%. Balance the budget, cut out all the bullshit and i'm sure there will be a ton of money for some fun social experiments.

 

[Pseudo Nym]

EDIT: @Pseudo, so again where is the trade off? Who has the right to decide if one form of suffering is more acceptable than another?

In a democracy, the people, through the political process. It makes sense that the people of a society get a say in how it is run, no?

You can argue against the legitimacy of the state if you want, but we all know states aren't going away any time soon. In the mean time we've got to do the best with what we've got. Frankly I don't see the last 30 years of deregulation and economic liberalization in the US as much to be proud of. The average first-worlder in not-USA is better off in many ways (e.g., health care) than his American counterpart. Gross wealth inequality is bad for any society IMO; it creates social stratification, us and them mentality, power imbalances, etc. The pie may grow, but if all the extra portions go to the 1%, what good is it? What you're seeing now with these protests is a clear sign that people aren't taking it any longer.

 

[pfgannon]

Pure democracy is mob rule, which is why the US was set up as a democratic republic bound by the constitution. Not perfect, but focused on liberty and the pursuit of happiness (property).

I'm not proud of the last 30 years either, but I certainly wouldn't say the last 30 years have been filled with deregulation and economic liberalization. Weakening of property rights swiftly counteracts any progress that may have been made by this supposed deregulation.

Of course wealth inequality is bad for society, but redistribution of wealth doesn't eliminate us vs them mentality or power imbalances, on the contrary, it reinforces them and the idea that you can use force to get what you want. Of course, in both democracy and socialism a central group of crooks are pulling the strings and receiving the most benefit, and will continue to by making intelligent people like yourself believe these are the only two solutions.

I think these people are upset because, fundamentally, they believe they aren't afforded the same opportunity to prosper. But, of course, if you deny yourself self-ownership, how can you possibly take advantage of opportunity? Because, with this logic, if you take advantage of opportunity to better your life, then you're taking it away from someone else. However, the opposite is true. By bettering your life, you have the opportunity to better society - peacefully.

 

[geomark]

I would like to see the effects of tort law isolated - is that a major cause of differences between cost of health care in first world countries?

 

[Falian]

I would like to see the effects of tort law isolated - is that a major cause of differences between cost of health care in first world countries?

I read that it only directly accounts for 1% of the US health care budget. Directly is the key point. You have to factor in indirect expenses like malpractice insurance that raises the cost of healthcare.

 

[Berto]

One wonders why virtually every other first world county has some form of universal health coverage, yet the US spends 50% more (as a percent of GDP) than any of them and there are still millions without healthcare. It seems to me the problem is not government provided healthcare per se, but rather some aspects of American culture and politics that screws it up..

Here's your one word answer:

CORN.
​

NO system will work here until you treat the CAUSE, not the effect. Our diets are shit, our animals are shit, even our vegetables are shit.

Fix the problem and you can get a workable system. Until then, nothing works because we're chasing shit (corn) with more shit (drugs) and paying for it with even more shit (inflated US dollars).

/thread for me.

 

[Moxie]

Obesity is part of it, but even if Americans started to be in the same shape as the Japanese, the US would still have very high health care costs.

This article lists a lot of the reasons :

Why Is Health Care So Expensive? Let Us Count the Conspirators | Moneyland | TIME.com

 

[pfgannon]

Here's your one word answer:

CORN.
​

NO system will work here until you treat the CAUSE, not the effect. Our diets are shit, our animals are shit, even our vegetables are shit.

Fix the problem and you can get a workable system. Until then, nothing works because we're chasing shit (corn) with more shit (drugs) and paying for it with even more shit (inflated US dollars).

/thread for me.

 

[geomark]

I read that it only directly accounts for 1% of the US health care budget. Directly is the key point. You have to factor in indirect expenses like malpractice insurance that raises the cost of healthcare.

Yeah, that's the part I'm talking about, the threat of huge malpractice awards that makes insurance so expensive and adds tremendous friction to every step in the health care system. For example, trying to get power of attorney for an elderly parent - every single doctor insists on their own individually customized version, it's ridiculous. I can't remember the statistic I once saw about how the large fraction of a doctor's expenses was for malpractice insurance premiums - 40% or something like that?

 

[Kiopa_Matt]

*scratches head*

Healthcare in the US is so expensive because it's a privatized, FOR PROFIT industry. They don't give a shit about taking care of you. They're there to make money, and as any good business people would do, they'll do everything in their power to grow the margins.

Now in places like Canada, UK, Sweden, and so on, it's all nationalized and for the most part, government run. So instead of you personally paying the bill, the government is paying it, so they make damn sure everything is as cheap as possible. And considering the government runs the country, they have quite a bit of bargaining power when it comes to drug companies, equipment companies, wages, etc.

For example, in Canada there's strict laws against drug companies saying you can make a tidy profit, but can't outright rape & pillage people, and basically hold them at hostage (ie. pay this extortionate fee for your drugs, or die), like they do in the US. This is why you see loads of Americans going to Canada to get their prescriptions filled.

That's actually another sad thing about that healthcare law / sham that took place in the US. Originally, it would have opened up access to Canadian (and other country) markets for Americans to buy their prescriptions. Pharmaceutical industry had their influence though, and nope, that portion of the bill was removed. You're buying your drugs from American companies only, damnit!

Too bad the single payer option got left out of the US bill, because without that, there was almost no point to the entire bill. That's the one thing that would have drastically lowered all of your costs.

 

[geomark]

lol, for-profit market driven without government distortion brings the best products at the lowest prices to the consumer. The examples are countless. U.S. healthcare is no such thing.

 

[Kiopa_Matt]

lol, for-profit market driven without government distortion brings the best products at the lowest prices to the consumer. The examples are countless. U.S. healthcare is no such thing.

Ok, then how about some example countries where for profit health care works like a charm? Thailand even has nationalized health care nowadays.

 

[geomark]

Yep, Thailand's national health care is a travesty. The so-called "30 baht plan" since that's what it costs to go to the doctor (about USD1). I know first hand, having taken eligible relatives to public hospitals and observed the horrors. Government funded and operated, speaks for itself. Absolutely no Thai person who can afford private health care goes to 30-baht public hospital.

In contrast, the private health care system in Thailand is stellar, world class and better than what you can get in the west, at about 1/10 the cost. Why? Local costs are lower. A number of reasons for that. One reason is that if you sue for malpractice here you are awarded costs for remedial care but not enormous "pain and suffering" monies. Another is competition - the private hospitals compete for your business and prices are published not hidden like in the U.S. You can buy medical insurance here but it is generally actual "insurance" which means it is for large unexpected medical events, not routine and expected events like the joke you call insurance in the U.S. is used.

One interesting twist I should mention is that some public hospitals have "private" after hours clinics which charge almost private hospital rates and deliver private hospital quality. I did that myself recently because the doctor I wanted to see keeps hours at a public hospital. It's a very interesting effect - as soon as the hospital switches over from public to private at 5:00 p.m. the service and quality jump. There you have a side-by-side comparison of private versus public.

I'm very familiar with the systems in Thailand but not so much other countries so can't comment much on them except to say that I believe that several other countries in Asia have similar systems and their private health care is great and relatively inexpensive, thinking of Malaysia, Singapore and South Korea.