these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.
Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
great that private healthcare companies profit off of sick people. Wow Medicare I can choose my own doctor and its a government program. Didnt know that was possible.
Most people are aware that the majority of other westernized nations use some form of universal healthcare. The Scandinavian countries are always the most interesting comparison because they seem to have accomplished what the ultimate goal is for the US in regards to healthcare - which is that they've maintained their wealth as a capitalistic society, remained having some of the healthiest populations of people in the world, but have done so while also still spending significant amounts of money on healthcare as a percentage of their GDP.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
Yeah. I agree. Seems a shame to save all this money for healthcare only to have a third or so of your lifetime costs in the last few months of life. Seems inefficient and silly
Is that it's a free market system. In a free market, there is competition on price, and consumers can make informed choices. Go to a grocery store and all the prices are marked on the shelf. Go to a hair salon and they have a price list of their various services. You can go elsewhere and compare those prices. That's a free market.
Now go to a drugstore and ask for a price list for prescription medications. Go to a hospital and ask for a price list for common procedures and costs of overnight stays. You won't get one.
That's not a free market. It's an opaque broken one.
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
But in my opinion something needs to change. I remember the days when you heard the word Cobra coverage and you would cringe on the thought it was so expensive.
When I was laid off last year from work I opted for Cobra figuring I would be back in the saddle pretty quick with work and a month or so would be ok. Well my hopes did not happen still looking for work and had to decide what to do the first of the year.
I figured I would find something on the market place at least comparable to what I had for much cheaper than I was paying for Cobra. Not so much I opted to continue my cobra coverage with a savings of approx 120.00 per month. And the amount I pay for Cobra is no picnic approx 650.00.
The system is broken and I hope they can fixit… I am fortunate and can afford this but far too many Americans cannot.
make available all their pricing. That way for non emergency procedures people could more easily "shop around" and compare. Make for a little competition instead of they having such a rigged system.
I hope the Republicans can do better than the garbage they are offering us. All of a sudden, Obamacare doesn't look so bad.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
Along those lines isn't the personal tax rate in some of those countries around 60%?
It's all relative.
They are all much higher than the US in terms of income tax for the most part (Finland 10% more), but the author claims she paid the same in Finland as she paid in the US, but sources say otherwise.
When people want to make a point, people are willing to take liberties, so who knows what's right.
I love America but think there are problems that we should develop institutions and resources to fix, and healthcare is one of the top of the list.
I don't have the answers, but the system, both before and after the Affordable Care Act, is broken and needs solutions.
Maybe the Scandinavian system has solutions and maybe they won't work here. Would like a bi-partisan approach but given how the ACA was treated as will any republican attempts, it really sucks that the American populace will suffer with expensive and confusing care
I'm just saying when people suggest that what works in Finland or other Scandinavian countries may not work in the US, they're not being all "'Murica fuck yeah" they're actually simply highlighting a non-valid comparison.
Sure there are things Finland may do that the US system can adopt and help it to improve, but I'll tell you the statistics the author cites, that's pretty damn good considering the size, diversity, and vastness of the US. Can it be improved? Absolutely and it needs to be and I too think the best solution should be something bipartisan, but this article seems bloggish to me.
I hope the Republicans can do better than the garbage they are offering us. All of a sudden, Obamacare doesn't look so bad.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
pays such high prices for drugs, it subsidizes other countries costs? That is one of the reasons that we pay more. We also pay more because if we want, we can get an MRI immediately instead of waiting for months. Canadian healthcare may be great, if and when you can get it. Last time I went to the imaging center for an MRI, there were more than a few Canadians there who flew down specifically to get an MRI because they didn't want to wait for months.
isn't to join the chorus of saying European healthcare systems are better than the US, but to make the more finer point about how disingenuous it is to try and sell Americans on a piece of healthcare legislation by saying people will benefit because it provides more freedom of choice.
Really this writer is just pointing out the absurdity of the suggestion that people can shop around for healthcare much in the same way they can shop around for a pair of jeans.
Other countries, like Finland, came to a consensus quite some time ago that it is not realistic to expect it's people to be in a position to make informed-enough decisions related to cost and quality of critical services - or that they should be even burdened with doing so for the such potentially stressful and life-altering moments that take place at a hospital.
More significantly, they recognized that individuals have no leverage to broker lower expensed services through the market. For someone who requires an individual plan, the only option (without incredibly generous government subsidies) that allows them to have comprehensive coverage at a low cost is a single-payer system.
A valid point can be raised about wait times in the Canadian system. They occur for sure and as I mentioned can be frustrating. Some provinces including Quebec, have allowed physicians to set up outside clinics to help alleviate this problem. It is not perfect but the results are improving as the privatisation of the system takes hold. It has always suggested to me that a public system, blended with some sort of private providers for the cases discussed might be what would be best. No solution is ideal, all systems have faults. That said, we can not claim to have a functional system when so many have so little access. Criticizing others solves little, we must learn from them and adopt their best practices. Only then can we be assured of improvements in our own back yard.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
Don't tell people that. Healthcare, no matter what the cost, and in spite of whether or not is largely self inflicted due to bad lifestyle choice, is a RIGHT damnit !!
I have said before, create a system in which the federal government is the insurer for catastrophic medical expenses. Private insurers pay a certain amount per year per insured (100-250K). The federal government pays everything over that amount. The amount rests to zero every January 1.
The system is funded with the following taxes:
(1) Reclassify carried interest from a capital gain to ordinary income.
(2) Elimination of "stepped up" basis for stocks, bonds, and most real estate.
(3) 4% national sales tax on all Internet purchases.
(4) 1% financial transactions tax.
Premium is a function of risk. Cap the amount the insurers have to pay, and premiums should come down. The system would still allow for copays and deductibles, but they would be much lower. HSAs would also still be allowed.
One thing I don't think many understand about US healthcare Â
We actually have a single payer system in Medicare and Medicade. It's available to all Americans precisely when their healthcare will be the most expensive and the most necessary and the least profitable. That's right, old people and disabled people qualify for the government to pick up the tab but if you're young and healthy and employed you get private health insurance which is extremely expensive and extrememly profitable to the health insurance industry. Hmmm... I wonder why that might be? Healthcare in the US is a racket. The drug companies manufacture drugs in Ireland to avoid taxes and legislation passed by Congress makes it illegal for me as a US citizen to buy my medication overseas where it's cheaper. Public hardship for private profits, it's the new American way!
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
RE: One thing I don't think many understand about US healthcare Â
We actually have a single payer system in Medicare and Medicade. It's available to all Americans precisely when their healthcare will be the most expensive and the most necessary and the least profitable. That's right, old people and disabled people qualify for the government to pick up the tab but if you're young and healthy and employed you get private health insurance which is extremely expensive and extrememly profitable to the health insurance industry. Hmmm... I wonder why that might be? Healthcare in the US is a racket. The drug companies manufacture drugs in Ireland to avoid taxes and legislation passed by Congress makes it illegal for me as a US citizen to buy my medication overseas where it's cheaper. Public hardship for private profits, it's the new American way!
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
GiantsUA--Thank you for saying what I was thinking about this moron. This is your typical mindless post. Nothing intelligent to offer but to attack a person with an opposing point of view. I was not saying America has no issues with healthcare, what I was implying is that it's apples and oranges to compare healthcare in the U.S. to Finland.
"somefan" not GiantsUA. The point of my post had nothing to do with American superiority. I do believe we can learn from other countries, but in regard to healthcare, it's probably not Finland.
RE: One thing I don't think many understand about US healthcare Â
We actually have a single payer system in Medicare and Medicade. It's available to all Americans precisely when their healthcare will be the most expensive and the most necessary and the least profitable. That's right, old people and disabled people qualify for the government to pick up the tab but if you're young and healthy and employed you get private health insurance which is extremely expensive and extrememly profitable to the health insurance industry. Hmmm... I wonder why that might be? Healthcare in the US is a racket. The drug companies manufacture drugs in Ireland to avoid taxes and legislation passed by Congress makes it illegal for me as a US citizen to buy my medication overseas where it's cheaper. Public hardship for private profits, it's the new American way!
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
Medicare is not single payer... straight Medicare pays 80% of outpatient billing so the 20% is either out of pocket or from a supplemental. Medicare advantage plans are administered through private insurance companies. Medicaid is paid for by the federal and state governments.
The closest thing we have to single payer is... the Indian Health Service. Which is an utter disaster that can't attract quality doctors and doesn't provide quality health care. It does have a relatively lower cost though. Win win.
RE: RE: already paying for national healthcare - just Â
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
I agree the 3% Medicare number is faulty at best but the authors metric also needs work.
The author states that the Medicare number is the total admin cost divided by total dollars spent. And it does not include many costs from the admin bucket that are included in private health care. No doubt of it and fully agree. The author also states that Medicare is mostly elderly with higher cost per visit it unjustly lowers the percentage. Also agree.
But, the metric the author states of admin costs divided by beneficiaries is also faulty. The elderly typically have more visits, than the largely under 60 insured privately, therefore more claims. And since the elderly have more complex claims the average cost per claim is higher. I would assume that the admin cost of an elderly beneficiary for exceed that of the average privately insured. Would anyone be surprised to learn that the elderly cost more in admin than the rest of the population?
So I think it is improper to use probably the most costly sector for admin cost as a basis for how efficient the private sector is.
Like I said, the 3% figure is BS but the authors metric is also flawed. What the true cost difference is I don't profess to know but I would use neither of the figures used.
I think my overall point stands even in light of your additions about Medicare. The overwhelming cost of providing healthcare is already born by some form of government. Consider as well, all the public and municiple unions that provide gold plated healthcare to their members.
If you had to pick the best system in the world, which would it be? And how are you quantify your selection?
Sam, the high costs for Vermont were due to the fact that Vermont Â
has a very elderly population; if the entire country had universal healthcare, costs would be distributed in a way that would bring costs per capita down significantly compared to what Vermont was going to deal with.
What started out as a Democracy with decisions made for the common good has evolved into one that has politicians at the beck and call of big money. Today's politician makes decisions based on pleasing his biggest donors and selling it to those that vote for him as being good for them, all for the sole purpose of getting re-elected.
You can't even call it a Capitalist Democracy because that would invoke an idea of a level playing field that would promote innovation and development at a scale we sorely lack right now. Not only is it a fixed game, it's one where every angle is covered. From tax breaks to locking competition out to suppressing competitive research, the medical and Insurance industry is a rigged game here in the states and it is a result not of one party but the political system as a whole.
It will never be completely fixed here until we get people in office that actually put the good of the country before anything else. That won't happen until we develop a politic system that takes the ability away from the Mega-Donors to impose their desires. This is not a rant against the current party in power, this problem goes back for decades and is equally owned by both sides. I don't know the solution and it most likely is naive to believe it could change at this point, but there is no question that the great ideas this country was founded on are nothing more than a footnote in a history book at this point and we are in a steady decline.
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
Actually I think contempt for the politicians and political institutions (I include the media in here) is good for democracy. We should not trust any of them. A little bit of revolting peasants once in a while is a good thing.
- BBI
Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
Well said, Sir!
Quote:
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
Yeah. I agree. Seems a shame to save all this money for healthcare only to have a third or so of your lifetime costs in the last few months of life. Seems inefficient and silly
Now go to a drugstore and ask for a price list for prescription medications. Go to a hospital and ask for a price list for common procedures and costs of overnight stays. You won't get one.
That's not a free market. It's an opaque broken one.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
So yeah, let's just do single payer cuz it works in some other countries.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
False.
https://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/#35e4d2e9140d
When I was laid off last year from work I opted for Cobra figuring I would be back in the saddle pretty quick with work and a month or so would be ok. Well my hopes did not happen still looking for work and had to decide what to do the first of the year.
I figured I would find something on the market place at least comparable to what I had for much cheaper than I was paying for Cobra. Not so much I opted to continue my cobra coverage with a savings of approx 120.00 per month. And the amount I pay for Cobra is no picnic approx 650.00.
The system is broken and I hope they can fixit… I am fortunate and can afford this but far too many Americans cannot.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
It's all relative.
It's all relative.
They are all much higher than the US in terms of income tax for the most part (Finland 10% more), but the author claims she paid the same in Finland as she paid in the US, but sources say otherwise.
When people want to make a point, people are willing to take liberties, so who knows what's right.
I trust nothing anymore.
I love America but think there are problems that we should develop institutions and resources to fix, and healthcare is one of the top of the list.
I don't have the answers, but the system, both before and after the Affordable Care Act, is broken and needs solutions.
Maybe the Scandinavian system has solutions and maybe they won't work here. Would like a bi-partisan approach but given how the ACA was treated as will any republican attempts, it really sucks that the American populace will suffer with expensive and confusing care
I'm just saying when people suggest that what works in Finland or other Scandinavian countries may not work in the US, they're not being all "'Murica fuck yeah" they're actually simply highlighting a non-valid comparison.
Sure there are things Finland may do that the US system can adopt and help it to improve, but I'll tell you the statistics the author cites, that's pretty damn good considering the size, diversity, and vastness of the US. Can it be improved? Absolutely and it needs to be and I too think the best solution should be something bipartisan, but this article seems bloggish to me.
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I hope the Republicans can do better than the garbage they are offering us. All of a sudden, Obamacare doesn't look so bad.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
Well said.
- BBI
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
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I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
Agreed.
I hope this thread doesn't take any nasty political turns and is allowed to stay up.
Really this writer is just pointing out the absurdity of the suggestion that people can shop around for healthcare much in the same way they can shop around for a pair of jeans.
Other countries, like Finland, came to a consensus quite some time ago that it is not realistic to expect it's people to be in a position to make informed-enough decisions related to cost and quality of critical services - or that they should be even burdened with doing so for the such potentially stressful and life-altering moments that take place at a hospital.
More significantly, they recognized that individuals have no leverage to broker lower expensed services through the market. For someone who requires an individual plan, the only option (without incredibly generous government subsidies) that allows them to have comprehensive coverage at a low cost is a single-payer system.
Exactly. My interest in what this European blowhard has to say is between zero and none.
Don't tell people that. Healthcare, no matter what the cost, and in spite of whether or not is largely self inflicted due to bad lifestyle choice, is a RIGHT damnit !!
The system is funded with the following taxes:
(1) Reclassify carried interest from a capital gain to ordinary income.
(2) Elimination of "stepped up" basis for stocks, bonds, and most real estate.
(3) 4% national sales tax on all Internet purchases.
(4) 1% financial transactions tax.
Premium is a function of risk. Cap the amount the insurers have to pay, and premiums should come down. The system would still allow for copays and deductibles, but they would be much lower. HSAs would also still be allowed.
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
THIS^^^^^^^^^^^^^^^^^
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Murica fuck yeah
- BBI
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
GiantsUA--Thank you for saying what I was thinking about this moron. This is your typical mindless post. Nothing intelligent to offer but to attack a person with an opposing point of view. I was not saying America has no issues with healthcare, what I was implying is that it's apples and oranges to compare healthcare in the U.S. to Finland.
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
Medicare is not single payer... straight Medicare pays 80% of outpatient billing so the 20% is either out of pocket or from a supplemental. Medicare advantage plans are administered through private insurance companies. Medicaid is paid for by the federal and state governments.
The closest thing we have to single payer is... the Indian Health Service. Which is an utter disaster that can't attract quality doctors and doesn't provide quality health care. It does have a relatively lower cost though. Win win.
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not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
False.
https://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/#35e4d2e9140d
Lies, damn lies and statistics.
I agree the 3% Medicare number is faulty at best but the authors metric also needs work.
The author states that the Medicare number is the total admin cost divided by total dollars spent. And it does not include many costs from the admin bucket that are included in private health care. No doubt of it and fully agree. The author also states that Medicare is mostly elderly with higher cost per visit it unjustly lowers the percentage. Also agree.
But, the metric the author states of admin costs divided by beneficiaries is also faulty. The elderly typically have more visits, than the largely under 60 insured privately, therefore more claims. And since the elderly have more complex claims the average cost per claim is higher. I would assume that the admin cost of an elderly beneficiary for exceed that of the average privately insured. Would anyone be surprised to learn that the elderly cost more in admin than the rest of the population?
So I think it is improper to use probably the most costly sector for admin cost as a basis for how efficient the private sector is.
Like I said, the 3% figure is BS but the authors metric is also flawed. What the true cost difference is I don't profess to know but I would use neither of the figures used.
If you had to pick the best system in the world, which would it be? And how are you quantify your selection?
Why do you think many went red this time around?
Many articles come up when googled. I picked one.
Link - ( New Window )
You can't even call it a Capitalist Democracy because that would invoke an idea of a level playing field that would promote innovation and development at a scale we sorely lack right now. Not only is it a fixed game, it's one where every angle is covered. From tax breaks to locking competition out to suppressing competitive research, the medical and Insurance industry is a rigged game here in the states and it is a result not of one party but the political system as a whole.
It will never be completely fixed here until we get people in office that actually put the good of the country before anything else. That won't happen until we develop a politic system that takes the ability away from the Mega-Donors to impose their desires. This is not a rant against the current party in power, this problem goes back for decades and is equally owned by both sides. I don't know the solution and it most likely is naive to believe it could change at this point, but there is no question that the great ideas this country was founded on are nothing more than a footnote in a history book at this point and we are in a steady decline.
+1
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It's very sad.
+1
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
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In comment 13398984 yatqb said:
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It's very sad.
+1
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
Actually I think contempt for the politicians and political institutions (I include the media in here) is good for democracy. We should not trust any of them. A little bit of revolting peasants once in a while is a good thing.