- cross-posted to:
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- cross-posted to:
- [email protected]
In 2017, Donald Trump and Republicans in Congress tried to eviscerate the A.C.A. and almost succeeded in passing a bill that the Congressional Budget Office estimated would have left 22 million more Americans uninsured by 2026. There’s every reason to believe that if the G.O.P. wins control of Congress and the White House in November, it will once again try to bring back the bad old days of health coverage. And it will probably succeed, since it failed in 2017 only thanks to a principled stand by John McCain — something unlikely to happen in today’s Republican Party, where slavish obedience to Trump has become almost universal.
If you want to preserve that access to health insurance, it’s worth checking your voter registration, getting involved as a volunteer for the Democrats and doing what you can afford to provide financial support
The only source I found for the graph you linked is some guy’s anonymous blog post. I only skimmed the article because I’m not reading the MANY pages’ worth of text from an unreviewed, unpublished source. I’m open to new ideas, but I want better sources. Harvard’s School of Public Health tells me that US healthcare is the most expensive in the world and that’s a problem. For a primary source, here’s a study published in JAMA that concludes, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries.” Similar utilization rates = people are not getting significantly “more” healthcare for their significantly more money.
I read some of that blog but gave up after a few minutes because I hate the premise - just because the US is rich does not make it ok that US healthcare is more expensive per capita and as a % of GDP. Given how critical healthcare is to quality/length of life, I believe it can only ethically be a guaranteed safety net - not an industry that excludes. It’s not ok to charge people higher prices for a life-defining procedure that would be cheaper elsewhere for profit’s sake and justify it by saying there are enough wealthy people to keep the system going.
Inserting for-profit insurance means companies charge what they can to be maximally profitable, which prices out the poor and leads to the problem we see where healthcare is almost a luxury. The free market means not everyone can afford luxury cars and that’s ok, but it has no place in determining whether everyone can access to “luxury” healthcare. It also complicates health care at a detriment to patient wellbeing - a great example is doctors having to get approval for life-saving/improving procedures from a corporation motivated by wealth. I try not to be close-minded, but it’s going to take far more for me to ignore criticisms from credible sources and the realities of medical bankruptcy or people scared to get an ambulance ride because of personal cost.
Just look at the Wikipedia page on List of countries by household final consumption expenditure per capita. Americans consume much more than anyone else on the world, and it’s not even close. Americans even consume at a higher level than the “ultra-rich” countries that exceed it in GDP per capita, e.g. 30 percent more than Luxembourg (which is number 2 on the list)!
This covers all forms of consumption, in which healthcare is only a fraction. The discrepancy is so great that it can’t be explained by US healthcare being expensive. It’s the other way round, it’s healthcare consumption that is being pulled along by the rest of the consumption.
That is just restating the argument. There’s nothing new in that response and I addressed the flaws of the idea that a richer country should = more expensive health care. It’s not as if healthcare costs have some inherent reason to increase along with wealth. As an analogy, paying 50 dollars for electricity while earning 1k/month doesn’t justify paying 5,000 for the same electricity usage while making 100k/month - it’s 50 dollars’ worth of electricity either way. Most glaringly, if healthcare is priced based on what the market will bear it excludes/punishes many folks by making care more expensive (as a %) the further down the ladder you are. It’s the market model you’d expect for an optional product, not a life-defining essential.
US citizens aren’t even getting “more” for the extra cost. The JAMA article I posted states that a) Americans utilize healthcare at largely the same rate as cheaper countries and b) the extra cost is primarily due to increased pricing of labor/goods and administrative expense. Expensive privatized healthcare resulting in huge amounts of medical debt is a solvable industry-created problem that the USA’s peer countries have reduced or avoided entirely. If a Canadian and American live near the border, on average the Canadian pays half as much per year (link here again for convenience), is guaranteed coverage, and lives 3 years longer than the American a few kilometers away. While life expectancy is undeniably decided by multiple factors (certainly more than just healthcare quality), we can say for sure that Americans are not getting appreciably more frequent health care nor are they living longer than their neighbors for all that they pay double.
Well, there are several big reasons. For example, doctors and nurses in the USA have much higher pay than those in Europe. Part of this is because of policy differences (e.g., the supply of US doctors is artificially restricted by the AMA). But part of it is simply that educated professionals are paid much more in the USA than in Europe, and it’s nothing specific to healthcare.
The point is that when making comparisons between US and other rich countries, the first thing you have to do is to account for the fact that Americans (i) have higher GDP per capita, and (ii) have higher levels of consumption even after compensating for GDP per capita. That should be the first-order effect, with stuff like the public-versus-private issue as second-order effects.
I do agree with the benefits to the US not being proportional to the cost, to a point. Lots of healthcare spending goes into things that don’t really benefit aggregate outcomes, like heroic interventions that end up extending end-of-life by a few months, or treatments that only benefit one-in-a-million conditions. But this is not just an issue for the US; for example, the UK spends 18x on healthcare per capita compared to Thailand, for 2 extra years of life expectancy. And those individuals who get their lives extended by a small amount, or get their rare condition treated, may have different views on the matter.
Doctors are paid more, but still a small slice of healthcare costs. Doctors in the US working entirely for free would barely make a dent. All administrative costs, including doctors and nurses salaries, but also our bloated health care administration, add up to 8%. A lot of the extra administration costs are also things like all the staff needed just to interface with the giant mess of different payers including multiple private and government programs, all with different documentation and billing requirements.
The insurance companies, pharmaceutical companies, medical device and equipment companies, and private equity owners of hospitals and practices who are all reaping windfall profits at the expense of patients love to direct the blame to doctors though.
Doctor salaries do not account for the 550 billion dollar pharma industry or the 1.7 trillion dollar health insurance industry. As a comparison, Canada’s health industry is 112 billion USD. The USA’s population is 8.4x greater, 8.4x112 billion = 940 billion instead of 1,700 billion (1.7 trillion).
Canadian doctors earn 3rd most in the world, around 200k/year. US doctors earn about 117k more a year. There are just over a million doctors in the USA = about 117 billion dollars which brings the cost from 940 billion to 1.057 trillion instead of 1.7 trillion.
I don’t give a damn about GDP/consumption and have explained why in detail. You keep on saying the same thing, but you’re not going to convince me that US healthcare should be more expensive to the tune of 700 billion/year because Americans buy more electronics, vehicles, etc. Especially given that wealth inequality means there’s a huge variance in what people can afford.
With regards to pharma, other developed nations pay less than 1/3rd for the same medicine, which nullifies any inherent cost argument. Americans pay much more for medicine just because of allowed corporate greed.
I acknowledged that there’s more to life expectancy than cost of healthcare, but we don’t need to compare the UK to Thailand. We can compare the US to Canada, New Zealand, Germany, Japan, Korea, etc to see that it’s more expensive and yet does not extend American life expectancy past that of cheaper countries. If you read my links, you’ll see that the US has low doctors per capita, and high avoidable deaths per 100k when compared to peer nations - proof that Americans are not getting more for their money.
In order for your point about heroic interventions etc. to be valid in a US vs. other developed nations argument, you’d have to prove that the other countries are not saving their citizens (otherwise it’s a wash, with both groups saving seriously ill patients). Not only would the US have to be saving their citizens where others don’t, but they’d have to be doing so in large enough quantities to skew national statistics.
Even if experts agreed that the US system was great, I’d disagree because I can see the real-world end results. It’s not ethical that doctors have to argue/plead with profit-motivated insurance accountants to properly treat their patient. It’s not ethical when a seriously ill/wounded patient in a hospital is trying to figure out how they are going to deal with medical debt/bankruptcy that’s going to leave them impoverished.
However, I don’t need to worry about that dilemma because experts are not fans of the US for-profit system. As I’ve provided several links to prove, both economists and medical professionals regularly publish criticisms of the USA’s expensive, under-performing healthcare.