US Health Care System

While I am not a pom or yank, I wanted to know if this statement was true or if it varied from state to state in the US? It comes across as being that bad that it would seem to be pure fiction?

@THUMPTABLE:

The short, honest answer is Yes, the medical treatment provided to the victims would be billed to the responsible party. For children, that would be their parent(s).

In the USA we expect people to take responsibility for themselves and their dependents. Providing for their basic needs and purchasing insurance when needed to cover possible liabilities they cannot afford.

The one thing in this woman's statements that I would dispute is her assertion that GoFundMe pages would not provide enough money. That is her assumption, not a fact. I would point out that after the 9/11 attacks, the people of the US donated so much money, charities were struggling to find ways to spend it. Time and time again, the people of the US have proven willing to support their fellow citizens in the face of tragedy. We just choose to do it voluntarily, through private channels, not by force of government.

@comeonman: I'd bet it would pay more than a fraction, but given the number of people who could need a GoFundMe in this example, I still think several would be left with great medical debt. Great if none are.

Let's agree that we hope to never need to find out, eh?

@comeonman: 9/11 is an outlier example. For one thing, not much treatment was given because very few people survived. On top of money, a lot of blood was donated but once again there was no one to give it to at the time.

Then in the following weeks, a lot of people doing the cleanup at ground zero were injured. Since many of them were contractors being sub-contracted out, their employer's insurance didn't have to cover them. By then, the charities had moved on, so they were left high and dry. These are the people Jon Stewart keeps advocating for.

To get back to the OP, yes what this person wrote is true. There would be some people with good insurance who would be completely paid for, there would be some with decent insurance who would have to pay a few thousand out of pocket, and there would be some with bad or no insurance who would pay anywhere from $20,000-$200,000 depending on injuries.

Doesn't even have to be a big tragic event either. When my daughter was born a few weeks premature, it took 8 months for the various departments in the hospital to finish sending us bills. Almost as long as the pregnancy. Our healthcare system is such a giant bureaucratic mess, that putting the goverment in charge would actually make things simpler.

Yes.

The answer is yes it is that bad. While I don't particularly enjoy the context of that article as it largely comes of as victim olympics (oh your tragedy is bad, well have a load of THIS tragedy!), the reality is that a majority of Americans are in debt or cannot afford a single emergency. Endless bills and anxiety follow any serious injury or diagnosis, with outside charitable support hardly being a sure thing, and insurance out to **** you over as hard as possible.

And considering we also deal with the most mass shootings of any country (more than 1 per day), this is less a nightmare theory and more a nightmare reality.

US “healthcare” system is a joke solely because it operates on free market principles and that it is a profit-based venture. They literally profit off dying people who have no choice but to accept being price gouged. Healthcare is treated like any other commodity rather than a human right and one which free market principles don’t apply.

You can’t “shop around” for insurance or a doctor or a new lung like you would for the newest smartphone.

We've had health insurance companies pull out of our state (Tennessee) because people are too sick. Hospitals are closing all around the rural areas here because people are too poor. Some communities don't even have ambulance service.

Healthcare shouldn't be a luxury afforded only to the rich. Privatization doesn't work.

@leicam6: Remeber when the GOP kept compairing buying health insurance to buying a pizza? It boggles my mind that there is a political strategist out there somewhere who was given actual money to come up with that talking point. And the fact that no party leaders questioned it? I mean, I know they're all rich douche bags with government health insurance, but that was nuts.

What drives me nuts are all the people who hate healthcare costs, hate the way the industry is becoming less accessible, hate Obamacare, yet the minute you mention single payer they just completely check out and accuse you of being a communist. You either have market based insurance, in which case you're going to continue to have holes in coverage, or you have government based insurance which will cover everyone. Pick one or the other, don't just endlessly complain about the one you want but start attacking people the minute they start offering solutions.

It's actually worse than that because it's not even operating on free market principles. Many of the insurance companies and pharmaceutical companies utilize anti-competitive practices to artificially inflate their prices. There is no free market for healthcare under that system.

@sonicare: The doctors do, too.

Of course it’s operating on free market principles. The free market eventually devolves into all those things you describe because of a lack of oversight, which is the entire basis of a free market system. What you think as free market principles is an idealized free market with perfect competition which hasn’t ever existed. The government allows all those things to happen and in some cases, exacerbates it.

Anti-competitive practices, price gouging, monopolies, as well as collusion between drug manufacturers, instrument manufacturers, hospitals, and insurance providers is all fair game in the Wild West of American healthcare because it makes the shareholders and CEOs a few extra dollars. A “free market” has nothing to do with perceived “fairness“ it just needs to be free of government interference so the robber barons of Big Pharma can do their thing unimpeded.

@theone86: Genuinely curious about the Rorschach avatar. You’re about as left-wing as I am and that character is a massive fascist.

@THUMPTABLE: short answer is yes. Unfortunately.

Though I have to admit, despite her best intentions, "Hannah" describing herself as a "Social Justice Warrior" like it is a good thing is a bit scary.

She is also providing very one-sided information. Yes, medical bills are expensive and you are expected to pay them. But a lot of people (most?) have halfway decent insurance. With that said, if your deductible (or whatever the term is for your max) is like 10,000 dollars, that's still 10,000 dollars you are responsible for.

I believe the average deductible in the US is like 5,000 dollars or so. So if your bullet wound costs 300,000 dollars to fix, you need to pay 5,000 of that (did I explain that right? Correct me if I am wrong).

Healthcare in the US is severely fucked up, though, I don't think anyone can dispute that. For starters, it needs to be non-profit. And no, that's not going to stop doctors from wanting to be doctors, you can still make six figures and work for a non-profit.

Yeah this is a good summary. I also read that in communities where mass shootings happen, people generally support each-other. If a bunch of kids get shot at a school, that city/country/state tends to look after them, at least for their immediate future.

Jesus that is terrible. I didn't realize that was even legal to do. You'd think the government would step in at some point.

I can't imagine facing any sort of emergency health crisis--heart attack, severe broken bone, seizure, and so on--and not having the ability to call an ambulance.

@mrbojangles25: "I believe the average deductible in the US is like 5,000 dollars or so. So if your bullet wound costs 300,000 dollars to fix, you need to pay 5,000 of that (did I explain that right? Correct me if I am wrong)."

You've oversimplified to the point that I'd argue you're wrong. You've left out coinsurance, out of network, and surprise billing considerations. But at least we no longer have to concern ourselves with lifetime caps. Thanks Obama.

Yeah that's all very true.

I read somewhere that only a very small amount of the population has more than 900 dollars lying around for emergencies.

So if you're hurt, your roof is broken, your water heater breaks, your home floods, and so on, you're screwed no matter what. 5,000 dollars might as well be 50,000 dollars.

The U.S. healthcare system is expensive, but things like cancer survival rates are among the best in the world. Like everything else in life, you get what you pay for...

lol But people are so opposed to "paying more"

Well, it's operating on an unregulated free market practice. You're correct in stating that the free market often devolves into these things. The free market is just as idealistic as communism in practice. Neither system works when left to its own measures. One ends up in crony capitalism and the other ends up in totalitarianism.

So punish labor then. Cut their salaries by 80%.

I don't think wages for the common worker in the industry is what drives the costs up. The demand for profits above a certain level perhaps...

We're referring to doctors as the labor. But I suppose you could extend that to all health care workers. I don't know the percentage of health care costs that come from doctors fees. I'm of the belief that its a smaller piece of the pie than drug and hospital fees, but many people believe doctors are overpaid in the US. So have the government step in and dictate who can make what can be a solution. Have them slash reimbursements to physicians but also eliminate the restrictions on the productions of doctors. Eliminate all the barriers. Currently, US medical schools have limited space and high academic restrictions. Open that up.

@sonicare: So you want to lower the restrictions and requirements to become a doctor, then have the government come in and limit their pay and reimbursements? That’s the stupidest thing I’ve heard in a while.

Good luck with Dr. Nick from the Simpsons treating your loved ones...

Source? The US in terms of healthcare quality is bang average compared to other nations. You definitely don’t “get what you pay for”. Sorry to burst your bubble but American exceptionalism doesn’t apply here.

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/

#37

It won't have to be by 80% to bring them in line, but yes, doctors will ultimately have to take a haircut either by reform or by market crash. Their wages are way out of line internationally, and rising along with other cost factors faster than inflation, growth, and wages. It can't continue.

Welcome to the industry protectionist camp. The AMA will love you.

I expect them to be in the 100-150K range in US. They are above that?

@horgen: General practitioners generally clock in around $200,000. Specialists generally around $350,000 to $450,000 depending on the specific specialization (although accurate specialist averages are hard to come by normal means - I'm relying on industry figures a family member of mine relayed to me a short while ago for those as he's currently in residency).

Damn. That's way above I expected. But they might have 150K in student debt?

They weren't always that high, but like I alluded to earlier since the 1990s they (along with just about all other health care costs) have been rising an average of ~6% per year. With inflation and wage rises less than 2% and growth less than 3%, they'll start eating away at the economy and incomes fast at that that rate. Hell, we're supposed to reach healthcare spending equal to 20% of total GDP soon.

I can't find that 6% number. Most of the sites I've checked have it anywhere from 1% to 3%. Certain specialties have seen some jumps, but others have seem some retractions. I still think that drug costs and hospital bills are the bigger driver's of the rising health care costs.

https://www.physicianspractice.com/salary/physician-salaries-which-specialties-have-highest-growth

@leicam6: Have you read the source or understand how those rankings work?

“Then the following weights were used to construct the overall composite measure: 25% for health (DALE), 25% for health inequality, 12.5% for the level of responsiveness, 12.5% for the distribution of responsiveness, and 25% for fairness in financing.”

You can pay attention to that bullshit list, but if you or you’re loved ones get sick, I highly advise against sending them to Oman or Saudi Arabia over the U.S.

Here is a ranking that matters.

“Based on this data, the highest survival rates were found in the following nations: United States Canada Australia New Zealand Finland Iceland Norway Sweden

http://worldpopulationreview.com/countries/cancer-survival-rates-by-country/

The US, Japan, and France have the highest cancer survival rates in the world. If your loved one has cancer, then I'd send them to the US. Now, if you're loved one doesn't have cancer, then the US may not be the best country for their overall health.

@leicam6: He's a lot of things, but he's no fascist. Fascists consolidate power within existing power structures like the government and armed forces. When the government banned vigilantism he burned a rapist to death and left the corpse on the doorstep of the local police station. Fascists promote false narratives to serve their own agendas. When Veidt fooled the world (murdering millions in the process) he stood up for the truth to the point of being murdered for it. I understand that he has a lot of problematic views and I don't make excuses for that, but he's no fascist. Ultimately I think I chose it because I was having arguments with people who were distorting the truth and fetishizing armed, right wing institutions, and he seemed the purest, scariest rebuke to that. Not only do I reject all the post-truth theatrics, but I do so in the most militant and uncompromising terms possible. I'm not locked in here with right wingers, they're locked in here with me.

@sonicare: The ranking used in this thread accounts for things outside of a health systems control. Interesting enough, the more government control over healthcare, the higher the ranking on that list. Things that aren’t accounted for are the level of technology or testing performed, availability of CT/MR/X-Ray/PET and nuclear med systems etc. What about the number of beds, nurse to patient ratios, emergency centers available per capita? That ranking over weighs economic availability and responsibility. 25% of the overall score is dependent on there being some sort of universal healthcare. What?!?!?!

France is #1. They also tax income 21% to pay for their healthcare, have 9% unemployment and a homeless problems that makes the U.S. look like paradise. But they scored well on that list!

@goldenelementxl: A lot of confirmation bias here to prove your point. In that link you cited there was another one that said best healthcare in the world and the US was nowhere on that list, lmao.

Have you ever been outside the US? Serious question. If you have, you’d understand it’s far from the best country to live in in the world. Healthcare may be the best for the top 1% but for the average person US healthcare is a joke.

@leicam6: I’ve been to Greece, Spain, Australia, Africa, Portugal, Germany and China for work. (Past and present).

To live, I prefer the U.S. and it’s not even close. Those who bitch about high taxes in the states have seen nothing until they go overseas.

I disagree that it's best for just the top 1%. The majority of people in the US have decent health insurance. Something like 92% of the population has coverage and its about 67% private and 33% government - or close to that. If less people had decent coverage or it was a joke, you'd see a bigger push to improve the system. Now that still leaves a decent chunk of the population with either no insurance or suboptimal -(hi copay/deductible, etc.), but good insurance is not just possessed by the wealthy 1%.

The US provides great acute care. If you have a heart attack, stroke, cancer, injury, etc., the care provided to you is generally among the best. For instance, in most of the articles I've seen, the US is listed as the best for cancer survival rates. (as an aside, the UK has surprisingly abysmal cancer survival rates) But, healthcare is more than just acute care. The flaw of the US system is that it's not as focused on primary care and preventative care. That type of care has a much more dramatic effect on measurable indices such as mortality and morbidity. So while improving the survivability of someone with stage 3 or 4 cancer is admirable, preventing or detecting it earlier is generally better and more cost effective.

I also believe it's very difficult to compare countries in terms of health care outcomes, because socioeconomic and cultural differences have as much if not more of an impact on outcomes than the quality of the health care system. Obesity rates, smoking, and alcohol consumption have significant roles in the health of a society, and as food for thought, I would strongly suspect that controlling those would have a far higher impact than providing universal access to modern medicine. The single biggest impact in life expectancy to date has been clean water and sewage, not modern medicine. It's not an argument against universal coverage, but rather, where the priority should be. The current US system is not ideal and is not working for many people. But I would also not say it's a joke.

it's the ultimate goal, but the process of installing it should come evolution and not revolution.

The country would accept by slowly expanding the eligibility of Medicare and medicaid, rather than just waving a wand and everyone is Single Payer.

Trust me Boomers LOVE their Medicare...

Medicaid for all. It would be more affordable.

@joebones5000: Except it would then tank the economy. The money has to come from somewhere. Democrats can’t just wave a magic wand and make shit free. I know that’s what they’re telling you, (that and the rich will pay for it) but that’s not how things will work out at all. Taxes will go through the roof. Unemployment will skyrocket. The cost of certain goods and services will shoot up. But the rich will remain rich, and the poor will still be poor. They’ll just have some healthcare to counterbalance their unemployment and homelessness. Yay?

I do think the democratic plans have been incredibly disingenuous about healthcare. They claim that they will cover everyone and yet save 100's of billions of dollars. Well, if you add more people to the rolls and offer the same services, that means higher costs in my book. So either that means they are going to cut a massive amount of services or severely cut reimbursements. This idea that single payer will pay for itself by eliminating "administrative costs" is incredibly optimistic and honestly naive and irresponsible. I remember the CBO said how much Obamacare was going to save. Healthcare costs increased, but then they revised the statement and said, costs went up but not as much as if we didn't have Obamacare. If we didn't have it, costs would be theoretically many times higher by their of course, nonpartisan, calculations.

If people want universal healthcare coverage, that means everyone is likely going to pay more in taxes. They have to. Sure, you can raise taxes more on the wealthy, but everyone will and should feel a bite from it. But what I've not seen in Sanders or Warren's plans is how they are going to finance it and how they plan to control costs. Simply saying you''re going to save 500 billions dollars because you will save 500 billion dollars is not a plan. Show me the math and where that 500 billion comes from.

So, so, so much wrong here, where to begin? Okay, first, healthcare is a complex, multi-layered industry with dozens of sectors providing different services and products. It's not like cutting payments to the fast food industry causing declines in the availability of hamburgers (although even there you have several different products going into the final product, not to mention distribution networks, etc.) In one hospital alone you could have billing, finance, ethics and oversight, shipping and receiving, hospitality services, R+D, delivery and transportation, emergency response, and this is all before we even begin talking about doctors and nurses. To say that we could find savings in a system that complex is not to say that we would automatically reduce our level of care or possibly even affect it at all, the industry is just that massive.

In fact, most savings in single-payer systems come from a reduction in bureaucracy. That's because, instead of a hodgepodge of individual providers attempting to bring themselves in compliance with a hodgepodge of insurance networks and employing a significant bureaucratic staff to do so, single payer creates one set of rules and payment systems that eliminates a whole host of inefficiency in healthcare. Furthermore, given that it's the only payer in the market, it has the power to negotiate better prices on everything from prescription drugs to actual care. Medicare is so popular in part because it negotiates better prices with hospitals than private insurance. Beyond that, single payer tends to crack down on a lot of the frivolous use of medical benefits that happens when you have people with high-tier medical coverage. If your insurance is going to pay for tests your doctor doesn't think you need why not do it just to be safe? Problem is, only the people at the very top of the system have access to that. Single payer tends to ration coverage in a way that gets everyone the care they need and doesn't allow wealthier individuals access to care they don't need.

Not to mention one of the biggest causes of waste in the industry, bloated executive pay. Under single payer systems you don't have insurance executives making exorbitant salaries while attempting to cut payouts to actual care providers in order to boost stock prices. Cuts are based on what is needed and what is not, rather than cutting everything possible just being seen as inherently good because of its ability to inflate bottom lines. Put all this together and you have a massive potential for savings in the healthcare industry, as demonstrated time and again by countries that went to single payer. Some care might be reduced, but it is only at the top end of the system. For people with bare-bones insurance, gaps in coverage, or no insurance at all they get access to essential services that seemed previously out of reach. If that means we have to end the unlimited access that current gold-tier plans allow that seems a small price to pay.

And it might be the case that all this won't add up to a zero sum cost, but so what? The military, the Wall Street bailouts, yearly crop subsidies and insurance, and a whole host of other programs aren't fully funded, yet we continue to invest in them each year because we find it necessary to the smooth functioning of our country. In fact, about the only government programs that are fully funded are social security and medicare. Regardless, it will put money into the pockets of everyday Americans who are struggling with costs, not to mention improve their quality of life and longevity in the workforce. And it will reduce lifetime costs by reducing the occurrence of chronic disease and complications later in life. When people go for extended periods of time without health coverage they become a larger burden on the healthcare system in their later years. And really, costs aside, isn't making their lives comfortable and dignified the right thing to do? Economic zealots want you to believe that if people suffer from chronic conditions or lack of good care we should just leave them to suffer, that it was some character defect or poor choice that led to their suffering. Every other advanced society has seen the inherent wrongness of this mindset, why can't we?

@theone86: So you point out bloat and excessive spending in healthcare... You know the federal government is full of all sorts of waste of resources and mismanagement at every level, right? If we were to make federal spending more efficient, maybe tax dollars would go much further. Instead, you want to increase tax revenue while cutting spending by the private sector which is far more efficient than the federal government has ever been.

You mention putting money into the pockets of everyday Americans. That doesn’t happen when you give the federal government more money and more control. The private sector answers to the stock market and investors, etc. The federal government doesn’t care if it wins or loses. I 100% guarantee you that the government will waste more with universal healthcare than any other company could dream of. Look at the things the government currently runs. All of it would be bankrupt and out of business if it were held accountable in any way. The private sector runs based on the free market. Could it be better? Absolutely. But a government takeover is the exact opposite of a solution. You will pay more, in tax dollars, unemployment, homelessness, cuts in safety net programs etc. France, the “#1 healthcare system” is the perfect example of this. 21% income tax rates to pay for healthcare, 9%+ unemployment, homeless numbers worse than the U.S., a poor GDP etc. It doesn’t work. Especially when you let dumbass politicians control the money.

A lot of what you say here is good, reasoned, discourse but I feel like it's a red herring to the topic. The fact is that the US is the richest nation the world has ever seen yet it still doesn't guarantee something as basic as healthcare to all its citizens. That to me is a joke, plain and simple.

Even a dirt poor country like Cuba, which also ranks higher than the US in areas like infant mortality, is able to guarantee healthcare to all citizens.

ALL of the other OECD nations have some form of universal healthcare while also being able to cut the price of healthcare with some providing better care than you can get in the US. Like for example you mention France, that country's problems are totally unrelated to the fact that the they have universal healthcare lol. How did you manage to reach the conclusion that these two things are linked? You are just repeating talking points and propaganda that have no basis in reality.

The fact that you think a free market solution with investors and stock markets taking their cut is quite frankly, absurd. The US’s healthcare right now is in disarray precisely because of these free market forces distorting something (healthcare) that doesn’t operate at all like other markets. It’s as brain dead as suggesting the answer to gun control is to give more guns to people. Like I said earlier, you can't "shop around" for a new pair of lungs or a kidney like you would for the latest video game console since people's lives literally depend on it.

Also, the comparison with a business doesn't even make sense lol. Are you aware that a business and government entity have wildly different purposes and goals, right? The goal of a business is profit and to enrich its shareholders and investors. A government's role in very short terms, is to promote the general welfare of its citizens. You can't in good faith compare a government and business because other than being groups of people in charge of something, they have nothing in common. The US right now has a self-proclaimed successful businessman... how is that going for you?

“Government takeover” rhetoric is just a plain misunderstanding of how universal healthcare works. I live in Canada and the government hasn’t “taken over” healthcare, what it has done rather is give everyone a basic provincial health insurance to cover us, while also regulating the market in terms of what providers can charge you. That's it. Private insurance is still available if someone wants it, only now the private companies have to compete with the government in the market.

@leicam6: “Like for example you mention France, that country's problems are totally unrelated to the fact that the they have universal healthcare lol.“

France pays for their healthcare by attaching a 21% tax on income. To lessen that asinine burden, employers pick up over 1/2 of that tax bill. That is 100% related to Frances unemployment numbers.