I find the status quo rather difficult to bear. My wife and I purchase health insurance for our family, with no employer support, and it is very costly.
No kidding. We have the full range of choices between pretty expensive and incredibly expensive. At the low end, still pretty expensive, we get to choose between high premium/low deductible, or low premium/high deductible. We’re stung either way.
The bottom line is not our coverage, but it is the cost.
You go to other nations around the world. See how much less they pay for x-rays, ultra-sounds, and other type of scans.
Hospital stays in other countries cost about the same as a night in an average hotel or motel in this country.
Factor in the cost we overpay here for meds. We may too much for procedures and medications.
My biggest problem with our health care system are these:
A bogus pricing structure. Look into it; you’ll see. It makes pricing used cars seem like a dream world. It is all “funny money” pricing, except that it is devastating if you fall into the wrong pricing rabbit hole in which you are expected to actual pay that ridiculous bill or else go into bankruptcy. We can do better than that.
We aren’t so draconian that we’re willing to let anybody go without basic health care, but we have not let ourselves pay for it in a uniform way. The minimal healthcare that society is not willing to allow anyone go without ought to be paid for with a sliding scale co-pay. Private insurance ought to be for those who want more than that minimum. Our current system, which is to assume that some people won’t be able to pay their bills and raising the prices on everyone else to compensate, not to mention the price breaks for “group buyers,” is ridiculous. No one would have ever invented our system. It is not only unfair but also arbitrary. Even the people in the business can’t explain it.
Far too many tests and far too much money goes into avoiding litigation. We need to get a grip on how to handle malpractice by healthcare providers and unethical business practices by companies that sell medical supplies and pharmaceuticals.
Healthcare for people living in areas with low populations. There are entire counties with no OB/GYN doctors because the price of litigation insurance doesn’t cover the income that could be hoped for. We gave everybody in this country electricity; we could give everybody access to healthcare.
Far too much provider time is spent learning how to code medical charts so that insurance companies will pay for care given. This is also ridiculous. I understand that it cannot be helped that a medical chart is a legal document with all the perils of a legal document, but it has gotten out of hand.
Unless you can show that it’s fundamentally flawed or somehow manipulated, research isn’t propaganda. The way they crunched numbers for this study seems pretty airtight.
Honestly, I’m open to a creative-problem-solving approach to this problem. Medicare-for-All may be one solution. Others have proposed that private insurance no longer be employer-based and instead go out on an open, more competitive market. I’ll frankly take either option over what we have now.
I see them as inter-related. With rising health care costs - and little to no accountability for them - insurance companies are charging higher premiums for ridiculously high-deductible plans and less willing to cover these high-cost services.
I agree with pretty much all of your post but wanted to single out this point.
One thing we’re learning in this mess is how, for lower risk patients at least, many other providers can more affordably replace doctors. For a fraction of the out-of-pocket cost for a hospital, I had my prenatal, delivery, and post-natal care from a team of Certified Nurse Midwives and Certified Professional Midwives. My babies were born at a free-standing birthing center just a stone’s throw away from a hospital, where emergency care was available if necessary.
Meanwhile, for primary health care, my family sees a Family Nurse Practitioner, who has her own private practice.
Many of such providers are making themselves more available in rural areas.
I once read that up to 1/3 of health care costs go toward dickering with insurance companies. The bureaucracy-at-large is out of control.
but when you bring in payments we are compelled to pay
The OECD may not be able to include employer-based health insurance premiums into its model, but I certainly can.
the disagreement is on what we are compelled to pay (we now aren’t) and who is covered (only 49%)
According to recent data from the Kaiser Family Foundation (KFF), about 156,199,800 Americans, or around 49 percent of the country’s total population, receive employer - sponsored health insurance (also called group health insurance )
This kind of study is sometimes useful to put things in perspective, but we can never forget at the end of the day that we are comparing apples and oranges and that we need to take that into account when reviewing the final results.
Medical malpractice insurance premiums, which is the bulk of the cost the medical industries bears, is a fraction of 1% of what we spend on healthcare. Even allowing that some tests and procedures are done to cover themselves (though this may be offset by tests and procedures they should do that they don’t because insurance won’t pay) it’s not as big a % as people think.
THIS however is an excellent point and one of the biggest savings a single-payer system provides. Hospitals have teams of people sometimes who specialize in knowing how to place claims with each insurer to maximize the chance of being paid in full. It’s also why many hospitals are now part of networks, because you can consolidate that team and benefit from scale.
An intermediate step would be for insurers to voluntarily standardize their forms and procedures, but they don’t seem inclined to unless forced.
If the Senate and House pass a tax bill that includes the mandate repeal, those who do not purchase health insurance will no longer have to pay the penalty, and an estimated $338 billion would be saved to pay for tax cuts. The savings would come from fewer people claiming federal insurance subsidies or Medicaid benefits.
Yes because that $338b (which appears to be over 10 years) isn’t magically used to pay for those people who don’t buy insurance when there’s a medical emergency. As noted in the Times article there were also massive tax cuts around the same time so the money is already gone, disproportionately to the already wealthy who almost certainly have insurance anyways.
US medicine is the most expensive in the world. Public health provision is cheaper. Therefore if your insurance were replaced by tax, AND public provision you would be better off.
There is an argument that medical advances are driven in part by the huge profits to be made in the US. Even if this is so, these advances are disproportionately skewed towards what rich people want, rather than what poor people need, and towards the prolongation of life by very short terms when compared with interventions using cheap available technology aimed at mothers and children.
I always find it interesting when US people talk about medicine that they see their own systems as completely normative and the other 198 systems as somehow heretical.
Like defence, health is too important to be left to private enterprise.
If we were all healthy, physically-fit, non-addicted (I’m talking sugar, salt, and food, not opoids–I honestly think that sugar, salt, and food kill more of us than drugs and alcohol, although drugs and alcohol certainly take a toll), then our health care costs would be minimal, and our dying would be natural and at-home.
But…many of us end up with illnesses that we probably (??) could have avoided–heart disease, stroke, Type II Diabetes, various painful disabilities related to weight and lack of fitness (e.g. chronic back pain), etc.
But there is no rhyme or reason–there are plenty of people who practice a healthy lifestyle and appear much younger than their years, but they still end up with cancer–my dad was one of these. At least his cancer fight was short–only four months. And he spent much of that time at his beloved VA hospital in Madison, which, as far as we were concerned, provided excellent care (unlike some of the VA hospitals in the U.S.).
And some of this is because of genes–we’re all dealt a '“hand” of genes, and the bad ones can and do end up with the “good” people who never did anything to deserve deaths from lung cancer, stroke, ALS, dementia diseases, etc.
And then there is the horrible possibility of dying or becoming disabled in a car accident caused by either someone driving impaired (alcohol, drugs, meds, etc). or driving sleepy. At least half of all auto accidents have alcohol as a factor. So sad.
However, I do think that if we all took better care of ourselves from our childhood through our senior years, we would all be healthier. That includes maintaining a decent weight, eating a fairly-healthy and moderate-calorie diet, not smoking, not drinking to excess, avoiding all addictions (including sugar), getting plenty of sleep (a practice that is becoming better understood as one the best ways we can immunize ourselves against pathologies), getting our vaccinations on schedule, having regular physical exams that include the various screens like mammogram, prostate exam, basic lab tests (including urinalysis), mental and emotional health screens, sleep studies to rule out sleep apnea, keeping our dental work up-to-date (dental problem contribute to other health problems), and getting our hearing and vision checked and getting new glasses, hearing aids, etc.
And of course, staying as active as we can and staying involved with real life (not TV and other stay-home media) in the real world as much as we can.
I have worked in my hospital lab in microbiology for almost 30 years.
It’s staggering how much one lab test costs. For example, a sputum culture costs approximately 271.00 plus another 111.00 for the gram stain that is so important to interpreting the culture. It takes us about 5 minutes to set up the culture and read it 24-48 hours later. Of course, if there are pathogens growing, it will take a little longer, and if anything has to be sent out, it will take several days to get results back (which means time).
And many sputum specimens that we receive are nothing but saliva. We are supposed to reject these inadequate specimens and credit the patient, but I’ll admit that when we are short-staffed and swamped with work and already on overtime, techs tends to just set the sputum up and report the results without canceling the test and crediting the patient. Don’t criticize us until you have worked in an under-staffed lab.
Don’t even think about the cost of a wound culture. Many of the patients who have surgery end up with several cultures that cost over $500.00 apiece. I remember a few weeks ago, we had a patient who had 32 cultures on a leg wound (ended up amputating the leg), and each culture cost around $1000.00 by the time we factored in the send-outs (for rare bacteria)—and all of this doesn’t include the cost of the infectious disease doctor who was called in on consult, and the extremely-expensive antibiotics that we needed to treat the infection–and he still lost his leg.
I believe the leg injury was caused by a fall at work, so at least the patient will be able to sue his company and receive a huge settlement that should pay all his bills and provide him with an income for the rest of his life–he was in his 50s, so plenty of life left (hopefully).
I wonder what Senator Elizabeth Warren’s answer is to something like this?!! Free care for all? She’s so ignorant.
We’ve looked into open-market insurance and are better off with employer-sponsored. And saying “better” is like, to paraphrase a famous comedian, pointing out the skinniest kid at fat camp. All of our options frankly stink.
If open-market insurance were the Answer, believe me, all of us would have it. And I doubt the author’s outcomes would have been more compelling had this data been included. But the current data indeed stands because:
NTCPs are no different from taxes except that NTCPs are made to private corporations like health insurance companies rather than to the government.
Employer-based insurance is a bit of sham, and sort of arose by accident in the 1940s, because placing that burden on employers stifles entrepreneurial growth among small businesses.
We can still opt out of car payments and mortgage. Health care is basic survival. At one point or another, we all need it.
It’s easy to bash on single-payer coverage with the usual talking points, but that’s not the only conclusion to draw from this study.
Europeans smoke more and eat plenty of sausage and cheese and manage to keep their costs down. Our costs are high because they can be. Health is the one commodity that doesn’t play well by the rules of the free market.
Actually, a single-payer system does keep costs down substantially because there’s more accountability. If we’re not picking up the tab for what the system won’t cover, health care entities will be forced to lower their prices.