US health care the worst while spending the most

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uncgriff

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Explain again why our system is so good again?

Costs born by corporations that make them less efficient. Why is health care a 'benefit'

Huge amount of money made by people who never see a patient or add any real value other than being middle management or suppliers.

CEOs of hospital systems with massive salaries

Incredible duolication of services with subsequent marketing wars to fill up the scanners/hospitals/centers of excellence

All for shitty outcomes.

But mention single payer and prepare for incoming fire.

Retirees count the days until they can start on Medicare but somehow we need to keep government out of our healthcare.
 
When the researchers analyzed each country by each key domain, the United States ranked last on access to care, indicating that Americans face the most barriers to accessing and affording health care. The nation also ranked last in health outcomes, including acute illnesses, chronic diseases and death.
 
Our system is good because it works for those with money. You know, the political donor class.

Unfortunately, we can’t afford universal care. The country is pathetically out of shape and we eat garbage. Even something that should be relatively okay, say a peanut butter sandwich, is loaded with crappy flour, preservatives, sugar etc unless you’re forking out for high end bakery bread and natural peanut butter that only has peanuts as an ingredient.

If we were in better shape, our costs would be lower and outcomes would be better.
 
Our system is good because it works for those with money. You know, the political donor class.

Unfortunately, we can’t afford universal care. The country is pathetically out of shape and we eat garbage. Even something that should be relatively okay, say a peanut butter sandwich, is loaded with crappy flour, preservatives, sugar etc unless you’re forking out for high end bakery bread and natural peanut butter that only has peanuts as an ingredient.

If we were in better shape, our costs would be lower and outcomes would be better.
Speaking for my 70 year old self I can say those negative health care trends I have are my own doing. I can also say I know a lot of people in a couple of States that live in Health Care "deserts" and or just can't afford good Health care
I knew a gentleman that died a few years ago who got almost zero Health care in retirement. He turned down Medicare because he knew it owuld impact his lifeline Soc Sec $ ...Now he could have gotten Medicaid/Medicare-but that was too complicated........
 
Our system is good because it works for those with money. You know, the political donor class.

Unfortunately, we can’t afford universal care. The country is pathetically out of shape and we eat garbage. Even something that should be relatively okay, say a peanut butter sandwich, is loaded with crappy flour, preservatives, sugar etc unless you’re forking out for high end bakery bread and natural peanut butter that only has peanuts as an ingredient.

If we were in better shape, our costs would be lower and outcomes would be better.
Universal healthcare has been shown to be cheaper than our current system.
 
People vote continuously to keep it
Polling shows that an overwhelming majority of Americans, including Republicans, would prefer a universal system. It’s the lobbying/money by the industry that is the barrier to universal healthcare.
 
Our system is good because it works for those with money. You know, the political donor class.

Unfortunately, we can’t afford universal care. The country is pathetically out of shape and we eat garbage. Even something that should be relatively okay, say a peanut butter sandwich, is loaded with crappy flour, preservatives, sugar etc unless you’re forking out for high end bakery bread and natural peanut butter that only has peanuts as an ingredient.

If we were in better shape, our costs would be lower and outcomes would be better.
We can’t? You must certainly be joking.

What’s wrong with preservatives?
 
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Polling shows that an overwhelming majority of Americans, including Republicans, would prefer a universal system. It’s the lobbying/money by the industry that is the barrier to universal healthcare.
Then why aren’t Americans voting for it?
 
Then why aren’t Americans voting for it?
Did I miss a time when we had some sort of national referendum on universal healthcare?

What do you suggest Americans do when they are faced with two parties that both benefit from our current for-profit health system?
 
Our system is good because it works for those with money. You know, the political donor class.

Unfortunately, we can’t afford universal care. The country is pathetically out of shape and we eat garbage. Even something that should be relatively okay, say a peanut butter sandwich, is loaded with crappy flour, preservatives, sugar etc unless you’re forking out for high end bakery bread and natural peanut butter that only has peanuts as an ingredient.

If we were in better shape, our costs would be lower and outcomes would be better.
Single payer would actually be less expensive than our current system.

 

Explain again why our system is so good again?

Costs born by corporations that make them less efficient. Why is health care a 'benefit'?
It is my understanding that during WWII the lack of available manpower made recruiting, especially white collar positions, a necessity. Thus corps started offering more benefits including healthcare which got baked into the system over time.
 
Did I miss a time when we had some sort of national referendum on universal healthcare?

What do you suggest Americans do when they are faced with two parties that both benefit from our current for-profit health system?
Oh. You must have been sleeping during the Obamacare deliberations. I understand. Republicans want a public option…that’s funny stuff right there.

When you say for profit, do you mean payers or providers?
 
Universal healthcare has been shown to be cheaper than our current system.
Define cheaper. If you mean cheaper per person or something like that, yes. If you mean that we would spend less on healthcare if we went to a universal health care system -- well, link please. Note that one of the arguments about American health care is that doctors make too much money. Fine. We'll get to that in a bit. But when people bake an assumption about doctors' salaries into the model, it's not sound methodology. You can't say, "if we had universal healthcare, we'd spend less overall because doctors would make less money in my system." That's changing a parameter.

There are two major problems with the idea that "doctors make too much money and we could reduce health care costs by reducing doctors' pay":

1. Education in the US is so expensive for would-be doctors. I dated an Austrian woman for a while, who was 25 or 26 and already had her MD, and had been doing research in the states for a year or so when I met her. So, was she some sort of genius? Not really. It's just that you can study medicine as an undergrad in Austria. I don't know if that's true everywhere in Europe, but it is in some other countries as well. And in most places, undergrad is subsidized to a cost not unlike UNC in the 1980s or 1990s.

So she had zero debt coming out of med school. Again, not because she was super-brilliant or had earned scholarships or anything of the sort. She just lived in a system that made her education inexpensive.

Compare to physicians in the U.S., who have to complete a four year degree to the tune of 100K+ or more, and then pay $200K for medical school. My wife is a psychiatrist and she was still paying off her med school loans after age 50. In fact, she never finished paying them off; she benefited from Biden's first loan forgiveness program (which was styled as a "fix" to an error in the income based repayment program but was really a forgiveness). She would not have been able to make ends meet with a $150K salary, and she's not a big spender.

If we want doctors' salaries to go down, then we have to fix the education costs. Ain't nobody going to pay for an undergrad degree, then a med school degree, then do a residency, only for the opportunity to make $120K after all that. We really should consider whether an undergrad degree is necessary, or if universities can offer hybrid programs that do undergrad and medical at the same time. A 6 year plan, instead of 8. This is definitely true for law school, which does not need undergrad in any way and is probably too long in its own right. Law could easily be a 5 year undergrad major.

2. There's also the Baumol effect. I've mentioned it elsewhere, but I'll recap. Jobs requiring roughly equal skill will end up with roughly equal compensation. It doesn't have to be the same, but roughly equal. Otherwise, nobody goes into the lower compensation field, and then there are shortages, and that causes prices in that field to rise. I've seen it with psychiatry. My wife's compensation has gone way up in the last 6 or 6 years, because for years and years psychiatrists were paid much less than other physicians. They were paid especially less well than dermatologists and cosmetic surgeons, which has always bugged the hell out of me. Well, anyway, med school grads weren't going into psychiatry, so there are shortages everywhere, and now psychiatrists make more. Not because their productivity has increased, but because competitor fields have.

This is true within the medical field, and just as true (or perhaps more) when comparing with other professions. Even with today's salaries, a lot of doctors feel as though they are underpaid, which is why they leave the profession and go into business. Private equity has been investing heavily in medicine, and there are always doctors as CEOs or top execs in these firms. Doctors can make more money going into pharma, or as professional expert witnesses, etc.

And while there's not a lot of doctors who take up law, that is absolutely a choice that many people make when they are young. If you want to be wealthy or even borderline wealthy, law is a much better choice than medicine. It's not even close. Keep in mind that med school admission is more selective than law school admissions for a number of reasons. So we can't compare the salaries of lawyers from Tier 4 schools to doctor salaries. Anyone who can get into med school would be able to get into a Tier 2 law school at a minimum, and probably Tier 1. And in that cohort, law definitely pays really well.

So, ironically, it's hard to lower doctor salaries if we don't lower lawyer salaries. If we wanted to reduce health care costs, one way to do it would be to eliminate income taxes for doctors, while decreasing reimbursements that they receive. Basically, pay them $150K a year instead of $300K a year, but the $150K is tax-free and so that helps equalize.

3. Unless we fix our doctor compensation issues, we aren't going to make a huge dent in our medical costs. There are plenty of other costs in the system, but doctor compensation is a huge reason why health care is more expensive than in Europe.

When I was much younger, I used to disregard this effect. Oh no, I would think, a doctor has to make do with a $200K salary instead of $300K -- how will they ever survive? That's true on an individual level for sure. My family would have been just fine if my father the surgeon had make 75% of what he actually made. But as a public policy matter, asking doctors to just eat lower pay is a bad solution. It won't work.
 
It is fascinating screwed up system we have..Now I live in the triangular area and have Medicare and have no "issues" Before that I had State Employee coverage-which until about 15 yeras ago was really good
The "market " tries For example Urgent Care outfits helped clear up ERS a bit-at one tenth the price. The expanded use of PAs, Nurse Practioners etc (they have a new name today) is great for 90% of all visits-with a cheaper cost theoretically. Whatever "RX" is -seems very legit and cost oriented for prescriptions
But then you have the wild stuff. Big Pharma blows billions on Ads and Lobbying We know who pays for that
Facilities-Good gravy If you have a major Pediatrics Care outfit-it has to have a 30 foot ceiling Lobby Every little poor Rural county seat builds a 100 million dollar addition to their Hospital every couple years It is wild how money gets spent
And then of course if you live in Charleston Wva versus Durham N.C-your health care sucks-and the salaries are not that different Charleston needs to pay specialists a lot of money to live in that hell hole-and trust me they don't get the cream of the crop
 
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Did I miss a time when we had some sort of national referendum on universal healthcare?

What do you suggest Americans do when they are faced with two parties that both benefit from our current for-profit health system?
The 2008 election was pretty close to that referendum. So was 92, though a bit less so. You weren't around for 92, IIRC. Health care was a huge issue in that campaign. We all remember, "it's the economy, stupid" but that's not actually how the campaign did its messaging. I was essentially part of the campaign that year, and we spent a lot of time talking about universal care. Certainly, when Bill won, it was interpreted as a mandate to do something.

So one of the first things Bill did was to appoint Hillary to lead a task force to design a system of "managed competition" (which was to be largely non-profit) . . . and it died. IIRC Ira Magaziner was officially the head of the commission but HRC had an outsized role. Anyway, that committee spent a year trying to get the insurance industry on board, but in the end, the insurance industry didn't want any of it. So they started running ads in 94 against Hillarycare. The ads were pathetic -- they had a husband/wife sitting at the kitchen table fretting about bills, and then saying, "we just can't afford for our insurance to get even more expensive" or something like that. But they worked. And Hillarycare went down in flames; the GOP swept the 94 elections in part by running against it, and the issue had become such a loser that it was shelved for a decade.

It's really easy for young people to blame "both parties" for being sell-outs, but that's just not what happened. The Dems tried HARD from 92-94 to take on the health insurance industry, and failed, and then lost elections. Ultimately, the voters were easily fooled. Sound familiar? Note that a big sticking point in the negotiations was also . . . . yep, doctor compensation. The doctors felt as though they were being asked to take the biggest financial hit; and when the Magaziner committee tried to address that, the insurance companies were like, "well, we're not going to take the hit either" and it unraveled.

Most of the proposals from the left on universal care -- at least the ones that I have seen -- fail to grapple with the physician compensation issue. They just assume that doctors will accept Medicare reimbursement levels for all of their patients, and also they tend to model declining Medicare reimbursements. That is just bad policy. It's unrealistic, and if it were to pass, it would create massive dislocations. We can't fix our system without fixing doctor training.
 
But then you have the wild stuff. Big Pharma blows billions on Ads and Lobbying We know who pays for that
Advertising costs are usually not passed on to the consumer. Maybe in the very long-term. Mostly advertising exists to drive demand. Firms advertise because it is profitable for them to do so. They aren't in the ad business, so the costs of advertising aren't marginal and thus don't really affect prices. Think of them like sales commissions. They add cost to the seller, but aren't passed on. If advertising budgets were slashed by 90%, it would have next to no impact on prices.
 
It is interesting how insurance coverage/costs changes depending on where you live. Friend retired to his place on the water in Pamlico county from Raleigh. Blue Cross said uh-uh we don't offer your current policy there. You have a choice between these two shittier options (not their words).
 
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