Where is the money in US healthcare going to?

Back to the original post (1 mod warning already!)

I saw a stat - before the 08 crash so things may have changed, think it was 05-06-07 ish.

US Federal Healthcare spend per head - about half the total was almost as much as (as within a few % points) as Total healthcare spending per head in the UK.

Surely this means that a basic NHS style health service should be available to all US citzens, with the insurance going above and beyond.

Couple of weeks ago my dad had a heart attack on Holiday in Wales. He's 77 - ripe for the 'Death Panels' the US right keep going on about. The first responder and ambulance were at the campsite within 7 minutes from the nearest town. The air ambulance landed in the next field, and took him to Swansea hospital, where he spent a 5 days. No cost- its paid for by taxation.

If you want to know where the $$$$ go, read the articles on h/c charges by hospitals- PZ Myers did a good one. $10 for an over the counter pain killer. Now this happens in the UK, but always causes a stink: Though the Tories are on the 'Private Good' kick again, the opening ceremony had that celebration. That wasn't for the International community. That was Danny Boyle standing up for the public, a giant Middle finger to Cameron.

Edit

US Stats
http://www.nationmaster.com/country/us-united-states/hea-health

UK Stats
http://www.nationmaster.com/country/uk-united-kingdom/hea-health

edited 23rd Jun '13 1:46:36 PM by LastHussar

This might be just a Euro socialist talking, but after reading this thread, it looks like most of the problems in the US healthcare stem from either price gouging or inefficiency designed for the sake of being able to make more money of healthcare.

Whichever it is, I'm glad to be born in euro commie land.

Single payer "the government/taxes" pay for everything will never work here. Our population is too large and the healthcare system is just too big. If you took our healthcare system out of the US it could be the 6th or 7th largest economy in the world.

Yeah, hospitals can gouge, that's why people shop around. My sister had a 'script filled at a Wallgreens. Some Wal-Mart's even have physician assistants. Many docs have opted out of taking insurance altogether and have seen costs go down.

We don't have an army of government health care execs or government docs. If we tried a UK approach, the government would simply hand it over to the insurance companies. The logos would change and that's about it.

Why does population size matter? Just have it done at a state level, no individual state has a bigger population than say, the UK.

The problem is the states that will do anything to prevent public healthcare.

Well it can still be mandated from above, you just let the management be done at a state level.

Why do you assume that the government (state or federal) can run healthcare?

They'd simply turn it over to the insurance industry and the HMO's because there is no one at any government level that can run it.

Not at the state level, which is why many states subcontract to HMO's. And not at the federal level. I know, I did healthcare billing.

There is no easy fix. I know it's tempting to paint insurance/big pharama/hospitals as the boogyman. Honesty to blog guys, asking our government to run healthcare would be a disaster. There ain't no such thing as a free lunch. Not in the UK and in the US the ACA isn't all that and a bag of chips either.

edited 23rd Jun '13 4:29:22 PM by TairaMai

The NHS manages to be a darn sight cheaper bag of chips than you guys have got, though (even though successive governments have done their best to shoot it). <shrugs>

You can't deny this: we get a lot more bang for our pounds than you manage to get for your dollars when it comes to health care. And, a much wider degree of coverage across the population demographic.

edited 23rd Jun '13 4:33:51 PM by Euodiachloris

Why do you assume that for profit companies can? The government might not be very good at running healthcare, but if you look across the western world you will see that 9 times out of 10 it's a dam sight better than the private section.

Why do I assume government can run healthcare? Because governments across the world manage to run more efficient and more fair healthcare than anything the private sector has to offer.

Privatized healthcare feels a lot like privatized fire fighters: you give people an incentive to set fires. Whoever is in charge of the US healthcare, they make more money if they do a crappy job, so that people make more hospital visits.*

I really don't care how good or bad the government would do (though they'd probably do just fine, since running shit on a large scale is kind of their job), at least they have a reason to do it well.

edited 23rd Jun '13 6:37:36 PM by Kayeka

No such thing as a free lunch. Definitely such thing as a cheaper one. NHS, for all its issues, does a hilariously better job than anything we've got on the table.

I don't trust single payer at all. I used to do medical billing. The system is ripe for reform but not takeover. Given that "The One" opted for working with the insurance industry I doubt we'll ever see single payer (really socialized medicine) in the US. Governments right now are facing budget shortfalls in Medicaid and Medicare. There are no Subject Matter Experts in government at any level to make an NHS style system work in the US. We'd just turn the keys over to the various HMO's.

Look up TRICARE to see what a US single payer system would be like.

edited 24th Jun '13 7:04:25 AM by TairaMai

I see no reason to think that the US government/civil service are fundamentally less competent that those of the rest of the wealthy world. When the NHS was set up, the UK government also had very few medical experts in goverment, but we managed.

You could hypothetically just poach some people from the soon-to-be-defunct medical insurance industry.

I can sort of see the argument that our government has such entrenched interests in private insurance that any state model they make will basically be contracting to them instead of removing them. That is the problem with Tricare.

The point remains, almost every country that has implemented universal health care has observably better care and lower costs than we do, the reason is that insurers and hospitals alike have incentive to make money rather than do their damn jobs, and it's gonna stay that way until we take away that incentive by fixing their pay from tax money.

edited 24th Jun '13 10:15:22 AM by Pykrete

Taira, you seem to be against single payer just to be against it. "Too big" is just an excuse to not try, and it's one I'm tired of seeing people iterate.

Anyway, we have veteran's care, which is essentially socialized healthcare for veterans. And despite jackasses deliberately trying to mess it up it's done fairly well.

And for the "army of people" required to run such a program. Well, there's this little thing called a depression going on right now, with lots of people looking to be hired for stuff. I'm sure we could work something out with all those folks, you know.

One thing I'm kind of curious about regarding the cost breakdown posted earlier in the thread, is where exactly things like lab equipment, EMR software, etc. fits in.

(Speaking as a person who works for an EMR software company)

It's a silly excuse. The "too big" is not an argument. You have no evidence to support the claim. Countries of every size all the way up to 80 million in people have medical healthcare at half the per capita cost of the US system. All you can point out are cases of anecdotal corruption in the public healthcare system yet the private healthcare system shows off far more cases of the same corruption.

Additionally, Canada can run it, then USA can. There's no excuse about size or population density. Canada is basically 13 extra states. So if Canada can, United States can.

The lack of medical experts in government doesn't matter. Canada didn't start off universal healthcare with doctors flooding the government. We had nothing. It was just some idealist dreamer socialist politician in a prairie province who thought it wasn't right for people to suffer if they were poor, instituted it and then saved so many billions of dollars per year, all other provinces adopted it to cut costs.

I laid out point by point, the added inefficiencies and costs of the US healthcare system. You can either fix those point by point or you can continue throwing anecdotal news stories and vague philosophical statements about healthcare.

Canada has the moneygrubbing corporations and a government with no idea how to properly spend money and an incredibly apathetic populace. If we can handle universal healthcare, I'm pretty sure the States can too.

Yes, there you go. :)

The reason "too big" isn't an acceptable argument is because healthcare, like most other government programs, works on proportional size rather than absolute size. If your population increases by another million, and it's not a mass influx of the elderly or anything, it pretty much just scales all input-output accordingly — if you were breaking even before, you will afterward.

If you get into a problem like Japan has where those demographic proportions are fucked up, that's one thing, and it'll be a disaster at any scale. But for a country with a relatively good spread like we have, it doesn't really matter how big the scale is as long as the cross-sections along the way line up.

edited 25th Jun '13 9:58:30 PM by Pykrete

I would say that "too big" is a valid point if it were applicable. However, Canada has a provincial level system of healthcare. If the US adopted what Canada does then you have a state-level system, and individual states are generally smaller than European countries. This then completely blows away the "too big" argument. There are already over two dozen examples of American-scale healthcare programs already running and have been for many years. US can study what worked in those programs and adopt those policies in America.

Bill Whittle says it better than I can.

Oh, please, don't bring that kind of Slippery Slope Fallacy crap in here. The guy is a good talker, but what he says is rubbish.

If you have the money for over seas wars you have the money for public healthcare.