There's an additional wealth transfer between the owners of healthcare related stocks and non owners. If the US approached EU type health care costs we could easily give every one health care for free. The cost would come out of healthcare company margins.
Totally false. Total health industry publicly traded company profits (including drug companies, hospitals, and insurance companies) add up to about $50 billion per quarter, or $200 billion per year worldwide: https://www.thefiscaltimes.com/2018/11/12/Chart-Day-Big-Phar....
Total domestic hospital profits (including more than just public companies) is about $74 billion per year: https://www.modernhealthcare.com/article/20180104/NEWS/18010.... Insurance companies are $25 billion annualized: https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... ($7 billion per quarter for health insurers). The link above shows $100 billion in drug company profits worldwide; about half of revenues are in the US, so let’s say $100 billion in profits domestically. That’s $200 billion for the US healthcare industry, including non-public companies in addition to publicly traded companies.
Total US healthcare spending is $3.5 trillion. Profits account for just 6% of that spending.
To reduce healthcare spending to the same levels as the rich European countries like Germany or France we’d have to cut spending about $1.25 trillion. Cutting healthcare industry profits to zero (and note that there are for-profit hospitals and drug companies in the EU and they don’t make zero profit!) would reduce healthcare expenditures by just 1/6 of the amount required.
That's the big takeaway I wish more people understood. Health is broken not because of fat cats making obscene profits (although there are a few), but because we're fundamentally doing it wrong.
Its not one guy digging a ditch and charging too much. Its that for every 6 people digging, 5 are racing behind them filling it back in and all of them are charging us for the "service".
A better estimate for savings from some parts of the industry is revenue not profit. That’s because the work done by, for example, insurance companies is largely useless paper shuffling that doesn’t need to exist under single payer.
Edit: oh yeah, and marketing. So much health industry money ends up in marketing. Something almost completely unnecessary under single-payer as well.
The post I was replying to was talking about wealth transfer from people to shareholders. Profit is the proper measure of that.
As to cost savings, you can’t use insurance industry revenue because that includes money spent on services. And a lot of the “paper shuffling” does need to exist under single payer. Most universal healthcare systems aren’t nationalized systems like the UK NHS. Germany for example has mandatory membership in Public health insurance organizations for those making under 60,000 euro. There are 100+ of those. Then 15% of the population has private health insurance. Care providers are mostly private. So there is still medical billing that needs to be done. Most EU countries are similar in that regard, and unlike the UK NHS.
As to marketing, now you’re talking about a drop in the bucket. Pharma industry advertising adds up to just $6 billion per year.
I support pretty much any solution that provides guaranteed access to effective acute care (the fact that the ER can’t legally turn you away doesn’t mean it’s effective care).
But people who advocate for this position (which, again, I believe in) all too often live in a fantasy world where we can magically switch systems and pay less. If we keep paying US medical personnel their prevailing wages, there is no way we’re going to lower costs.
Nurses and doctors are too popular in the US to ever even suggest that we reduce their wages to European levels.
Acute care, including the ER, is a small fraction of the total cost of health care. If the health care problem was simply ensuring everyone access to a GP's office and an ER for emergencies, we'd have solved it by now.
Providing effective and low cost chronic care is an unsolved problem everywhere.
I can’t say that I support any and all entitlement schemes I’ve ever heard for chronic care, is why I was singling our acute care, where I do, but you’re right that I was mixing up arguments.
But of course when you provide low cost acute care, and don’t cover chronic conditions, there’s strong pressure for chronic problems to wait until they’re acute and harder to solve, and for chronic patients to use the acute system very inefficiently.
First, the location and timing of accounting profits is not the same as economic profits and the return on capital.
Second, what do you think the point of single payer negotiation with healthcare providers is? The NHS in britian negotiates prices on behalf of the entire country. This system in the US would massively move producer surplus over to consumer surplus by reducing prices through negotiating power.
Lastly, healthcare outcomes in the US are terrible and prices are astronomical compared to Europe, do you think it's a coincidence that their systems are centralized while ours is distributed? The US system massively favors capital returns over service cost and quality.
Yes, but some of this is funny money. Like when you go to the hospital and get charged $50 for a tablet of aspirin. I can see a coordinated national system to be far more efficient than the system we have now of fake list prices where some parties get a negotiated real price
As an European with family and friends working in health care in several countries, I think the general impression most people in US have about the European health care is idealized and very far from reality. It is not the place for a long discussion here, but we are having serious problems in most countries, from waiting lists longer than the expected patient's life to lack of "free" drugs that you have to buy yourself if you want to live.
Am not saying the system is problem free, but I've had multiple surgeries done for free, whereas in the U.S I'd most likely go bankrupt.
Also the point about waiting, not only did I not have to wait, but are you seriously comparing this to a system where I don't have to wait if am wealthy, but can wait until I die if am not?
> A study published in the journal Health Affairs reviewed Justice Department data and discovered that among Americans who cited medical debt as a
contributing factor in their bankruptcy filing, only 12 to 13 percent of their total debts were medical.
Also the studies that are invoked for that proposition don’t distinguish between bankruptcies due to medical bills and bankruptcies resulting from reduced income due to health issues.
Regular people have ended up in debt just to live, and can carry a surprising amount. If we build a society where everyone carries debt, often ongoing, it's hardly surprising just bunging another few thousand or tens of thousands surprise medical debt at them may break them. Even if it turns out to be just a proportion of total.
Your link makes no mention of mortgage or home loans. If they are included in the debts at bankruptcy, it's not in the least surprising that medical debt is "only" 12%.
The 12-13% was unsecured debt (which would exclude mortgages, which are secured by the house).
> This past year, the U.S. Department of Justice (DOJ) responded to a request by Sen. Charles Grassley (R-IA) by examining 5,203 bankruptcy cases from the files of the U.S. Trustee Program. The filings occurred between 2000 and 2002, the same time frame as the filings studied by Himmelstein and colleagues. The DOJ reported that 90 percent of filers had medical debt of less than $5,000. Of those reporting medical debts, those debts accounted for only 13 percent of total unsecured debt. The DOJ summarizes the evidence against Himmelstein and colleagues' thesis as follows: “The conclusion that almost 50 percent of consumer bankruptcies are ‘medical related’ requires a broad definition and generally is not substantiated by the official documents filed by debtors.”
The study is a little old, but the “medical debt is the leading cause of bankruptcy” trope is also old.
OK, that rules out my second point then. Still the first applies. I don't find it terribly surprising that $5k could break someone's back. Plenty of folks seem to run at maximum possible credit. Others will no doubt be able to take it on the chin.
Never heard of it being the leading cause of US bankruptcy btw. My distinctly European perspective is it's problematic it's a possible cause at all.
Yes, there are many success stories of people using the healthcare system in Europe (EU, more precisely), more than people winning the lottery, but there are also many stories of people dying because of the failures. In a few countries (especially Germany) the system still works pretty well, but in the majority it does not, it is in various degrees of failure.
There are long waiting times to access American health care too, anyway, even with insurance. I feel like the people who make those sorts of claims must never do more than use the ER or walk-in clinics.
"paid by the state" and "free" are not the same thing and shouldn't be used as such. I realize I'm nit picking here, but when people banty about the term "free health care for all" I really do think there is a disconnect somewhere. It's paid for. And while the IRS may be an efficient system, the government certainly is not. Now, while I'm not opposed to medical coverage for all, saying that our government running insurance instead of rolling hospitals into one of it's emergency services, like police and fire, is a different discussion.
Well, considering I said maybe we should move health care to emergency services,like the police and fire services, added to that comic, I can only assume you completely missed the point of my statement. And while not everything is paid for except sunlight, everything the government provides IS paid for, yes. There is a ledger to be kept. I'm not some hard core conservative, nor am I some hardcore liberal. Like most Americans, I'm somewhere in the middle and am capable of more nuance and critical thought than I am given credit for.
