Frank discussion about healthcare costs

You said that Across State Lines would be marginal, not significant fix. Yet according to some studies, if we took such 'marginal' steps, in 10 years our financial system would be much stronger. My argument is: let's take those marginal steps, and let's see how effective marginal is.

 

Some really good comments. Thank you.

 

Actually, no I am not a socialist. Far from it. But, simple history and economics shows that some things are better within the state rather than private.

Healthcare is certainly not like any other service. As I have stated, unlike anything else, it isn't a choice. If I have spare money, I have a lot of choices and it is important to have those choices. I can choose to spend it, I can choose to save it in a bank or keep it in a jar under the stairs - all services. But, if I get hit by a car, I don't have a choice if I need to go to hospital.

As for comparisons, actually, where essential services such as health, utilities and national level transport such as trains are owned and operated by the state, the examples around the world prove they operate better than models where these are in the private sector.

 

You are, even if you don't self-identify as one. If I said Donald Trump is white and he said, "nut uh, I don't self-identify as white", I'd still say he's white. Because it doesn't really matter, for the definition, what he self-identifies as. Likewise here, whether you like the term or not, you are a socialist. Even though you have evaded my primary question, what parts of the government should be private vs government run, you have said that you would like to see much of the economy run by the government, and attested that in any case the government would do it better.

I'd still like to know - you think that the government can run the medical sector more efficiently than private companies can, inherently. You have not stated any reason why that would not be true in any other sector - so if the government can run everything better, why would you be opposed to it running all businesses?

Not more efficiently.

 

Hey, I never said "more pc bs,if you do not like caps do not read the post." Learn how to use the quote function.

 

It's really just common sense. People on single-payer don't get to have whatever care or medicine they wish, it is rationed - it has to be approved by the system. Consumers in the U.S. don't have that restriction and will have it covered through private means.

That's a lie - I made justifications for each of the four points. I did not bother to source information that is readily available or common knowledge. I'm not going to give you a link to tell you the length of medical school training.

how is whether or not medical training is subsidized relative to a discussion about HEALTHCARE COSTS, you mean? I stated right in the statement you quoted: "training doctors is expensive, and that has to translate to higher incomes - in many countries doctors education is subsidized, so the expense goes into a different category (education) and is hidden."

Maybe you missed it, but it's in the thread title: this discussion is about healthcare costs, not just some generic single-payer debate. The OP, as I thought was abundantly clear, discusses the reasons for why healthcare costs are different. As stated, personnel costs are a large part of healthcare costs. Germany has free education - the U.S. doesn't. This is a hidden cost of healthcare in many single-payer systems, like Germany. We don't have that hidden cost, hence a part of the reason why we pay more is we do not have that hidden cost.

You mean how is that relevant to a discussion of HEALTHCARE COSTS? Again, this isn't titled "generic single payer debate". The point, made so clearly in the op, is that patent law is one of the reasons why healthcare costs more in the U.S., as compared to other systems. If you're going to cite that some single payer systems pay less for healthcare than the U.S. does, then this is relevant, because this differences explain a large part of the gap.

lol, are you even reading what you're responding to? Your response clearly suggests you did not understand what you were responding to.

thanks for not responding to points I actually made and instead opting for generic partisan talking points about single payer.

 

If you would provide such studies, I'm sure they wouldn't actually disagree with what I said when you look closely at them (and what I said).

 

smfh

See OP point #3

See OP point #2, 3, 4

See OP Point #2.


It's almost like you read the OP, with it's description of the REASONS WHY HEALTHCARE IS MORE EXPENSIVE IN THE STATES, and then wanted to say, "nut uh! We DO pay more!"

 

I know we have some resident bridge trolls that will cry foul at me for guessing at these without some official study, but they do cost quite a bit relatively when combined. The across state lines bit likely only accounts for 1-2% of our costs (this of course not including the costs added by states mandating certain coverages and things of that nature). The licensing would likely be a bit more. As I said, we don't have free education to become doctors, and that translates to higher salaries (because students have to pay for it themselves), and that portion (when you include staff that aren't doctors) likely accounts for about 2% of our total costs, but the other aspect of licensing is that there are too few doctors in part because we have some of the most stringent requirements to become a doctor, and if we had a larger pool of doctors simple supply and demand would lead to lower costs for the same care, though I'm not even comfortable guessing about that portion. Patents, however, are a big deal. We've heard so many times that prescriptions are so much more expensive here - and that is mostly due to patent laws.

Those three put together I would reckon account for more than 10% of our current costs, which would be about 20% of the difference between U.S. and costs in other countries. I agree, end of life is the biggest of any of them.

That's true too - another reason why healthcare costs more here than in single payer countries, and switching to single payer (ahem, Golem) won't just *poof* fix that.

It is overly complex and poorly managed. Though I'm not really speaking to the specific fees - I'm interested, as far as this thread goes, in the big picture stuff. It is a common thing for hospitals to grossly overcharge for one thing to make up for where they do not charge their own costs elsewhere. So in that regard, the overages is more of a wash.

Right - I do think that the way our current system is made encourages bad practices. I've heard so many doctors say that medicare patients cost more to treat than medicare pays, and the only way to break even with that is to provide lower quality care (less attention).

I think that's a non starter. Any government system, like medicare, providing financial incentives for quality care will not even become a thing, because that would necessarily increase medicare costs or such a plan would not work. As far as flat pricing like that, I don't think that's going to work without upping the price. I've seen this before with construction contracting - people might like to have a flat fee and if the project takes longer than have the builder eat the costs - but no builder is ok with that, unless the fixed upfront fee is so exorbitant that its nigh impossible for a bad job to cost them money.

 

Obvious problem with that is that it won't work. There are certain places that will be more expensive to operate in, and any such law would either mandate gross overpayment at some hospitals or put all healthcare providers in certain regions out of business. Neither is a fix.

That also would preclude people paying more for better quality - which isn't a fix either.

 

All I hear is how Americans pay the most for health care in the world. You never hear about the fact that more of us take prescription drugs. More of use receive elective surgery. More of us receive diagnostic testing. I don't know if it balances out, but Americans use the most health care of any nation in the world as well.

The US also focuses more on specialties than general physicians. There are fellowships available in the US in abundance that my appear a few times a decade in Canada. Specialists cost more.

 

If we really wanted to get serious about reducing health care costs, we'd establish a Federal commission on pricing. A committee made up of medical professionals, administrators, and insurers sit down and settle on numbers for what health care costs. Require all hospitals publish their prices, along with a letter grade on the scale established by the committee for the price.

 

We need uniform pay in the NBA.
Why should one point guard make more than the next? All four bedroom homes should cost the same. While we'really at it, all sneakers should cost the same as well

 

Your income is too high. Think what would happen if we just cut the pay for everyone in your occupation by 20% and applied that to medical care for the poor. Now we'd have some great care for the poor.

 

The AMA is a private corporation. Other than the laws granting an incorporated organization, the government is more influenced by them than vice versa.

 

Government controls licensure.

 

At the state level.

 

There is no federal license to practice

 

That is correct. Each state sets the licensing for a doctor to practice. Your use of "government" appeared you were speaking on a Federal level.

 

Bureaucrats are bureaucrats

 

On this one point, are you implying they cannot get that same care or medicine if they pay for it themselves?

I'm not familiar enough with NHS to know this one way or the other, but I would imagine that in just about ANY western democracy, you cannot be prevented by the government to purchase any kind of medical service you wish, so long as it is ethical.

 

There are too many myths about Universal Healthcare. And this is one of them. "I heard it somewhere" is the most common defense. Not true.

1- I don't know what U.S. you are talking about. Healthcare is rationed by Insurance Corporartions. Not even by governments, in which we would at least get a vote. This has significantly improved thanks to Obamacare. But before Obamacare sick people were literally kicked out of hospitals because their maximum stay had been used-up. Improvement is not complete with Obamacare, but it is much better.
2- Single-payer system is not rationed anywhere in the world. They get whatever care or medicine they and their doctor agree on.

I have lived under single-payer system. Not providing coverage to a patient is unthinkable. Where I lived, there was a patient who was turned away form a hospital,, and later died of appendicitis. It was a case of sloppy diagnosis. But there were accusations of "rationing". Protests in the streets for days accusing the government of a "conspiracy" to save money by putting people at risk. The President had to go on national TV to explain that there was no order to ration. The Minister of Health was called before Congress to declare under oath. Hospital authorities, experts, employees... they were all called to testify. It was determined that there was no order and no attempt whatsoever to even hint at rationing. It was a bad diagnostic. Even so, a civil suit failed in favor of the guy's family in the largest payout in the country's history.

This happened because it was the government. Insurance Corporations ration healthcare all the time. And there is barely a recourse to obtain even compensation.

In the countries I know where they subsidize medical training, those doctors pay back the subsidy by providing a certain number of hours after they graduate for a certain number of years. That allows them to gain experience, and the system gets back its investment.

That's what the title says. But then on the OP you go right on into attacking single-payer, by submitting false accusations and not a shred of support for them other than "it's common knowledge".

As I said, in the countries I know (don't know the German system), medical students pay back with time when they graduate. But "single-payer system" has nothing to do with this. It's an independent decision. You keep saying that you want to talk about costs, and keep inserting things that have nothing to do with them.

No! I am asking how that changes by selecting one or another healthcare system?

You say that you are only want to talk about Healthcare costs. But keep poisoning the well over and over by inserting "single-payer" system.

And if you're going to say that that explains a large part of the gap, you will have to document it and explain how much. I'm sure it has an impact. But I have yet to see numbers that indicate that it's a major reason for the differences.

I think it has everything to do with it. You are talking about selling insurance across state lines as a possibility. Saying "it's no silver bullet" does not change much. Fact is that I am explaining why that isn't even a possibility.

I'm afraid that you were the one who brought up single-payer. The fact that the title doesn't mention it does not remove the fact that your posts do.

 

You won't have any money left after paying your tax bill

 

Oh yeah, just look at the list of all these impoverished people living in these countries:

1. Belgium, 42.0%
Belgium, like many countries we’ll discuss here, has a progressive tax, which means that higher-income individuals pay more taxes than lower-income individuals do. Its top progressive rate is 50%. Income from property, work, investments and miscellaneous sources is all taxable. Capital gains tax rates depend on the type of capital. Employees also pay a social security tax of 13.07% of their income. The government allows deductions for business expenses, social contributions and 80% of alimony payments, and there is a personal allowance based on filing status.

2. Germany, 39.7%
Germany levies a progressive income and capital tax that caps out at 45%. Sources of taxable income include agriculture, forestry, business ownership, employment, self-employment, savings and investments, rental property and capital gains. The first EUR 801 in savings and investment income is not taxed, thanks to the saver’s allowance. There is a 25% withholding tax on interest and dividends and a 15% withholding tax on royalties.

Members of certain churches pay an 8% or 9% church tax, which is tax deductible. Church taxes are levied in many European countries. In some cases only church members are required to pay a percentage of income to the church to which they belong; in others all taxpayers pay a church tax, but have the option of paying it to the state instead of to a religious organization.

Income of up to EUR 8,652 is considered a personal allowance and is not taxed. Other deductions include a percentage of contributions to a statutory pension insurance plan; health insurance premiums; private accident, life, unemployment and disability insurance premiums; donations to registered charities; and up to EUR 6,000 per year in training for a future profession.

3. Denmark, 36.1%
Denmark’s progressive income tax tops out at 55.8%, and the average individual pays 45%. The Danes pay an 8% Danish labor market contribution tax, a 5% healthcare tax, 22.5% to 27.8% in municipal taxes, social security taxes of DKK 1,080 (USD 155) per year and capital gains taxes of 27% or 42%. There is a 27% withholding tax on dividends and 25% on royalties.

Employment income, bonuses, fringe benefits, business income, fees, pensions, annuities, social security benefits, dividends, interest, capital gains and real estate rental income are all taxable. There is also a voluntary church tax of 0.43% to 1.40%.

Tax deductions are available for limited contributions to approved Danish pensions, unemployment insurance, interest on debt, charitable contributions, unreimbursed work travel and double households. The personal tax relief allowance was DKK 43,400 (USD 6,212) in 2015.

4. Austria, 34.9%
Austrians pay progressive taxes as high as 55% on earned income, which includes employment income and certain fringe benefits. Investment income and capital gains are taxed at 27.5%. White-collar employees contribute 18.07% of their income to social security, while blue-collar employees contribute 18.2%, subject to a ceiling of EUR 4,530.

Austria provides automatic tax credits based on the number of individuals in a household that earn income, as well as credits for travel to work and number of children. Certain work-related expenses and child-care expenses are tax deductible.

5. Hungary, 34.5%
Unlike other countries discussed in this article, Hungary assesses a flat personal income tax, not a progressive one, and the rate is 16%. This rate sounds relatively low, but as it applies to all income, it does not necessarily mean that Hungarians have a lower overall tax burden. Passive income from sources such as dividends, interest and property rentals is also taxed at 16%. Hungary provides deductions for professional training and business travel expenses, and families receive a deduction for each child. Hungary treats each spouse as a separate taxpayer. Social insurance contributions are 18.5% of income for employees.

http://www.investopedia.com/taxes/countries-highest-income-taxes/

Seriously, do you guys hold onto this belief because of paranoia about the government, or that you actually approve of the ways white collar criminals steal you blind?

THE TRUTH ABOUT TAXES: Here's How High Today's Rates Really Are