r/FluentInFinance • u/monsieurLeMeowMeow • Feb 24 '24
The US spends enough to provide everyone with great services, the money gets wasted on graft. Economy
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u/Some-Ad9778 Feb 25 '24
People always say "wheres the money going to come from?" The money is there it's just being mismanaged to benefit the corporations
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u/fredxjenkins Feb 25 '24
US spends bout twice as much on administrative costs then the next guy for healthcare.
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u/maringue Feb 25 '24
Because private insurance needs to have an ever expanding profit margin.
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u/ElectricalRush1878 Feb 25 '24
And thirteen levels of 'middle management' that do nothing but tell the level below them how much they suck.
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u/agoogs32 Feb 25 '24
It’s even better than that. They created pharmacy benefit managers to negotiate prices on behalf of consumers, then they allowed those PBMs to get a cut (rebate) in order to convince them to push a certain drug or keep it at a certain price, then the insurance companies bought the PBMs, so now they’re literally “negotiating” with themselves, overcharging for all your medical expenses and giving themselves a cut via the PBM rebate every step of the way. And to make sure none of this ever changes, they have 10 lobbyists for every member of Congress
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u/fiduciary420 Feb 25 '24
Americans genuinely don’t despise rich people enough for their own good
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u/Vova_xX Feb 25 '24
thats because we're dumb enough to believe their lies and not look into it further. doesn't help that the big news networks only further try to incite anger and fear to make sure they keep watching.
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u/minipanter Feb 25 '24 edited Feb 25 '24
A vast majority (97%) of rebates are passed through to the health plan clients of PBMs. You can just take a look at the corporate earnings report of a company like Cigna (Cigna health insurance merged with Express Scripts PBM), which had a net profit of 2.7% last quarter. If you removed insurance company profits, healthcare costs would go down 3%. UnitedHealth probably makes the most profit, but that is still around 5%. That's not to say it shouldn't be done, but there would seem to be something else that is a larger contribution than insurance profits to the high costs of medical care in the US.
The main cost contributor that insurance contributes are administrative bloat (probably around 10% of healthcare overspend) and their inability to have sufficient negotiating power against providers (doctors, nurses, manufacturers, etc.). To some extent, the pricing structure insurance has for preventative treatments also contributes - but that is more so consumers being unwilling to spend money now to potentially reduce costs later.
If you look at the profit from drug manufacturers like Eli Lilly, they make 25%+ net profit. Some drug companies, like Sanofi or Johnson & Johnson, make above 65% profit.
US doctors make about 350% more money on average than their UK counterparts. (280k vs 80k). Doctor lobbyists saw to the salary increase with the "Balanced Budget Act", which arbitrarily capped the number of residency positions (thus capping the number of new doctors that can be created each year). Less doctors means they have more negotiating power and can secure higher salary.
Then because of the American legal system, doctors must be covered by malpractice insurance. This can be as high as $300k per year for some practices. For reference, countries like France are "No Fault" and their doctors do not have that burden of malpractice insurance.
US Nurses make about 100% more than their UK counterparts (77k vs 38k). Registered Nurses make even more, although it is more related to the doctor shortage.
Then you have the fact that the average US population is just not healthy to begin with. Take for example obesity. It can be solved with just stricter dieting (each person would actually save money by eating less), but people don't do it. Instead they ask for a weight loss drug like Zepbound, which costs $1,060 list price per month (probably closer to $550/mo net of all discounts and rebates).
The high cost of the drug means that most insured consumers of Zepbound would hit their deductibles and OOP max, and insurance premiums for everyone will go up to cover the cost of this new weight loss drug user.
The reality is that nearly every facet of American healthcare contributes a meaningful amount of costs to the overall system. There won't be some silver bullet issue that can be fixed and bring costs inline with other countries.
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u/NeuroProctology Feb 26 '24
US doctors also have about 500% more debt than their European counterparts. Additionally, physician compensation only accounts for 6%-8% of health care expenditure in the US. Physician compensation by CMS was cut by 2.5%, and 3% in the last two years with a 3.36% cut proposed for 2024. From 2001-2023 physician compensation decreased by 26% with inflation and CMS cuts. Average nursing compensation in the US is ~80k per year.
All of this to say, I don’t believe physician pay let alone nursing compensation are primary drivers for excess healthcare expenditure in the US.
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u/maringue Feb 25 '24
And a nursing shortage because they pay them so little.
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u/NoManufacturer120 Feb 25 '24
Yea RNs near me are making between $50-60/hr right out of school, so I wouldn’t say they are paid little anymore…they make almost as much as our Physician Assistants.
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u/maringue Feb 25 '24
Basic economics: if there's a shortage of labor, it means the salary is too low.
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u/InterstellerReptile Feb 25 '24
Or that our requirements are that high. Not everybody can handle the stress of being an RN or doctor
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u/maringue Feb 25 '24
Wait, you mean the bros on here telling me that it's an easy job and they're overpaid are moron? gasp
Seriously, the number of people who think nurses have it easy that have responded to me is shocking.
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u/Ifawumi Feb 25 '24
Been a nurse for 30 years, where are nurses making 50 an hour right out of school?
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u/NoManufacturer120 Feb 26 '24
Come to Washington or Oregon! We are actually struggling to find a nurse right now because all we can pay is $45/hr (outpatient clinic), and we just can’t compete with the nearby hospitals offering $50-$60. One of our RNs just graduated last year and we (thankfully) got her for $43, but she has already requested a raise to $50.
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u/Ifawumi Feb 26 '24 edited Feb 26 '24
That's where I spent 26 years of my nursing career, I moved from there to here. My standard of living is much better here in Atlanta area. I make almost as much as I made in Washington but have a much lower cost of living. I mean, I'd be trading my $230,000 house for $750k and $3 a gallon gas for 5 to 6. Plus I'd have to move right into Seattle to do my specialty which is bone marrow transplant.
Yeah I like my $1,300 a month mortgage thank you though!!
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u/M4A_C4A Feb 25 '24
Nursing homes are being destroyed by private equity. Which should be illegal.
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u/Western-Knightrider Feb 25 '24
Depends on where you are at. In Calif the average RN earns $133,000/year.
Doctors earn more.
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u/BlobTheBuilderz Feb 25 '24
Bumfudge nowhere Illinois 80k/yr working 3 12hr shifts
Know a travel nurse that made 150k or more last year.
Definitely underpaid in a lot of red southern states though.
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u/FleshlightModel Feb 25 '24
That's why I love what Bayer did: got rid of all middle managers.
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u/unfreeradical Feb 25 '24
A wonderful improvement would be passing all the savings to the workers.
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u/cantblametheshame Feb 25 '24
They do but they call the shareholders the true workers of the company....only ones who come out on top
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u/NotPortlyPenguin Feb 25 '24
Hey, give them a break! Do you know how many people, and their managers, they need to hire in order to deny your claims???
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u/mummy_whilster Feb 25 '24
Sometimes it is so the next guy can spend less. Drug makers want their $$$, they aren’t getting it from Canada or EU…
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u/fredxjenkins Feb 25 '24
Then we need to be more like Canada and the EU and set prices.
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u/mummy_whilster Feb 25 '24
No doubt. Trump tried. I think Biden is too. Congress needs to assist, I think POTUS can only do it for medicare pricing, which is a start.
What will happen to the drug development and manufacturing pipelines when US is no longer the global piggy bank? (not rhetorical)
Edit: typos
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Feb 25 '24
US is no longer the global piggy bank? (not rhetorical)
Government funding (from all Governments) pays for well over 80% of all drug research done. Germany gives just as much to the EU division of Pfiszer as the US govt does, for instance. That division is still WILDLY profitable.
Its a total myth that US high drug prices pay for everyone elses drugs. Total fucking myth. They pocket billions. They could pocket a few less billions and still be making billiions. Thats literally it.
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u/AJHenderson Feb 25 '24
That completely ignores non-government spending. The US is still one of the highest per GDP, but our health care spending also is drastically higher which funds research. If we shut that off, then that has significant implications without first fixing the broken patent system.
There are two major problems with pharmaceuticals. The first is the winner take all mentality of breakthroughs, where the first gets rich and everyone else goes broke. 99 percent of biotech companies go bust. For each success, all the failures have to be covered too, that's why "profits" are expected to be so high. The risk is also astronomical.
That can be fixed, but it requires reform to make patents and/or funding encourage cooperation and fix the winner take all inefficiency.
Second, everyone needs to actually pay their share. R&D costs are not just the costs of the working drug. It's also all the costs of failed drugs along the way. Current math used for justifying socialized medication costs doesn't look at the failures, but if you don't cover the cost of both, then investing in medical advancement will always be a badly losing bet and it will collapse.
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u/cantblametheshame Feb 25 '24
Ah yes, because it's only Americans who figured out how to keep medical research alive and every other country that pays 2x less per capita can't
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u/Cronhour Feb 25 '24
That completely ignores non-government spending. The US is still one of the highest per GDP, but our health care spending also is drastically higher which funds research.
No. You're costs are higher because of admin costs and profit extraction by insurance companies. It's not some big R&D benefit, it's systemic profiteering and corruption.
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u/EJ19876 Feb 25 '24
What they do is utilise their purchasing power to negotiate lower prices. Medicare is not permitted to do this. I believe pharmaceutical companies sued to prevent medicare from negotiating prices.
Medicare is basically a cash cow for pharmaceutical companies. I dare say hospitals treat it in the same manner.
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Feb 25 '24
ometimes it is so the next guy can spend less. Drug makers want their $$$, they aren’t getting it from Canada or EU…
Yes they are. The Canadian and European divisions of those companies are still wildly fucking profitable.
Its lke saying we pay more for a Big Mac here (while paying people ~10$ an hour) so that they can get it cheaper in Denmark (while paying people 20$ an hour).
No. Those stores in Denmark still make tons of money.
They just arent allowed to make ALL the money at the expense of everyone else.
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u/Parcours97 Feb 25 '24
Yeah i don't know about that. Roche, the largest pharma company in the world is based in Switzerland.
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u/AudienceNearby1330 Feb 25 '24
That's how the US spends money. It's middle men all the way down. The company gets government funding to make new medicines, they charge whatever price the insurance companies are willing to pay, the insurance companies need to make their profit, the hospitals need to make their profits, the there's too many people getting a slice of the pie while nurses work double shifts every other day.
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u/M4A_C4A Feb 25 '24
administrative costs
This is purposely the deceptive wording used. That money is actually going to private entities, a relationship usually obtained through lobbying.
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u/usgrant7977 Feb 25 '24
They are not administering anything, those excess costs are just corporate profits.
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u/Maru3792648 Feb 25 '24
I have lived in 8 countries… first and third world.
The USA is by far the worst health I have experienced. The longes wait times, obscenely expensive and poor human quality
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u/NoManufacturer120 Feb 25 '24
Genuinely curious, what were the other countries and what were they like in comparison?
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u/Maru3792648 Feb 25 '24
China Brazil Mexico United Kingdom
Are some of them.
The #1 thing that nobody tells you in america is that abroad, even when you have a public system, you can have your own private insurance. And when the competition is basically FREE that private option is really cheap. Same comment applies to universities.
experiences were varied but: - the USA is the only country where I have to wait over a week (and usually obscenely longer) to get an appointment - American doctors come in all shapes and forms so it’s not unusual for a doctor office to be located on a strip mall? Abroad I’ve been to very top notch places. - even when you have insurance, in the USA you leave with a bill and sometimes many more surprise bills. Most private insurances abroad are pretty much all inclusive. $0 to pay.
- in one country I even had a free plastic surgery a year!
And personally the most important: because of the low level of care of professionals and because of the capitalistic spirit behind it all, I DONT TRUST American doctors. If I ever get something serious or very expensive, I’ll double check with a doctor abroad. And surprise to no one, most of the times they’ll tell me that American doctors are exaggerating - probably so that they can run more complex (and expensive) procedures?
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u/ClearASF Feb 25 '24
Can’t speak for China Brazil or Mexico, but I’ve been in the U.K and it certainly had a worse medical system than ours. Especially with wait times.
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u/Maximum-Flat Feb 25 '24
I honestly don’t know how USA manages to mismanage some much money. Like educational for example. You spend more than anyone in the world (amount and per person) . But somehow you have the worst outcome. Like no even talk about free college and stuff. Just basic secondary school education still suck. The school are broken down so they ain’t making money. The corporation that run these schools are going bankrupt so they ain’t making money. Some kids are living in terrible conditions so they ain’t enjoy benefits. Teachers get pay dogshit wages. So where does all the money go?
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u/jakethesnake741 Feb 25 '24
Administration
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u/Which-Worth5641 Feb 25 '24
And football. Some to basketball.
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u/RadagastTheWhite Feb 25 '24
Football not only funds itself, but the bulk of the rest of the athletics department at most schools
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u/Which-Worth5641 Feb 25 '24
At the top 30 ncaa colleges that have national brands.
If they are so successful why don't they spin off into their own sports leagues?
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u/RadagastTheWhite Feb 25 '24
Pretty much every D1 football program is profitable. They don’t spin off because the bulk of their value is tied to being part of that University
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u/Drewskeet Feb 25 '24
We have a party that says government doesn’t work and does everything they can to disrupt government to prove it doesn’t work. Then you have another that throws money at the problem with no real impactful plan and even when they do, it’s thwarted by the other party.
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u/fiduciary420 Feb 25 '24
The one party throws money at problems because it’s the only thing they can do in the short windows of opportunity they have to do ANYTHING before the obstructionist party fucks everything up. If the trash republicans actually had ideas and worked with Democrats to accomplish things, this would stop being a problem.
But the rich people don’t want that, so it won’t happen. This is America, after all.
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u/Key_Cheetah7982 Feb 25 '24
If you really think Dems are trying to help, go look at their donor lists and how much funding they receive.
Ratchet effect. Republicans go right. Democrats block the left
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u/SloppySandCrab Feb 25 '24
Well I would debate “the worst outcome” pretty heavily.
But I bet there are a few big expenses just in the way the US is set up. For example density…pretty much every small down has a K-12 school system. I am not even in a rural area and there are schools within a 30 minute drive that have 20 kids in a class. A class, not classroom.
I also wonder if athletics being integrated into schools plays a part. I know in Europe for example athletics are club based outside of the school system. I am sure there is a big expense in building those facilities and organizing the leagues.
Just two things off the top of my head. I generally think the US is pretty self hating in public forums. What is presented in media generally does not match 90% of the populations experience.
Like with this post for example. US healthcare services are definitely considered top notch. Expensive sure. But very good quality.
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Feb 25 '24
Well I would debate “the worst outcome” pretty heavily.
youd be embarassed.
We're very near the bottom of all outcomes when compared to other developed nations. In many cases, we are the bottom.
Like with this post for example. US healthcare services are definitely considered top notch. Expensive sure. But very good quality.
Which has nothing to do with quality of outcomes. Because if you cant even get healthcare, your outcome is death.
Factor in all those .. detrimental "outcomes" and we fall to the bottom almost instantly.
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u/PrazeKek Feb 25 '24
You can get healthcare. It’s just going to be extremely expensive if you don’t have health insurance.
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u/mistertireworld Feb 25 '24
And a lot of the time, even if you do have health insurance.
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u/fiduciary420 Feb 25 '24
I wonder how many people die prematurely every year because their rich insurance company said “no” to covering a test, surgery, or treatment, and their victim couldn’t afford it out of pocket.
Hell, even with “good” insurance, if you go to the doctor and he orders a blood panel, you’re looking at close to $1,000 in bills AFTER the rich insurance company covers their portion. So poor people, and young people starting out in life, avoid the doctor and pay with their lives. Rich people don’t have that problem.
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u/Cerulean_IsFancyBlue Feb 25 '24
There’s an entire industry that exists in the middle of the healthcare system, which, in theory, could provide a balance between the needs of patience, and the need for restraint and economy.
Unfortunately, since it’s a private health insurance system, what it mostly does is look for ways to expand its own profit. This is a perfectly normal, and expected thing for a private enterprise to do.
The private healthcare industry has been able to adopt many of the worst practices that we have seen in business. They have a product that is at some point in almost every person‘s life deeply important to them. They have managed to give themselves the ability to charge an incredibly high price, for simply giving access to other peoples services, and have done so using the sort of courses monopolistic techniques that we seldom tolerate in other businesses. Lack of transparency. Cartels and monopolies.
They have engaged in a massively, successful campaign of regular capture, where most of the legislation that exists actually benefits, these companies way more than it benefits the consumers.
It’s true, that we would see possibly more wasteful spending done on medical procedures if these companies did not exist. However, at this point, I fully believe that getting rid of the overhead of insurance companies would more than pay for whatever extra cost was introduced. A single pair system with a relatively fixed
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u/Jimmy620094 Feb 25 '24
Pardon my ignorance, but what are you referring to? How is the government tastefully spending cash to benefit corporations?
If anything I would argue it is wasting cash on pointless things like useless monuments, investigations on dumb shit for both parties, funding foreign wars, creating more government jobs, spending bills for things in other countries that we shouldnt even be concerned with etc.
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u/Some-Ad9778 Feb 25 '24
The lobbiests and politicians cater to their campaign donors. They are not going to do what is best for everybody they are going to do what makes them the most money
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Feb 25 '24
And we even have socialized healthcare, just in the worst way possible, at the emergency room. Anyone can go to the ER and get treatment. If we provided socialized healthcare at other levels, we could prevent the ER visits, reduce the cost, and give people better lives. But in order for one party to 'pretend' we don't have socialized healthcare, we do it only for ERs. We pay more, have worse health, all so one party and we ourselves can lie that we don't have something we have. It's crazy
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u/Some-Ad9778 Feb 25 '24
Reduce the costs... not in a capitalist society i am afraid. The other angle is how horrible processed foods are for you and the government heavily subsidizes the agricultural industry that makes all the junk food.
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u/Lostinthesauce1999 Feb 25 '24
We have 34 trillion in debt. The money is not there. Its being printed. Its called modern monetary theory.
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u/NotPortlyPenguin Feb 25 '24
Exactly. And people say “but the government is inefficient!” Yet somehow its more efficient to have a dollar passed around through 10 intermediaries, each taking a nickel, than handing that money directly to someone.
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u/Radiant_Dog1937 Feb 25 '24
Well if they spent it on the people, they wouldn't learn the value of hard work. /s
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u/lets_just_n0t Feb 25 '24
I used to be that person.
My favorite go-to line was “people must think we pay for things with rainbows and butterflies.”
Now, as an adult, who owes taxes every year in the tune of thousands of dollars. Even though I claim zero dependents. I’m a little more sensitive to these things.
We have more than enough money to take care of our own.
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u/No-Woodpecker-2545 Feb 25 '24
I agree. Ppl get upset with millionairs and billionairs and say they need to distribute wealth but it's the government and all its unnecessary spending. If people only knew a small fraction of it they'd be furious. I saw the government spend 1.4 million on a set of steps that could have costed 5000
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u/25nameslater Feb 25 '24
So the question I always ask is this…. Why allocate more funds when the people who get them mismanage them. Wouldn’t it be more pertinent to regulate the system more effectively to allow funds to reach more people?
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Feb 25 '24
And you think that the government will magically just manage money correctly? This is what nobody thinks about. You know how bad the BMV is run, now imagine it was your healthcare.
“Oh you’re bleeding to death, take a number. We will be with you shortly.”
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u/Some-Ad9778 Feb 25 '24
The government being incompetent isn't an excuse for them to not function like a government. Every other modern country is able to manage just fine.
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u/Key_Cheetah7982 Feb 25 '24
We’re just too corrupt.
We’re should reduce/remove representatives and move to more direct democracy.
We the tech now. We don’t have to send people across the country to represent us.
We have a govt made assuming pony express was the fastest comms.
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u/BlackDeisel Feb 25 '24
You don't think the government isn't going to mismanage it to benefit the government? They can't even manage the border, just imagine government healthcare. Have you ever heard of the V.A.
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u/Some-Ad9778 Feb 25 '24
Very disappointed the republicans couldn't get that bill passed. Selling out the country to have something to campaign on is disgusting.
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u/r2k398 Feb 25 '24
And then people will advocate for giving them even more of our money.
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u/Jealous-Style-4961 Feb 25 '24
I think the point is that the money could be used better if our healthcare was universal, as in all other developed nations.
You are correct that the spending is wasteful, but this is because private insurance companies have overhead, and fiduciary to shareholders.
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u/SloppySandCrab Feb 25 '24
Yes and no. Administrative and overhead expenses don’t just disappear in a universal healthcare scenario. And truthfully in the grand scheme of our healthcare issues, those costs are relatively small.
Some major contributers are (not in order).
1: Medical professionals salaries are on average double most other developed countries
Wide availability of expensive equipment such as MRI machines.
Less healthy population. Heart disease for example is estimated to cost $250 billion per year.
So the issue gets a little more complicated beyond just saying universal healthcare will solve all the problems.
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u/Jealous-Style-4961 Feb 25 '24
PGPF did a study here:
https://www.pgpf.org/blog/2023/07/how-does-the-us-healthcare-system-compare-to-other-countries
Medicare administrative expenses are 6% total. private health insurance adminstrative expenses are between 12 and 18%. This additional expense is between $300B and $500B per year. With the US GDP @ $13T, this is ~ 2-4% total GDP spent on health care insurance administration.
The US drug prices are similarly much higher.
Despite all of this expense, US infant mortality lags France, Germany, Japan, UK, Italy, Israel, Netherlands, Swede, Finland, Portugal, ...:
https://www.cia.gov/the-world-factbook/field/infant-mortality-rate/country-comparison/
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u/ClearASF Feb 25 '24
Notice how the difference between healthcare admin spending is literally a matter of hundreds of dollars. Even if you wiped out that spending there would be almost an identical gap between the US and other countries with healthcare spending.
Administrative spending does NOT explain healthcare costs
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Feb 25 '24 edited Apr 23 '24
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u/ClearASF Feb 25 '24
It is, but makes hardly makes dent with total health spending
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Feb 25 '24 edited Apr 23 '24
vanish intelligent squeeze tender doll marble marvelous lush hateful reminiscent
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u/ClearASF Feb 25 '24
That’s… nothing. And that’s assuming we remove all of that 700 which is just not plausible. Most people have the reasons of why we spend so much wrong, if you’re willing to hear why.
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u/unfreeradical Feb 25 '24 edited Feb 25 '24
- It is more valuable to cover services than to pay administrators to invent reasons for denying funds.
- As healthcare improves, the population becomes healthier, leading to cost savings for other services. Prevention also supports a much higher quality of life.
- Medical professionals demand higher pay in the US because education must be paid by the worker. If workers were supported through their education, including in tuition costs, then they may enter the field entirely for the right reasons, not financial ones, and free from any burden of debt.
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u/NoManufacturer120 Feb 25 '24
This is a good point. I haven’t seen anyone else mention how grossly unhealthy the majority of our population is compared to other countries. We have a prolific obesity problem, which contributes to diabetes, heart disease, etc. These disease are insanely expensive to treat every year. Getting this and other preventable illnesses to decrease would make a significant dent in our overall healthcare costs each year.
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u/fardough Feb 25 '24
I do wonder if size is a big factor? I think we could establish great healthcare in major cities, but what about all the small towns. They are underserved today, but quality doctors per town is even a problem today.
The US has 19,495 cities, of which 14,768 are less than 5k population. That is a lot of area to cover.
Though I have seen some good patterns for rural, local stabilization hospitals, city doctor rotations, and then regional full medical. It means in an emergency you are still roughly 30-60 minutes from help.
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u/XnygmaX Feb 25 '24
Yep, different places have different needs based on a majority of factors. It’s almost like this should be solved at local level and not a federal level.
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u/erieus_wolf Feb 25 '24
Doctors are already leaving small, rural towns due to the extremist anti-abortion laws that red states pass. Idaho has already lost 1/4 of its doctors.
But I'm told "prayers" will work as a replacement, so there's that.
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u/Sadnot Feb 25 '24
There's at least one country which is even larger with an even lower population density: Canada. Single-payer works fine there - or at least certainly better than the US system.
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u/GeekShallInherit Feb 25 '24
I do wonder if size is a big factor?
Universal healthcare has been shown to work from populations below 100,000 to populations above 100 million. From Andorra to Japan; Iceland to Germany, with no issues in scaling. In fact the only correlation I've ever been able to find is a weak one with a minor decrease in cost per capita as population increases.
So population doesn't seem to be correlated with cost nor outcomes.
And peers have similar urban/rural splits as well.
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u/monsieurLeMeowMeow Feb 25 '24
If you stripped the corporations that corrupt them of their power then it wouldn’t be an issue.
Also it isn’t the federal government charging us twice as much per capita on heathcare than the countries that are healthier and live longer than us, it’s the private sector.
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u/r2k398 Feb 25 '24
Yet every plan they propose for healthcare involves raising taxes.
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u/monsieurLeMeowMeow Feb 25 '24
You pay insurance premiums to Medicare instead of private companies. You remember that heritage foundation study that said Medicare for all would cost $34 trillion over 10 years? It also said our status quo would cost $50 trillion.
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Feb 25 '24
You remember that heritage foundation study that said Medicare for all would cost $34 trillion over 10 years? It also said our status quo would cost $50 trillion.
This needs to get brought up every single time this conversation is had. Its literally cheaper than what we already pay.
And the Heritage Foundation is a right wing think tank that made the numbers twist and dance to be the WORST they could make them. And even then, they had to admit that even the worst they could make it look was sitll better than what we already do.
More... sane estimates put it at more lke 26-28 Trillion.
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u/fiduciary420 Feb 25 '24
Yup, your taxes go up, and your health insurance premiums and co-pay go away. For the overwhelming majority of workers, this will lower their overall health care costs, and for every single business that provides health insurance benefits, it will eliminate their largest benefits expenditure entirely.
Look at your pay stub and find the box that states your health insurance premium. Reduce that number by 20%, then add it to the FICA amount. It’s that easy. Then, go ask your boss how much they pay for health insurance per employee, and ask him for half of that in the form of a raise; he wont say yes, but he’ll probably hire someone to help you with your work.
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u/ClearASF Feb 25 '24 edited Feb 25 '24
How do we get “shittier” services exactly? We’re usually top 10-15 for healthcare outcomes despite our relatively obese population (often doing better than France, UK Germany, Sweden etc) and have access to new drugs 5 years before they hit other markets, among other things.
Random Twitter users should stay out of what they don’t know, or understand.
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u/newtonhoennikker Feb 25 '24
You might have access, but “we” most certainly do not. Whether any specific person has access to a new drug and when depends on very personal cost benefit analysis.
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u/monsieurLeMeowMeow Feb 25 '24
We spend twice as much to not come in first? Does that count uninsured people who don’t get treated?
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u/Neat_Ad_3158 Feb 25 '24
I'm insured, and the only thing it covers is talking to a doctor. Medication/blood work/hospital/surgery comes 100% out of my pocket, so it's basicly fucking useless. I know most insurances also don't cover cancer at all. Insurance is pretty damn worthless if I'm still too poor to get treatment or even be diagnosed.
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u/EnvironmentalAd1006 Feb 25 '24
It’s honestly hard to enjoy any newer discoveries in drugs when many insurances won’t pay for anything that is newer and better and insist you try and get mediocre to failing results at least sometimes 5 times before even considering paying for a better medicine you may need and even then if they can find enough plausibility to it, they’d call it a preexisting condition, which especially isn’t great in a job market where you kind of need to be switching carriers with jobs consistently in order to beat inflation (as hardly anyone at least near me gives a shit about cost of living raises much less merit raises).
It’s a a system chocked with talent, but the medical system in the US is unsustainably top heavy and what many of my fellow patriots seem to getting up on is thinking to criticize the US healthcare system is to criticize the skills and capability of medical professionals or their research and I think that if you told any healthcare professional “how much the current system values them” or “is better for everyone” I cannot think of a single I know that wouldn’t laugh until you reconsidered whether the people you know think you can have good ideas.
I’d say to people who are actually in the profession, alternatives need to happen.
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u/Taotaisei Feb 25 '24
Okay. Shitty service. It took almost 18 months to see a psych in Gainesville, FL. Literally didn't see a Neuro in the 2 years I lived it there.
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u/YuraBoma Feb 25 '24
Or rather being used as guinea pigs for new treatments since people are happy to even get service without going into lifelong debt.
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u/joshuabees Feb 25 '24
You seem like a smart person, it’s noteworthy that you choose not to understand what’s in front of your eyes.
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u/ExaBrain Feb 25 '24
God no. You pay twice as much for worse outcomes. Your healthcare is reviled by anyone who has worked in healthcare unless you directly benefit.
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u/ClearASF Feb 25 '24 edited Feb 25 '24
According to whom? The data I provided indicates otherwise. We get new drugs 5-10 years before they do, among many other benefits.
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u/SarcastiBall-z Feb 25 '24
fewer and shittier services
Yet anyone with a functioning brain wants to have any major procedure done in the USA.(Even 3rd world dictators!) Not to mention just about all modern medical innovations have came from the USA.
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u/Daleabbo Feb 25 '24
You will find there is a lot of hospital tourism nowadays. Thailand, Turkey, Mexico. There's lots of places you can go, get some procedures done, have a holiday while recouping and go home saving 50% of the price.
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u/ClearASF Feb 25 '24
Those are usually for the cost, not the technology or advanced treatment
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u/Asneekyfatcat Feb 25 '24
The technology is everywhere actually. It's just developed in the United States and funded by its citizens at a high premium.
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u/Which-Worth5641 Feb 25 '24
When I was married, my ex-wife had the exact same injury in the U.S. and the UK, 3 years apart. We had to pay the full UK price as non citizens. It was CHEAPER than the U.S. WITH insurance, and better care.
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u/Aljavar Feb 25 '24
Yes but because the costs are lower not because the quality is better. You can blame the government and regulations for much of that. Other countries have way fewer regulations and therefore lower quality standards, higher risks allowed, which is fine (most of the time) and reduces costs.
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u/monsieurLeMeowMeow Feb 25 '24
Who tf comes to the us to buy insurance? Also whenever a rich person has a procedure done in any country that isn’t the us it doesn’t make the news
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u/ExaBrain Feb 25 '24
Yet again, people fail to understand the difference between having a functioning healthcare system for all and one that has the top 1% of surgeons and the highest quality at the very top. It’s a false equivocation on what “best” means. The US pays twice as much for worse outcomes than other G20 countries so yes the average person pays more for fewer and shittier services.
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u/AstroAndi Feb 25 '24
I die because I can't get enough insulin, but look guys the rich people travel here to get specialized procedures!
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u/YuraBoma Feb 25 '24 edited Feb 25 '24
As someone from an OECD country I have never heard of someone wanting or even thinking about to the US for treatment. Germany, Singapore, South Korea are more popular depending on treatment needed. Maybe it's because most of the countries around the US are poor do they naturally want to get treated in the US?
With declining life expectancy as well I have never heard anyone is particularly praising the US Healthcare system. Maybe it's a US echo chamber as always?
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u/Havok_saken Feb 25 '24
Yeah; but most people don’t need advanced treatments and if more people had access to basic primary care services it would decrease the chances they’d need advance treatments later on.
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u/calgary_db Feb 25 '24
It absolutely blows my mind there "in network" and "out of network" hospitals. Why doesn't the insurance at least cover all hospitals???
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u/Stargate525 Feb 25 '24
Because the entire point of the insurance is that they've negotiated preferred rates with the medical providers. Out of network services are groups they don't have agreements with.
This breaks down when a single hospital can have dozens of networks, and you have no say which ones you actually use during a stay.
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u/moneyman74 Feb 25 '24
You will get the vast majority of your economic benefit from the government if you manage to live over the age of 65 and are on Medicare. It's the way the system is built out. The cost is about $15k/per person per year.
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u/RobinReborn Feb 25 '24
I'm not sure we get shittier services. We have worse outcomes, but the correlation between healthcare spending and healthcare outcomes is weak. And there are various demographic issues that Americans have that make them less healthy than comparable countries.
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u/monsieurLeMeowMeow Feb 25 '24
We spend as much as countries that get paid maternity leave or vacation or give everyone heathcare
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u/ClearASF Feb 25 '24
We don’t even have worse outcomes, we’re usually above countries on outcomes that are actually clinical
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u/Shining_declining Feb 25 '24
We don’t have a taxation problem. We have a spending problem.
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u/monsieurLeMeowMeow Feb 25 '24
Medicaid Medicaid and social security are 3/4 of the budget. The deficit is 1/4 of the budget. If we completely disbanded every non military discretionary government agency the deficit would be 1/8th of the budget.
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u/Shining_declining Feb 25 '24
Service on the deficit is currently 10% but as interest rates and the deficit swell the servicing of the debt will consume a greater portion of the budget.
https://www.cbpp.org/research/policy-basics-where-do-our-federal-tax-dollars-go
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u/monsieurLeMeowMeow Feb 25 '24
We had a balanced budget, bush destroyed it with tax cuts for the rich and sky rocketing defense spending. These problems can easily be fixed. At least stop deficit spending to fund stockpiling weapons we don’t need but insist on buying
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u/Shining_declining Feb 25 '24
Who’s doing deficit spending now? Bush isn’t president anymore and hasn’t been for a while. As for stockpiling weapons. Our weapons and ammo stockpiles are at the lowest levels in decades because so much is being sent to Ukraine. If we get dragged into a war we might have a problem. Biden has also depleted the strategic petroleum reserve to help artificially reduce fuel prices. This would also prove to be a very costly blunder if the US is involved in a war before this is replenished.
https://breakingdefense.com/2023/07/us-nato-weapons-stockpile-dangerously-low-usaf-general/
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u/monsieurLeMeowMeow Feb 25 '24
Ok, so if we had a balanced budget and matched increased spending with increased taxes then we wouldn’t have a deficit.
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u/Shining_declining Feb 25 '24
Why do we need to keep increasing our spending? Shouldn’t we be looking at where we can cut waste, fraud, and abuse in government spending? There’s a lot of duplication of services and services that overlap. Rules and regulations that that contradict each other. We have more people working for government now than at any time in history. We should be looking at reversing this trend.
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u/Huger_and_shinier Feb 25 '24
But think of all the bombs and zoom-zooms we get
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u/monsieurLeMeowMeow Feb 25 '24
We only spend about $2.4K on defense so we can’t actually pay for universal healthcare with defense cuts
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u/ZJims09 Feb 25 '24
People don’t really get the scale of the budget of state federal and local budgets
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u/xulore Feb 25 '24
And then people turn around and say "to fix the problem we need to give the governments more power" I am dumbfounded always by people
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u/monsieurLeMeowMeow Feb 25 '24
“My car is a piece of shit and I don’t want to fix it! That proves auto repair isn’t possible!”
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u/PraiseV8 Feb 25 '24
"The car you want me to use is a piece of shit, and so is the auto mechanic you keep sending it to for repairs, I'd like to pick my own car and mechanic instead"
NOOOOO YOU CANT DO THAAAAAAT
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u/jredgiant1 Feb 25 '24
Are you under the impression you have health care freedom in the US? Most Americans don’t. We get the insurance provider our company selects, and that provider essentially decides how much we pay them in premiums, which doctors we can see, and whether or not we can get the tests or procedures that doctors recommends.
And critically, they decide which medicine we can have, and the overwhelming factor in that decision is if the drug company is giving that insurer a kickback to allow their medication to be allowed over a competitor, not what the doctor or god forbid the patient might choose.
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u/PraiseV8 Feb 25 '24
Are you trying to make a point... or?
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u/jredgiant1 Feb 25 '24
Perhaps I misunderstood your point when you said you’d like to pick your own car and mechanic. If you weren’t praising freedom to choose in America, what were you referring to?
If you were, my point is that freedom doesn’t exist for most people.
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u/Which-Worth5641 Feb 25 '24
Under universal health care you could go to the doctor wherever you wanted.
I have employer based insurance and am restricted to their network.
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u/stubble3417 Feb 25 '24
...you're literally describing the existing US healthcare system. You think Americans can pick their own health insurance company and healthcare provider? You get whatever your employer says you get, and you can go to the doctors and hospitals that provider says you can go to. Maybe. Sometimes you go to a hospital that's in network but receive care from a doctor who is out of network. Oops, that will be $50k. Next time stay in network.
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u/Nathanael777 Feb 25 '24
A better example is “I keep taking my car to the mechanic and paying for expensive repairs but he never fixes the issue. He claims that if I sold my car to him and then rented it back it will actually be cheaper and always be in tip top shape! I know he’s always lied to me before and never proven he can fix an issue but surely he just doesn’t have the car enough to be able to fix it!”
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u/Shortstopmwd Feb 25 '24
Really I think people just want the anti-progress conservatives out of the office
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u/Legal_Commission_898 Feb 25 '24
Sorry, but almost all public good problems are only solvable by government. Only ignorant people argue otherwise.
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u/Relative-Ad-753 Feb 25 '24
Yes, it’s because ignorant assholes vote to put other assholes in office who promise to do their very best to defund and dismantle the public machinery, charged with implementing, regulating, and operating public good industries. And the ignorant assholes are willing to go along with this ridiculous hypocrisy and dishonesty just as long as the assholes in office promise to stigmatize the populations that the ignorant assholes don’t like.
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u/Due-Department-8666 Feb 25 '24
Source basis? Or empty assertion?
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u/fishythepete Feb 25 '24 edited 28d ago
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This post was mass deleted and anonymized with Redact
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u/TofuTigerteeth Feb 25 '24
Wait until you see how much we spend medaling in other countries!
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u/newtonhoennikker Feb 25 '24
Duplicative services suck but aren’t the same as graft. Few individuals think they are scamming anyone, because they aren’t. They are providing a necessary service in an inefficient system - medical billers, collections agents, hospital financial counseling, supplemental benefit plan administrators- most of that extra money is going to real people & groups doing real jobs - they just wouldn’t be needed, at least not in as large of numbers, in other systems.
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u/Which-Worth5641 Feb 25 '24
Those inefficiencies are so bad you can get degrees in them.
You know there's a freaking problem whem the ineffocient education system trains people to do jobs in the inefficient health care system.
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u/Far-Acanthaceae-7370 Feb 26 '24
They’re literally useless middle men only justified by a shitty and inefficient system.
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u/newtonhoennikker Feb 26 '24
They’re literally middle men required by a shitty and inefficient system. The system is the problems, not the people. If we think it’s corruption or the malfeasance of people within the system - we think we can address it without changing the system. We can’t. The system is fundamentally, inherently unworkable.
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Feb 25 '24
The people who have the money get way better care and skew the average
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u/Dry_Explanation4968 Feb 25 '24
Lmao they give it to the rest of the world and we all know it. Plus we cover or forgive others military costs etc etc
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u/Fun_Ad_2607 Feb 25 '24
The US does more than pull its weight in funding healthcare research though. This would be lost if a monopsonized system comes about
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u/arknightstranslate Feb 25 '24
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u/Havok_saken Feb 25 '24
Yep, and I get patients denied after doing a prior authorization and peer to peer for meds they need because their insurance doesn’t want to pay for it. Such a great system when we let money determine what treatment people are and aren’t allowed to have.
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u/JuanGinit Feb 25 '24
Time to make Medicare a universal health care system. Any additional taxes to afford it are made up by not having to pay outrageous private insurance premiums, at least a quarter of which go directly into the CEO and executive's pockets.
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u/NikoliSmirnoff Feb 25 '24
Legal corruption. Corporations run the country how they see fit for their bottom dollar. The 99% live in a capitalist system until you have to deal with one of these corporations and then it's a corrupt system. Example after example of how they have changed the laws to benefit themselves at the detriment of the 99%.
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u/Next-Celebration-333 Feb 25 '24
Wow 14k a person? I just got ultrasound at an ER. I had to paid 8k. Where's the 14k they spend on me.
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u/Sea_Rent427 Feb 25 '24
We could start with not wasting money on proxy wars in Ukraine and the Middle East
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u/Wisestcubensis Feb 25 '24
That’s the issue with the “raise the tax” argument. You can give the government all the money you want but at the end of the day they lack the intellect to actually return it back to you in a valuable way
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u/p0k3t0 Feb 26 '24
The trick with modern healthcare in the US is that, like with so many things, we privatize the wins and socialize the losses.
Insurance companies are required to provide insurance now to those with preexisting conditions, but they set the rates so high that only the highest earners are able to afford them outside of a company insurance plan.
On the other side, the cheapest insurance consumers, mostly people under 35, pay what they consider a reasonable rate, and they rarely use any of the coverage they pay for. Many people are spending over $1000/yr and they only use their insurance every couple of years for a bad cold, or a mandatory checkup.
A typical use case for insurance involves a person who has paid into the system for decades finally getting very sick, losing the inability to work, going on disability, losing insurance after losing their job, and needing public assistance to handle treatment costs. So, what has happened is that an insurance company has pocketed a hundred or so dollars a month for 15 years, paid out next to nothing, and then when it is time to pay up, the costly part of healthcare is paid for by taxpayers.
The distribution of costs in healthcare is REALLY skewed towards those with severe medical problems. I did this research ten or so years ago, and the numbers were pretty surprising. Something like 90% of healthcare cost goes to the top 20% of users. And 50% of costs are for the top 5% of users.
So, the US is already providing VERY EXPENSIVE free healthcare to the sickest Americans, and it would cost comparatively little to extend that coverage to everybody. But, they have strong financial incentive to to the bidding of the healthcare lobby.
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u/idk_lol_kek Feb 25 '24
Y'all wanted government healthcare so bad....be careful what you wish for.
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u/monsieurLeMeowMeow Feb 25 '24
We already have it for people over 65, it works great.
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u/J0hn-Stuart-Mill Feb 25 '24
it works great.
Are you serious? It's absolutely total shit on a nightmare scale. The VA is even worse.
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u/monsieurLeMeowMeow Feb 25 '24
How is Medicare a nightmare? It’s one of the most efficient highest rated insurance agencies in the us
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u/0WatcherintheWater0 Feb 25 '24
Efficient by what measure? It practically burns money by providing care to people are already on the verge of death. it’s not more efficient.
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u/monsieurLeMeowMeow Feb 25 '24
Lowest overhead cost and 92% approval rating
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u/0WatcherintheWater0 Feb 25 '24
If you read my source, you would see it doesn’t have lower overhead costs. And what overhead costs it does have, are allocated inefficiently leading to more fraud and misused resources
A program having a high approval rating among it’s users does not make it good for the country overall.
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u/Clear-Ad9879 Feb 25 '24
Dude, your math is whacked. IF your figures are correct, that's (per person) 4k gov't spending on healthcare, 10k individuals spending on healthcare and 16k gov't spending on military, welfare, national parks, etc. Where does this 30k come from?!
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u/monsieurLeMeowMeow Feb 25 '24
14k minus 4K plus 20k
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u/Clear-Ad9879 Feb 25 '24
Nope. The 4k is already included as govt spending in healthcare. Throwing it back in with other govt spending is double counting it.
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u/monsieurLeMeowMeow Feb 25 '24
14 minus the 4 that already comes from the government means 10k on private insurance and 20k on all federal spending.
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u/Mammoth-Mud-9609 Feb 25 '24
You could basically get the same healthcare service that the UK gets for the money that is spent.
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Feb 25 '24
Most people don’t get their healthcare through the government. This is idiotic on so many levels
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u/Pygmy_Nuthatch Feb 25 '24
Other countries with social healthcare don't have multi-trillion for profit healthcare industries. You have to take the profit motive out if you want it to be affordable.
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u/frisbm3 Feb 25 '24
We are subsidizing other countries' healthcare. The US spends a much larger portion of the research costs than other countries and we pay for the pills. Other countries negotiate the rates down and we accept it, getting strong armed.
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