how did the US screw up health insurance so bad?

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how did the US screw up health insurance so bad?

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Anonymous 0 Comments

How bad it is is wildly over-hyped. If you’re an ordinary middle class person with a full time job, which is the overpowering majority of Americans, the health system will serve you just fine. If you’re a retired person using Medicare, the health system will serve you just fine.

Where the U.S. Health system falls apart is at the margins. Young people who never picked up insurance and got sick. People who can’t get hours because their employer can’t afford to pay benefits for the work they’re doing. Self-employed people who lack the bargaining power to get a decent price for coverage. Ultimately these gaps produce situations where your personal savings have to be demolished before you qualify for medicaid (the real NHS of the United States).

And, for what it’s worth, Obamacare did a **TON** to cover over a lot of those gaps. The health care exchanges make coverage more available to individuals, and there are subsidies for low income people to get covered. You can’t be denied coverage for pre-existing conditions anymore.

But what doesn’t get talked about is how much more people in countries with single-payer health care pay in taxes. Americans are taxed at a far lower overall rate than the OECD average, only 26.6% of GDP. By contrast, countries like Denmark, France, Austria, Italy, Finland, Sweden, Norway and Beligum pay north of 40% of GDP. And in case you’re under the impression that they only tax rich people, every single one of these countries levies a Value-Added-Tax upward of 20%. That’s a sales-tax to you and me.

So, for most Americans, if you pumped up your taxes by about 60% and zeroed out your insurance premiums, would you really come out ahead? I suspect that for the vast majority of people, that answer is no. That still might not dissuade you, and I’m not sure it does me, I’m generally in favor of improving health care accessibility, but much of our political discourse about Health Care costs is mediated by looking at European Health Care costs after all the subsidies and tax transfers have been applied.

Anonymous 0 Comments

Because the government is sort of it and sort of out of the market, and people don’t have any incentive to price shop.

Government, via Medicaid and Medicare, is a huge player in the healthcare market. In fact they are so big that many other insurers negotiate their rates with hospitals by saying what percent of Medicare they will pay. For example, making up numbers here, Humana negotiates they will pay 120% for service X and Blue across may negotiate they will pay 150% of Medicare for the same service. Medicare doesn’t negotiate these rates they just throw them out there and Provider’s can take it or leave it. Problem is that there’s so many Medicare patients that providers basically have to take them, and then they charge the other insurer patients extra to cover the cost.

For those other patients that have health insurance there is no incentive to price shop. You have your $20 co pay, and your deductible and max out of pocket, but once those are maxed you don’t care any more. Or for your “free” annual checkup and other included care you just go where ever is convenient because it’s “free.” So providers charge as much as they can get. And medical rates for being seen are rarely published or are hard to decipher.

Compare this to dental insurance which offers way less coverage for total cost if you actually need anything. Dentists often advertise with flyers and free checkups because people are incentivized to shop for these. services because dental insurance sticks you with much more of the bill. If you need a procedure the dental assistant has an easy to understand price chart they show you before you make a choice. Which is another difference between medical and dental. In medical situations you usually just go get seen and see what it costs after.

Anonymous 0 Comments

I don’t care for the American health care system as much as the next guy however to play devils advocate; due to being a for profit system if open leads to much more money being spent on R&D which in turn creates new products many being life saving. If someone tells you that you are limited to how much of a profit you can make it WILL limit how much you spend on R&D. Consider R&D the equivalent of discretionary spending. If the government told you no matter what you do be it being heart surgeon or a fast food worker you can only make so much money in a given year that is highly going to impact how much you spend at the movies or going out or endeavor that strays from your norm.

Again I dislike how our current system is and it most definitely needs to be reworked, however you can’t remove the incentive to make a profit. Otherwise you might as well be a communist state where the government owns operates and controls everything

Anonymous 0 Comments

It’s less screwed up than most want to believe. Because if it’s not screwed up, then it can’t be fixed.

Several different researchers have attempted to reconcile US Healthcare to European peers, to understand why our spending per capita is so damn high.

A few common threads emerge.

1 American Healthcare workers are very well paid (or less underpaid?). On average earning 20% or more than those in europe.

2 insurance companies are not as big of a cost sinkhole as people believe (some stuff could be consolidated, but most of the roles would still be needed under a govt system), but the incredibly complex billing and coding process consumes a ton of resources at the provider level.

3 defensive care, our legal system rewards caution, not efficiency. Charge $1000 for a CT, they’ll order one no matter what because they want to be sure they didn’t miss something.

There are others, pharmaceuticals, managed care,

Anonymous 0 Comments

It’s not screwed up, it’s working exactly the way they wanted it to.

The longer answer, everybody else has said it. You make it a for profit business and couple it with unfettered capitalism, and the result you get is… That.

Anonymous 0 Comments

Health insurance isn’t screwed up. Just see the salaries of upper management and CEOs of so-called nonprofit hospitals. Plus, the dividends of health insurance to its stock holders are robust. They are ‘winning.’

As far as universal medical coverage, the health industry (insurance, upper mgt, investors, owners, device manufacturers) wins as less of it is covered and administered by government. People cut out of medical coverage, those that are underinsured, and those insured people that suffer a catastrophic event means more $ for the health industry by raising costs/ prices on those that they cover!

Anonymous 0 Comments

The fundamental reason is pretty straightforward.

USA health care is designed to maximize profit. Hence everything should cost as much as possible. That’s why you get $1000/month insulin, for instance.

A bonus screw up, back in the 1970s there were various wage freezes, so employers started adding health care benefits in lieu of wages, to attract employees. This became extremely widespread. And objectively it is a terrible terrible terrible idea in every single way.

Anonymous 0 Comments

liability. US is THE most litigious country and when it comes to healthcare the damages can be awarded in billions. Hospitals have to take cover, doctors have to, care takers have to and ultimately the pharma companies have to. All this adds to high cost of services. For covering a high priced service, the premium would obviously be high. When was the last time a court awarded a million euro fine on a doctor/hospital for negligence in service?

Anonymous 0 Comments

The 3rd party payer system is stupid.

Imagine buying groceries in the following way. You pay company xyz $200 a month for groceries. Then you go to the store load up your basket and walk out. You dont know how much anything costs, you dont know how much you spent, you just leave. Then, a month later you get a bill from xyz because you got $300 in groceries so they bill you $150 for the difference, plus fees.

Thats how American healthcare works.

Anonymous 0 Comments

There is an argument to be made that they did not screw it up. When Obamacare was being “debated” polling showed something like 70-80% of the people liking what they had. You get 70% of people to like something in the United States, thats impressive.