I am attempting to gift a Wall Street Journal
article. I hope it works, but if not, all you really need is the headline: “The Average Cost of a Family Health Insurance Plan Is Now $27,000”. Think about that. Then consider that US health care is generally considered to be twice as expensive as health care in other, comparable, countries for worse results. Think what corporations, never mind employees, could do with an additional $6,750/year per person.
You might follow that by listening to this
podcast. A researcher is asking people to send her redacted hospital bills so she can attempt to figure out what hospital care costs. We know that bureaucratic overhead is one reason for our inflated costs – what other country has a degree in medical coding? – but high and undiscoverable hospital costs are another. A hospital can’t tell you what your elective surgery will cost, even if you ask, and you are certainly not going to spend an ambulance ride after a car accident or a heart attack calling around asking about the price of care.
An anecdote: Back in 2005 I fell and broke my wrist in Murren, Switzerland. I wound up in an emergency room in Interlaken. I was the only patient – it wasn’t ski season, so I was the only injury, but there were no uninsured people using the ER for primary care, either. Compare that with your local hospital any time of year. The doctors attempted to set the bones using X-ray, before taking me to the OR to insert pins under anesthetic, and then to a bed in a six person ward where I spent the night. Fortunately, I still had good retiree medical insurance, but the really interesting fact about the bill was that it was almost exactly the same as the bill for ten minute out patient surgery to remove the pins in the US. And Switzerland is one of the most expensive countries in the world.
Paying for health care in the US is a mess. Some people have no coverage. Some people have expensive employer coverage. Some people have reasonable coverage because they are over 65 or disabled. Some people have Affordable Care Act coverage that may or may not be affordable. Meanwhile the “system” piles on costs, some of which go for unnecessary or even dangerous care. Too much is spent trying to keep the frail elderly alive for a few more days. Too much is spent on unnecessary tests – no other country uses colonoscopies as the first line test for low risk people.
I understand that this “system” is the result of wage controls during WWII leading employers to offer health insurance in lieu of wage increases. That was eighty years ago. Isn’t it time for something better? I’m not advocating for the UK’s National Health System, although it worked well for me, but the system in France, or Germany, or Switzerland would require fewer changes.
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Here is my solution, based on my 45+ years in corporate employee benefits:
Basic concept:
(1) Individuals should be responsible for that which is budgetable.
(2) Society should be responsible for that which is not budgetable.
Funding what is not budgetable:
A national stop loss/reinsurance system with a $25,000 per capita, per year attachment point, where provider charges are limited to either the Medicaid or Medicare allowable for expenses in excess of the attachment point – funded by general revenues from a per capita premium. That is all American citizens, and all non-citizens who are lawfully present, are automatically covered by the stop loss (part of an individual mandate) and each must pay the per capita stop loss/reinsurance premium collected as an income tax (where all the regular income tax rules apply, and where non-payment accumulates with interest).
Should be something like $500 a year, or ~$40/person/month (revenue of approximately $200 Billion). Employers and not-for-profits could pay the premium on others behalf if they so chose to.
One estimate of cost for stop loss for an employer-sponsored plan: https://ethosbenefits.com/how-much-does-stop-loss-insurance-cost/
Funding What is Budgetable:
Each US Citizen, and all lawfully present in the United States are individually responsible for medical expenses up to $25,000 a year. Where individuals purchase insurance, there would be no point of purchase cost sharing (deductibles, copayments, coinsurance) on preventive care and primary care, and individuals could contribute to a Health Savings Account on a tax preferred basis (same rules as today).
Coverage could be provided by employer sponsored plans, individual insurance, options available in the public exchange, Medicare, Medicaid, VA (as all are available today) or an individual could post a bond and self-insure. The only difference is that the “individual mandate” applies to all, there are no free riders, and there is a $25,000 cap on covered expenses per year.
All are automoatically enrolled in a public exchange coverage default option each November – no free riders. Those who can show other coverage (individual, employer, exchange, Medicare, Medicaid, VA or post a bond) can opt out of the default option. Those who can’t show other coverage are covered, and premiums would be paid via income tax withholding (either from wages or estimated).
The cost of $25,000 in coverage per year is likely to be less than $1,800 per person, or $150 a month, on average – with age-based, unisex rates, ranging from about $500 a year for a child under age 18, to $5,000 a year for those age 65+ (who are not yet eligible for Medicare).
The result is “affordable”, universal coverage, where the coverage prior to the attachment point is “equitable” (both vertically and horizontally equitable, treating similarly situated individuals the same, and differently situated individuals differently, proportionately) relative to the anticipated cost.
All non-citizens who are not “lawfully present”, including those who are here on vacation, or business, as well as those who are here awaiting processing of their claims for asylum, are individually responsible for their own medical needs – other than stabilization per EMTALA. They are not eligible for exchange coverage, Medicare, Medicaid, or Stop Loss.
Bottom line, Americans want the best health care coverage YOUR money will buy. And, so long as we let Congress asserts that health care coverage is a right, and so long as Congress has authority to subsidize coverage, by running $1 – $2 Trillion a year in annual deficits, sending the bill to Americans too young to vote and generations unborn, we won’t solve this problem.
Since Health Reform was signed into law by President Obama, March 23, 2010, we have added $27 Trillion to our national debt.
Oh Jack, a recipe for confusion and chaos. The problem is lack of universal coverage. Universal risk.
We need a system as simple as possible that recognizes that people do not view obtaining or paying for healthcare as they do a car and never will. All health care is paid for with someone else’s money, that’s why it is insurance and if you are lucky you will pay and pay and never use a penny in health care.
Right now I wish I could say that. In an hour we will be headed to Connie’s first chemo treatment. I don’t know what it costs, I don’t care what it costs, I don’t care what I pay in premiums. I just want it to work … and that is how we humans think about health care. We are not consumers, we a patients.
Best wishes Dick and Connie.
Dick – my best wishes for both you and Connie on this medical journey.
I send you and Connie my best wishes that she tolerates the chemotherapy and that it is effective. You are so right that when any of us develops a major or life threatening medical problem, the cost and how we will pay it is not our first priority. Your experience is a reminder of why that is.
Sending strength to you both for today’s treatment. When it matters most, none of the costs or systems matter, only that it works.
Healthcare costs have now reached a potential tipping point and soon we will see many companies walk away from providing insurance to employees. They may give employees the cash equivalent and have them go into the private market. Many healthy employees will refuse to join the private markets and then private insurance goes into a death spiral.
According to this piece in the Washington Post, a number of employers are providing on-site clinics instead. Seems to be a popular move. However, it still leaves employers involved in healthcare.
The situation is not good, but it is not that bad yet. Companies just can’t walk away. They still need to attract and retain a workforce. Many have started using HDHP with reimbursement accounts shifting more of the risk to workers.
60% of American workers are in employer coverage that is self-insured, so insurance premiums are not the problem.
Employers should logically be pushing for a form of M4A to get out of the healthcare business, but they haven’t and the likelihood in the next four years is below zero percent.
But wont it be very high in within 10? In 10 years I believe we will see a significant increase in contract jobs. Basically everyone will be some form of an Uber driver – – i.e. we will all be for temporary hire. It has already been on the rise for a few decades in many industries and with AI some employers are already experimenting with “project job pools.” It wont be long before they will ask you to be part of the “project pool” as a contract worker not an employee. This will eliminate the need for medical coverage and other benefits as well as reduce office related expenses.
A similar experience in an EU country in 2017. I was treated in the emergency department and was then in the ICU for four days before being moved to a normal room. In addition to IV drugs, multiple doctors, expert nursing, and the machines at my bedside, I had multiple lab tests, an X-ray, EKG, and other radiology. The bill was 4500 euro. Back in the US, I asked colleagues at the medical center where I work what they thought it would have cost if this happened here. Per night, not total, the estimates ran from $12k (lowest) to $50k (highest).
Another benefit of the European healthcare model: residents of EU countries and the UK can access necessary medical treatment when visiting other participating countries, receiving care on the same terms as residents of that country. As an example, my grandson fell backwards off a swing while in Spain this August. He had severe concussion with vomiting and intense head pain. He spent two days in a local hospital with various tests and scans at absolutely no cost.
I did a little research from a variety of sources.
It seems the waiting time to have an MRI various considerably by country and system.
If you are told you need an MRI, do you want to wait? You may have no choice. What constitutes better healthcare. Is sooner better? Is waiting better? I don’t know. But I do know Americans do not expect a long wait- and pay the price.
United States 1-14 days
Germany 14-21 days
Israel 24-32 days
United Kingdom 18-126 days
France 30-60 days
Canada 84-147 days
Croatian 268 days
Norway 61-84 days
Citation?
I needed an MRI last year because of something weird going on with my eyes…seen my doctor on Monday morning, had the MRI on the Wednesday afternoon plus an hour long consultation with a neurologist. On the Friday morning I also had a PET scan plus another meeting with the neurologist. Seems pretty good to me.
Yes it does. We are citing reported averages here.
You didn’t cite. You just gave numbers from an unidentified source.
There are numerous sources, one being Kaiser Foundation, I didn’t keep track but I asked ChatGPT and Gemini to summarize after I checked several sources. I’m sure you can find the same data if you are interested. Here is a source for the NHS. https://practiceplusgroup.com/knowledge-hub/mri-waiting-times/#:~:text=Average%20waiting%20time%20for%20MRI,the%20location%20of%20the%20clinic.
Your cite is a private UK healthcare company website that provides services for a fee, including a MRI in one week for 334 pounds. This company clearly has an incentive to paint NHS waiting times in a negative light.
Your so-called averages are actually ranges that provide almost no information about what the median wait times are.
Believe whatever you wish. The fact is the wait times are longer in the UK than in the US. Whether that’s good or bad or insignificant is debatable. Certainly it means higher costs in the US.
The bigger issue is that you would be well advised to improve your research methods instead of blindly relying on the results of AI queries. Your “research” reminds me of when I was still working as a professor and I had to tell my students that they couldn’t cite Wikipedia. I told them that Wikipedia often had a mix of credible factual sources and biased opinions. Thus it was a good starting place, but they needed to use it only to sort the wheat from the chaff.
I don’t blindly rely on any one source. I try to verify from at least three different sources. AI tools are helpful in aggregating different sources and it often warns to check or that the data it provides may be questionable. For example, if it references the BLS or CBO I go to that original source. There is nothing wrong with using AI as a tool to assist researching a topic. If I want info on say SS or Medicare I go to .gov sites and the trustee reports.
AI can be a great help with research, but it needs to be used appropriately. Given that you mistook a private healthcare’s website for the NHS’s website you might want to evaluate your sources more thoroughly.
The length of wait times in the US depends on where you live, and it’s a large country. You can’t make a blanket statement like that. Probably depends on the type of specialist as well.
For example, see this study on access to ob-gyns. “There were 38 practicing OB-GYNs per 100,000 women in the United States, with higher ratios in metro counties (41) than in rural counties (13) in 2021-2022.”
It sure does. Rural areas have less access to all health care. That is not a revelation. I suspect the same is true in any country. Also a factor is the number of units per population which of course means higher costs the more MRIs available.
Fact is, we can’t have it all. You can’t have easy access on demand for services and low costs. One drives the other. The NHS attempts to manage that balance. The question is, would Americans accept that model or close to it? Not in our lifetime. Many still believe Obamacare provides healthcare.
You should have indicated your source was AI. I do not accept AI as a reliable source.
AI provides the source of each data it cites, plus I checked with three different sources which came up with very similar data. AI uses the same sources as if you used Google. It’s just as reliable as if you searched yourself. Are all the sources we find by any method always reliable? Good question.
A major problem with some AI search engines is that they don’t distinguish between credible and unreliable sources of information. Given this problem I would never simply rely on AI by itself. Instead, I would look at the sources it cites to see if the information is credible.
Many times they cite the source of the info right in the answer and in addition link URLs opposite data points.
I often ask the same question from three different AI services to see if they align.
Apparently you haven’t heard that AIs hallucinate. And again – cite your sources. And I use Duckduckgo, not Google.
And then there was the time I was supposed to see a hematologist for a non-cancer issue. Thirteen month wait. In the US. Four months is routine for a specialist, but this was extreme.
We just saw a hematologist within three days.
Maybe in some areas there are longer waits, but four months is not routine, but there are waits for sure that many Americans don’t acknowledge.
The average overall wait time for a specialist is about 31 days.
Well, it was thirteen for a hematologist here, but as I said, it wasn’t a cancer issue. Four months seems pretty standard, and we have two university medical centers plus a county hospital system. It was two months the last time I looked for a specialist, but maybe more than four for a rheumatologist as we lost a few.
In less well-served areas it must be worse.
Again, you need to cite your source.
But you are in North Carolina, right. In the last two months we have seen oncologist, gyno- oncologist hematologist, urology/gynocologist, had a CT and PET scan, numerous tests with no wait beyond our own scheduling preferences.
Again, you are dealing with cancer, right? I needed to see a hematologist for a non-cancer consultation.
Exactly. My dermatologist has a five month wait for a routine full body exam. However, when I called to report a suspicious lesion she saw me the next day. Scheduling with my gastroenterologist is similar. I have colonoscopies every three years because I have had benign polyps on three occasions. After moving to our present location, I had to wait 7 months to be seen as a new patient, but had my choice of several available times in the next two weeks after my initial evaluation.
My youngest daughter was diagnosed with thyroid cancer two years ago. Surgery happened six weeks after diagnosis, and targeted radiotherapy started five weeks after surgery. Thankfully, the treatment was successful and she’s now in remission. It was terrifying for us all at the time, but the treatment was prompt and professional. I’ve never had a bad experience with the NHS, although I know it happens.
To me, our Medical System very broken and is a MONEY making system for Insurance companies, Drug companies and the like. We need to change it to keep us healthy and not rob us when we are sick. The other day, Walgreens wanted to charge me with insurance, $80 for a generic drug, when the Pharmacy at the hospital charged $20 for exactly the same thing! You have to be observant and check as best as you can to compare, even though difficult or sometimes in hospitals impossible. The entire Medical system is broken, and it is difficult for me to believe Hospital’s are Not for Profit. We need an overhaul NOW.
That simply is not accurate regarding insurance companies.
Insurance is not the medical system, it’s insurance. The net profit margins for the top insurers is around 5.2% considerably less than regulated utilities. High premiums don’t go into the insurers pocket. The law limits their loss ratios (premium income vs paid claims).
You have to look at the big picture not what a facility may charge for one item, other items may be the opposite.
First we need to fix the coverage and payment system to assure one regional payment for the same service and that there is 100% coverage for health insurance.
Only then can there be an accurate evaluation of the care we receive. Right now everything is skewed by different payment systems and lack of any insurance coverage.
Responding to R Quinn’s numerous uninformed comments, here’s an up-to-date ranking of world health care systems. The U.S. doesn’t fare all that badly (except for being in a league of its own for inefficiency and high costs) but it should be obvious that it is in no way an appropriate thing to be crowing about. What it comes down to is that civilized countries view health care as a right – just as they do transportation infrastructure, clean air and water and so on. What we have instead is what the French call “capitalisme sauvage” – unbridled prioritization of money making hand over fist by a few at the expense of the common good.
https://www.usnews.com/news/best-countries/rankings/well-developed-public-health-system
Uniformed? I may be uniformed on many topics, but this isn’t one of them.
I have been pushing Medicare for All for years as the only viable way to improve our system of coverage. However, your description of our system is not accurate. You would not have the high level of care, the drugs, the technology and related equipment if it were not for the profit motive.
Of course, with that there are some undesirable incentives which need to be handled, but that requires a number of controls the American people cannot accept – now at least.
I recently retired after 43 years as an RN in hospitals. I tell people that I was in “sick care”, not healthcare. The entire system is designed with making money from disease, not creating a healthy population in the USA. I am a devout capitalist, but there have to be limits and a better way to provide healthcare.
Ken, I hear that often, but never hear any way to create a healthy population that doesn’t already exist if anyone wants to use it.
What system would not make money from disease? What system does not make money from any form of insurance?
As an RN you made your livelihood from the system as do millions of people connected to health care. Actually people make small fortunes selling stuff to supposedly make us healthy, even garlic and stuff for our brain. People make money creating and selling vaccines too.
I seriously doubt anyone would be happy with a non- profit healthcare system.
Our goal should be universal coverage, fully integrated patient data to minimize duplication and unnecessary tests, etc. and uniform fee and payment schedules so we avoid the crazy differences among payment systems – Medicaid, Medicare, various insurances.
If an office visit fair price is $75 that’s what should be paid by everyone. That would mitigate the incentive to create office visits for those with higher fee allowances to offset Medicaid fees that don’t even cover costs.
Paying for and sometimes receiving healthcare is a mess and driven by so much misinformation among Americans I wonder if we can ever fix it.
“I seriously doubt anyone would be happy with a non- profit healthcare system.”
Apparently you didn’t notice that the Brits were so happy with the NHS that they featured it in the Opening Ceremony of the 2012 Olympics. Of course, that was before the Tory government starved it of funds.
Perhaps you didn’t read the article I posted below about the disastrous results of private capital taking over a hospital system. Of course, people need to be paid, but that is different from operating a for-profit system.
Maybe you could spend less time hanging out on social media and actually investigate how the French, German, Swiss, Swedish etc. systems work before insisting on inserting the profit motive where it doesn’t belong.
I would have to agree, there’s nothing wrong with non-profit. When I was working, one of the best employer health care plans I ever had was a not-for-profit Blue Cross Blue Shield plan. That was before their new CEO made them for-profit.
A non-profit is focused on patient care, a for-profit saving money. CEO’s don’t like non-profit because they can’t pay themselves big salaries.
Wow!
I worked on health care plans my entire working life as I have described before.
Actually, I have not only investigated those systems, but interviewed people in all those countries, plus Spain and Portugal. I once spent an afternoon on the Queen Mary talking about health care with union leaders from London.
I have also discussed their care with friends in England and Paris.
To be honest, I never met anyone who claimed not to like their system.
But they are not Americans and have different attitudes about health care and taxes and generally accept as normal what most Americans reject outright.
And their systems sometimes incorporate elements of profit as well.
In other words, plenty of people are happy with non-profit, or predominantly non-profit, systems. And many, many Americans are unhappy with their for-profit “system”.
Many Americans are unhappy with their premiums, and even unhappier when anyone who tries to limit or delay any and all care their doctor orders. Americans see premiums as pure profit and blame insurance but ignore the link to the care they want, demand, don’t want delayed and don’t want to pay for.
if you invest in a PET scanner for say $1.5 million, you pay for it by using it. That isn’t a good incentive. The alternative is for government to pay for it but also determine how many and where they are placed which then determines the availability. That is the tradeoff Americans don’t want to recognize. So, for profit increases costs, but non-profit affects care and convenience.
One friend in England waited over nine months for a hip replacement in part because she was told she had to lose weight. Another was denied knee replacement for the same reason. Perhaps it was good care, perhaps to save money.
In either case we have a very long way to go for Americans to accept such control.
“That is the tradeoff Americans don’t want to recognize.” too broad a statement. As people experience our ‘system’ (more like ‘systems’), they come to realize the difference between theory and reality.
Not sure what you mean
Not sure whether this link will work, I don’t see an option to gift. Headline: “What happens when private equity takes over hospitals”. Surprise: nothing good.
Or you could deal with this.
Many sources indicate that UK hospitals are underfunded, with the British Medical Association stating that growth in health spending has been below average since 2010, leading to a cumulative underspend and impacting the ability to staff, modernize, and meet demand. This has resulted in significant challenges such as long waiting lists, staff shortages, and a crisis in emergency care
The late unlamented Conservative government starved the NHS of funds and Brexit starved it of staff. You may have noticed that I suggested France, Germany and Switzerland as models rather than the UK.
Still doesn’t distract from the fact that UK medical outcomes are superior to the US system. If anything, it highlights that even when struggling it still surpasses the US system. After leaving banking my wife Suzie worked for the NHS for fifteen years controlling surgical waiting lists for a number of cardiac and thoracic surgeons. The main takeaway and problem exacerbating waiting times was the simple fact of patients not turning up for appointments, causing procedure and surgery time being wasted. It seems providing free medical care can cause people to take it for granted. Suzie even had instances of patients telling her they didn’t come for surgery because it was their golf day.
Sorry, but as a I said it is not accurate to say medical outcomes are better in the UK. The statistics you note are not related to the health care system, but the access system and other factors. For the great majority of Americans excellent health care is normal, but too expensive. Our system is poor on coverage and too complicated and inefficient.
Even if we accept that the US has excellent medical infrastructure—perhaps the best in the world—you can’t evaluate it in isolation from the healthcare system as a whole. It’s like claiming your car is superior because it has the world’s best engine, while ignoring that the body rusts out after a year. No matter how exceptional one component is, if the overall product fails to deliver, it’s not a good system.
Our system of accessing and paying for care stinks. It is uncoordinated and overly expensive. In part trying to meet American expectations for more and more sophisticated and quick care.
We are also the most obese country in the world-aside from a few islands.
A substantial percentage of patients fail to follow their doctor’s advice or take medication as prescribed and not just because of costs.
Infant mortality is extremely complicated among many factors including reporting methods among countries and of course concentrated in certain low income populations.
Our system does not deliver as it should for the entire population. No doubt about that.
However, that is different from the quality of care that is available and provided to the great majority of the population.
I guess, on this topic, we’re at the stage of splitting hairs. But one thing I can say with heartfelt honesty: I’m glad your nation has world-class cancer care, and my fingers are crossed it works its magic for you and Connie.
Medical outcomes are better across OECD countries, not just in the UK. See here.
I agree with comments about lifestyle being a part of the solution. I owned and ran a small business for decades. I simply couldn’t afford to get sick, take time off, etc. When I began my first business I had a high-deductible health care policy. Basically a major medical policy. I preferred to spend elsewhere and that meant avoiding illnesses. I paid most of the bills related to my children’s childbirth and pediatric care out-of-pocket. Note that their insurance benefits kicked in after childbirth.
Things changed with growth and more employees, who argued for more benefits, etc. None ever argued to work more hours to achieve those better benefits. It is a competitive market, but there are limits. I think that is the real point of the WSJ article.
When the financial pain hits home, that is when real change begins. (For example, in another WSJ article: Union Pressures Democrats to End Government Shutdown The American Federation of Government Employees, representing more than 800,000 federal workers, urged Congress to end the government shutdown. “Both political parties have made their point” and ““It’s time to pass a clean continuing resolution and end this shutdown today,” AFGE president says.)
I lived a life of moderation, what some would call a “healthier” lifestyle. That included diet and exercise. Which is one of the reasons I did most of my lawn chores, etc. Pushing a lawn mower was part of a structure for fulfilment. I also avoided junk food, soda and alcohol. Oh, and today I avoid those flying petri dishes, too.
I’m six feet tall, medium build and for most of my life I was a trim 165 pounds. Same today, after a major illness, although I’ve lost muscle mass.
My lifestyle showed up in unusual ways, including my driving habits. An automobile accident could have resulted in a hospital stay. However, I was once struck by an automobile as I was in a crosswalk. They dragged me protesting to the ambulance. After sitting in a chair for two hours dripping blood I walked out of the emergency room with a bag of bandages and a few scrapes and contusions, etc. I never was X-rayed. There was a bill, of course. (Chicago, Illinois).
Back when there wasn’t the level of diabetes that exists today, there weren’t designer drugs, either. Junk food and soda was rare when I was a child. Of course, the naysayers tell me this has absolutely nothing to do with the state of health in the U.S.
Like the public education system we spend a lot of money supporting the medical system, with diminishing returns. But more money and more drugs doesn’t solve the health care problem.
It reminds me of the political system. I’ve seen surveys that indicate most Americans loath Congress, and that was before Trump. However, they generally gave their Congressmen and women high marks. Same is true of the medical system. Yet we generally like our doctors. How can that be?
Many will vote for more benefits, which is not better care.
The healthcare system we have is a result of the political contributions those benefiting from it make to politicians. There will be no changes for the better unless we change that.
There is a tendency in the U.S. for the consumer to conflate insurance with health care. The politicians are promoting this again.
My spouse became very ill at age 57 in 2014. She became unable to work and went on COBRA. She had intended to work as long as possible. When COBRA expired we switched her to ACA mandated insurance. As I recall, her premiums were about $9,000 per year. We also paid for a lot of her care out-of-pocket.
In fact, we reviewed ACA plan alternatives each year and looking at premiums and deductibles, her out-of-pocket costs were basically the same for all plans in all tiers. This was a factor in my determining how many hours to work each year and delayed my full retirement. She is currently on Medicare.
Today I understand that about 25 million are on such “affordable” care insurance. And, oh, my spouse wasn’t able to keep her doctor, etc.
The root of all of this is the politicians.
25M on ACA until 1/1/26 when subsidies for so many are not renewed due to lack of legislation. Going to hurt millions.
I agree 100%
Norm, I have to dispute your last line. The root of all this is the voting public, less than half of whom can be bothered to vote for his/her Congressional representatives in non-Presidential elections — and who widely decline to prioritize healthcare policy when they do vote.
The US healthcare system will only change when the American voter chooses to learn how the system really works and what changes are required, and elects officeholders based on those priorities.
Which will occur, in the words of Johnny Mathis, on the Twelfth of Never. We will remain stuck in this system because it is what the electorate chooses, through ignorance or ideology or indolence.
You forget the massive amount of money spent on lobbying. Unless we can get money out of the political process things are not going to improve. And I have no hope that will happen in my lifetime.
Your argument assumes voters have the choice of at least one candidate who supports better healthcare policies.
Or that if the voting public starts expressing a desire for such policies, candidates will emerge who support them.
The US has poorer overall outcomes in several areas, but it is not related to the quality of our healthcare, it relates to our disjointed system.
The biggest problem with US health care is the incentive structure. Doctors are rewarded for performing procedures, they are not rewarded for helping people stay healthy. Also, the quality of your care has a lot to do with where you live, and what insurance you have.
Your access to care is certainly affected by insurance, but not the quality of care once you receive it.
The notion of paying to keep people healthy has been discussed for years. It was the (mistaken) foundation for HMOs back in the early 1980, it’s mostly a red herring. There is little a doctor can do to keep a person healthy as opposed to what the individual can do.
Most people do not always follow doctors’ instructions, with studies estimating that 50-60% of patients do not take long-term medications as prescribed and up to 80% may not follow lifestyle advice.
If you don’t have insurance you put off seeing a doctor until things get bad enough you go to the ER. Obviously your outcome would have been better if you had been able to get treatment earlier.
The US has too many well-paid specialists and far too few worse-paid generalists and geriatricians.
You have a good point there.
Doesn’t early detection require diagnostic tests? You’ve argued that we get too many of those.
i know way too many people with insurance — some in my own family— who have put off seeking medical attention. The argument that with insurance more folks would get timely care is very simplistic.
Both comments are true.
Too many tests, that have limited value and carry risks. That is why there are guidelines for frequency of certain tests, scans, etc.
Also, true that the existence of insurance does not automatically change individual behaviors.
Well, there is surely no question that without insurance people do not get timely care. I am not against diagnostic tests in general, I am not even against colonoscopies for high risk people. I am wary of testing when there are cheaper options and especially when there is a risk of harm.
You’re singing to the choir again, Quinn. I jumped onto the high deductible, Health Savings Account bandwagon as soon as I could. They were supposed to make us better consumers of healthcare, however, if hospitals can’t tell us the cost of a procedure, how are individuals ever going to become savvy healthcare shoppers?
Regarding the uninsured using emergency rooms for primary care, I wonder how the problem will be exacerbated by changes to the Affordable Care Act, and also the effect on the paying customers.
Little to none of uninsured treatment cost is free. It is reflected in the healthcare premiums for all others. They pick up the bill. So all kicking people off of Medicaid will do is push up the premiums of the insured. There is no free ride!
Worse, people are likely to miss out on preventive treatment, and wait for care until they are really sick, thus costing more.
People who need healthcare are never consumers and never will be. Oh, they probably will ask for a generic drug or maybe go to a primary instead of the ER, but when it comes to a serious illness for themselves or a loved one, they are not going to nor should they have to shop for the lowest price.
Congress eliminated Medigap Plan F because they were told seniors would use more health without a deductible. That’s ridiculous.
The reality is once you enter the health care system you are going to follow where it takes you relying on who is providing your care. The idea anyone can factually determine the quality of care (especially in advance) is questionable at best.
What really blows my mind is the large differences in health care costs from state to state and county to county within a state. (Including Medigap premiums)
Did you mean to reply to Dick’s comment to Marilyn? This was my post, not his.
LOL, substitute Kathy for Quinn. I totally agree with you Kathy.
I once asked my son who is a doctor why health care is so much more expensive here. He offered this example. If I went to my local ER tonight and complained about chest pains, I would likely be in cath lab within a short time for tests. In most other places, I’d be observed for a few hours, and if I remained stable I would be given a couple of aspirin, and sent some with instructions to call my doctor in the morning, My son said that the latter treatment was likely to be 95% correct. Not bad odds, but I’m risk averse so I’d prefer the US treatment.
I also favor a colonoscopy over Cologuard, the pill is highly effective— but not 100% — in detecting polyps, But if it does detect something, a colonoscopy is necessary; I’ve known people who were very upset dealing with the possibility of a cancer diagnosis while waiting for the procedure.
i did one time have a $17 EKG in Costa Rica. I can’t imagine the cost here. But I don’t begrudge the money I spend on heath care. Before we became eligible for Medicare, we always paid high premiums, so I’m not one looking for Cadillac care on somebody else’s dime,
Personally, I would prefer to forego the tests if the odds were 95 to 5. Cologuard isn’t a pill, you send a stool sample for a test for DNA and blood markers. Yes, there may occasionally be a need for a follow up colonoscopy, but there is also a non-zero chance of a perforated colon from the colonoscopy. But the real issue is the cost – colonoscopies are a nice little profit center for the doctors performing them.
Precancerous polyps are found— and removed— in a third to a half of colonoscopies . I think it depends on age. I think Cologuard is a great alternative for those who are unwilling to do a colonoscopy — colon cancer is definitely on the rise — but personally I’m willing to undergo the misery.
The US health care system isn’t perfect, but there alsoare shortcomings with other models.
A lot of cases of prostate cancer are better left alone, equally we have no way of knowing how many of those “precancerous” polyps would have been fine left in situ.
There’s pretty good statistical data on the intestinal tract cancer prevention effect of colonoscopies. So while it’s true that you can’t know with certainty when discussing an individual case, one can speak confidently regarding the community effect in preventing cancer. Of course, prostate cancer is something else entirely and unrelated to colonoscopies.
As long as you are willing to pay for the most comprehensive often defensive care, but most of us are not paying, someone else is.
Certainly our premiums at any level do not pay for care we receive beyond very basic routine outpatient care.
We pay a bit over $2000 a month is premiums. Our healthcare during 2025 so far has cost many times that and will rise considerably over the next several months.
I feel any health system model ranging from the UK/Nordic Beveridge, European Bismarck, or Antipodean/Canadian National Health Insurance system would be better than the current dysfunctional US model.
Have you ever had any first hand with the US health care system? I find your blanket indictment very strange.
I admit no. My thoughts are this: a system that costs twice as much as comparable systems, produces worse overall health outcomes by every recognized metric, and doesn’t embrace universal coverage for all is not a good system. It’s certainly great and wonderful for those who can afford it, but that’s not a glowing recommendation for the large minority who live in the shadows of the US medical system that treats health as a commodity rather than a basic civil right. It’s designed to work brilliantly for some, adequately for many, and catastrophically for millions.
Hard to think of anything worse. It’s not like anyone planned it.
My wife’s job entails dealing with managed care companies all day long, and the insane amount of time it takes to get approvals just boggles my mind.
She frequently has to go back and forth for months at a time, with invoices being denied over and over, even when coverage is guaranteed according to the provider’s own documentation. Some cases have to be referred to the state for a final decision.
I can’t even begin to imagine how much this costs us, the people who actually pay the premiums. My wife makes a six-figure salary just to fight with insurance companies. She had more than $5MM in denials overturned this year.
My siblings live in Canada and Ireland, and both countries have their issues with healthcare, but when I was looking for coverage for my daughter while she was in college in Ireland, the plan I picked was $445 – for a year!
I thought that was going to be the monthly charge. It included $100,000 of coverage to have her flown back to the US if necessary, and covered her for travel around the world.
I think 2 facts contribute to encouraging insurance company denials. First, statistics show many people don’t dispute health insurance denials. Second, many insurance company management teams’ compensation packages are tied to the profitability of the company. Put the two together, and the outcome isn’t surprising. I’m reminded of Charlie Mungers famous quote “show me the incentive and I’ll show you the outcome”. I agree our system is seriously flawed.
Not accurate at all.
Actually, it is very accurate.
Thanks for the example! BTW, I believe that in Northern Ireland your daughter would be entitled to register with a local doctor under the NI version of the NHS rather than needing insurance. Perhaps Mark can clarify.
This was in Dublin, and she only stayed for one semester. Even with an Irish passport she didn’t qualify for free healthcare because she didn’t meet the residency requirements.
When a student applies for an education visa, they have to pay a separate Immigration Health Surcharge to access the National Health Service, at an approximate charge of $1000 per year. This covers unlimited use of the health system.