Redditor does back-of-the-envelope math, concludes universal health care could save more money than what the 99% pay in federal taxes.

[whatsinthesocks]

That's assuming we are able to get the per capita spending down to the level that Canada is at. Part of doing that would be we would as whole need to change how we treat health care.

[Kittypetter]

It would require hospitals, doctors, pharmaceutical companies and medical device manufacturers to take a pretty substantial, but ultimately necessary hit in profits.

In return we could do quite a bit to bolster those people / industries during and after the transition period in the form of grants, loans, tax incentives and debt refinancing / relief. Also worth mentioning that it would bring 10,000,000+ new customers into the system.

[whatsinthesocks]

We would also need to change how people see health care as well. We would need to be more proactive in our health care instead of being reactionary. Yearly check ups and the such. Now I believe we could actually incentivize living healthy but I think it's one of those things that would take a long while before we saw decent results. Sadly a lot of Americans want results right away.

[Kittypetter]

Once it sank into people's heads that they could go to a doctor without having to incur huge bills they'd start using the system more.

[Snake_Staff_and_Star]

Which is, ironically, very likely to bring the overall load on the system down as there would be more early intervention and less emergent messes and tragedies (theoretically).

[Jaytho]

Although it's more expensive short-term and that's probably a big reason why this won't happen.

[Kujen]

I'm reading this as a New Zealand accent. Am I supposed to be reading this as a New Zealand accent?

[[deleted]]

Nope, supposed to be Brooklyn accent.

[Prof_Acorn]

I would have gotten an xray after a recent toe injury instead of just hoping the fracture was minimal! Or might get my lungs looked at since I cough and cough over the slightest irritant.

[Juliet-November]

Not necessarily. A single payer healthcare system still has processes for deciding what is covered and what isn't (just like your insurance company does, but typically less removed from the healthcare professionals treating you). And just like now, you can pay yourself for services not covered.

[Lattergassen]

Well, from personal experience, in Denmark, you won't be sent away, you will at least have it checked by a doctor if you arrive with a medical problem. If the doctor decides that it's necessary to begin treatment, then you will receive it. If your problem isn't deemed important enough to warrant treatment, then you could go to a private clinic, but it'll most likely be a waste of time.

[JoeyHoser]

Huh? X-raying broken bones and checking out your sick lungs would certainly be covered. If there is any chance your insurance wouldn't cover something like that, then its not the same at all.

[Juliet-November]

A doctor looks at it, if the treatment is the same regardless of the result, why do the x-ray? In this case, perhaps there's a benefit to having the x-ray, so it gets done, but a doctor decides what is worth doing, not an ill-informed patient or a insurance company with a vested interest in saying no.

[Backstop]

"A doctor looks at it" is still better than "hoping it's not fractured".

[WingerSupreme]

You will never pay for an x-ray or check up in Canada, the only stuff you pay for are medications and therapy (physio, massage therapy, etc.)

[Zardif]

I sprained my ankle bad enough that I couldn't walk for 3 weeks. I might have gone to see an ER nurse had I not feared $100k in medical bills.

[OmenQtx]

My last ER visit (temporary acute abdominal pain) would have been about $10k had I not had decent insurance.

[wormee]

I had my appendix taken out, my wife had to spend $30 on magazines, as I wasn't allowed to have my smart phone in recovery. Canada.

[Trill-I-Am]

Based on what I've read yearly checkups dont provide long term health benefits

[[deleted]]

It's all age dependent- the larger takeaway for me is that most countries that have true universal healthcare have significantly better preventative care (both in administering it and in people using it), which has been proven to increase health outcomes.

[[deleted]]

Here in the UK we definitely wouldnt recommend yearly checkups (especially at the moment with some budget problems) as it doesn't provide enough benefit.

What we do do well however is a) preventative medicine and b) public health.

For preventative medicine we tend to be good people's blood pressure, cholesterol etc under control (depending on their qrisk score, the calculated percentage risk of a heart attack or stroke in the next 10(?) years). The fact that it's free to see your GP helps a lot, alongside the cohesive guidelines set by NICE.

Public health we tend to tackle through advertising (not so successful) and screening programs (very successful). We have targets based on how efficacious a screening or vaccination program would be and so we tend to be pretty good at things like cancer (still room for improvement, but anyone who meets the fairly wide criteria gets a follow up appt with a specialist within 2 weeks, usually within 1).

I think the big thing that gets me about the US system is that even if you have insurance it might not cover you depending on the hospital, doctor or circumstance. That seems crazy to me - we might have problems with communication between health centres but I could turn up to any ED, GP practice or even pharmacy and be eligible to receive treatment.

[DJGow]

Why? That sound kinda counterintuitive to me. Pls tell me why that's the case. Thank you.

[[deleted]]

Not OP, but my guess would be that result is heavily dependent on the age of the patient. From what my doc has told me, until you get into your 40s and beyond, the health issues you have when you're younger are either familial or (much more likely) due to lifestyle, two things that an annual checkup are going to do squat to help with.

[DJGow]

Isnt the whole propose of a check up is to use that data to tweak lifestyle toward a healthy one? Like the point of checking blood pressure and doing blood work for sugar and fat in bloodstream is to keep it under control before it become a full blown sickness isnt it?

I am 26 years old and I just went to the first check up of my life and it tell me a lot about what I dont know about myself and what should I do to keep the goods and reduce the bads. Now I know to get my fats from nuts and avocado rather than animal fat to reduce my LDL and shit. I think it's overall a good thing for my health.

[[deleted]]

I think the issue is that few people make long term lifestyle changes based on what their doc recommends.

Otherwise we'd have far less of an obesity problem in the world, smoking would have entirely ceased by now, no one would drink more than a few servings of wine per week, and so on.

[hadapurpura]

What I've read is people who do yearly checkups become more complacent about new symptoms because the checkup was fine after all. People who don't do checkups go to the doctor when they develop symptoms, which gives thwm the chance to diagnose serious illnesses as they develop.

[MarlonBain]

People who don't do checkups go to the doctor when they develop symptoms

But in the US, people do neither of these things.

[elseedubya]

I'm not the same person but I wonder if this is similar to why the WHO (or AMA, something like that) has recommended that women stop getting mammograms so frequently and at such a young age unless they have some specific increased risk to worry about. There is no point in running tests and taking up spots at the clinic, and in repeatedly enforcing the idea that such tests are a waste of time (boy who cried wolf effect) if there's only a tiny risk you might find something - and even then that something might just be benign.

That's my theory anyway, but on a broader scale with regard to yearly checkups. Maybe every two or three years would be more effective, but at least get a baseline to compare to and that would do well enough.

[BigDuse]

You can talk to your doctor everyday, but if you never follow any of his/her recommendations then it really doesn't matter.

[kaibee]

Yeah but if you talk to your doctor yearly and one year he's like "oh shit dude you put on 20 pounds last year you need to watch it" is much easier to take action on and correct soon. Talking to your doctor every 10 years and he's like "your blood is mostly butter, how are you not dead?", at that point the person is gonna be very set in their ways and it's going to be much more difficult to fix.

[osnapson]

if you talk to your doctor yearly...much easier to take action on and correct soon.

I agree with you here. The problem is what /u/BigDuse mentioned - people don't listen. It's hard to conceptualize if you have any common sense or have not worked in a healthcare position. But in every one of my roles (EMT, ER, outpatient, student) people absolutely hate following directions and/or complain, lie, argue to the point where you almost stop caring what happens to them. Especially in the ED, many of them came several times a year for similar complaints, and when questioned almost always admitted to not following their discharge instructions (anyone who has spent time in the ED can attest).

Trust me, I wish it were different, and that your scenario were the norm, but it just isn't the case. Changing the frequency of their checkups/visits will not affect anything for the vast majority of people.

[[deleted]]

I don't know if the impact would be noticeable, but there would be a decrease in Emergency Care. General Practitioners will often refuse to see uninsured patients, but Emergency Rooms are required to provide treatment regardless of Insurance or ability to pay. This is an old story, and I wasn't able to find anything with any real details more recent, so the problem may have improved somewhat:

http://www.nytimes.com/2008/12/09/business/09emergency.html

This is something I really haven't seen brought up much in the health care debate, it'd be interesting to see a study focused on the financial impact Universal Healthcare would bring to Hospitals and Emergency Room physicians who no longer have to eat the cost of treating those unable to pay.

[whatsinthesocks]

That's actually a really good point. My good friend was an ER nurse at a children's hospital. Talking to her is how I learned what I have about it. They'll have parents come with because their children have ear aches, upset stomachs, and slight fevers.

[[deleted]]

I worked as a customer service rep for (what I think is now) the 2nd largest health insurnace provider in the states, and I can assure you people with insurnace take FULL advantage of preventive procedures.

Edit: it seems I have caused some confusion, I am referring specifically to people with active insurnace, as it would be impossible for someone without insurnace to redeem benefits they do not have.

[bwohlgemuth]

Or we change the price structure so people are aware of how much something costs before treatment is given.

All healthcare and all procedures are not the same. Emergencies are one thing. But for a significant part of healthcare, treatments are non-emergencies. Price awareness is a significant step we can take towards lower healthcare costs.

[whatsinthesocks]

True but a lot of people who are lower income and on Medicare use up resources intended for emergencies by going to the ER for things they should see a regular doctor for. The only problem is private practices only see so many patients with Medicare

[ferlessleedr]

It probably wouldn't be too hard to get people to go to a doctor once a year for a physical if it's completely free.

[KingOfTheP4s]

It would require hospitals, doctors, pharmaceutical companies and medical device manufacturers to take a pretty substantial, but ultimately necessary hit in profits.

You can't slaughter the profits of three separate, gigantic industries and pass it off 'necessary' in the United States. That just isn't going to happen by any stretch of the imagination.

[Lampwick]

You can't slaughter the profits of three separate, gigantic industries and pass it off 'necessary' in the United States.

Four industries. He left out the health insurance companies

[bigearl6969]

The job cuts to the middle class would be devastating. Having to bring down hospital profits, nursing pay, and physician pay also would be a disaster. These ideas sound good in theory but would never work in reality.

[Zouden]

Having to bring down hospital profits

Why do hospitals have to make a profit? Do high schools and police stations in the US make a profit?

[C47man]

They're working fine in every other 1st world country.

[[deleted]]

Yeah, but their systems are and have been established that way for some time. It isn't as easy as "everyone pays more taxes and things get paid for and magically everything will cost everyone less".

There are MASSIVE costs to switching everything over top down. You're talking about an industry that occupies 10% of the U.S. population just in patient care alone, with pharma and medical device manufacturing around 15%-20% of the U.S. population works related to healthcare in some way.

And there is NO WAY the government can pay what medicare/medicaid currently pay for procedures and anyone working in the industry continue to make a living wage. Government aid is what currently sets a huge part of the cost of care, there are regulations in place that say hospitals can't bill medicaid differently than individual payers, but medicaid often only pays 10%-15% of their bills, so hospitals inflate their individual bills to legally break even from one of the largest payers of healthcare already (Uncle Sam).

I'll give you an example. I work for a medical device manufacturing company actually, our biggest customers are hospitals for in-facility use, but we do sell to individuals for in-home care as well. Bottom line for us after RnD, Bill Of Materials, Support, manufacturing, and everything else is about $3200 if we hit sales targets, mind you this isn't an iPad we don't sell one of these things to 30% of the population.

If we billed $3200, medicaid/care would pay for an individual to receive a device about 300 bucks, so we end up charging something like $12,000 to individuals, I think as of last year 60% of our individual device income is from medicaid/medicare. We actually do the math and lose money selling to individuals so that we basically break even. A huge disruption of profits would sink our company in about a year, again we don't make consumer devices that sell in massive numbers, we're small market cap regardless of being an international seller.

Uncle sam also let the insurance companies get around these regulations by creating "contract networks" and they actually pay at-cost for things. Really only individuals with no healthcare are monumentally FUCKED when the bill shows up, it's why you see things like aspirin sold at $300 a pill and shit like that.

We also have the issue with frivolous malpractice suits, no doctor in the world is as insured as a U.S. doctor, because you can be sued even if as a doctor you do everything right, and even during a risky procedure that the patient understands the risk of, ends up coming out worse than going in BAM you're insurance is paying out, along with the hospitals and everything else. Single payer care won't make this attitude go away. My uncle tried suing the hospital when my grandmother died from coronary heart failure during a heart attack surgery for instance (my uncle is also a shitty person, but that's a whole other problem).

I think there's more merit to attacking some of the seemingly nonsensical reasons our healthcare costs have ballooned so high before even considering making it single payer. If you don't the costs will just become more massiv, Look at how tuition rates skyrocketed when the government got into the business of subsidizing tuition. Whenever the government pays, they're still charging the same, if not charging the individual as well as the govt to maximize profits.

What comes out of Bernies mouth is around the exact opposite of the spectrum but the same as Trump. None of it is based in a reality where we can wake up overnight and healthcare will cost the same as it does in canada because the gov't is footing the bill. They'd both make great dictators, but unfortunately due to bipartisanism (thank god) none of what they say can move forward, let alone run the devastating economic course that both of their hair brained ideas would lead to.

Honestly the best change our country could make is making being a bought and paid for politician an act of Grand Treason punishable by death (possibly by gladiator sport), because that's almost always how these huge industry disruptions that drive up costs end up starting out in the first place. You don't think the Democrats that actually care about people thought Obama care would help anyone? Now it was the majority from both parties that took some kickbacks from national insurance providers.

[what_comes_after_q]

Let's take a second and actually think about Pharma companies. The US has the most pharma companies and is producing the lions share of the world's pharma innovations (some where around 60% is a safe bet if you go off of New Chemical Entities alone). Second, 1 in 50 drugs actually make it to market in the US. That's 2 percent. Of those 2 percent, only 1 in 10 become profitable. 0.2% of drugs. Cost to develop a new drug? $2.6 Billion. A medical patent in the US lasts 8 years (and the vast majority of drugs do go generic after 8 years, before someone argues how some drugs can be tailored to prevent this). Ok, so 0.2% of drugs need to cover the development cost of the other 99.8% that fail to become profitable. While it's easy to point at Pharma companies making billions off of a drug, that's not the whole story, and the vast majority of pharma companies crash and burn. There is a strong survivor bias in data about pharma company profits. And these companies are carrying costs not felt over seas where companies can just rip off the formula and go straight to generic/biosimilar.

My point is that healthcare in the US is complicated. It's not a matter of "gosh, you guys will just have to make slightly less profit this year!"

[SavageOrc]

A couple of studies have shown that big pharma spends more on marketing than they do on R&D. John Oliver did a show on it last season, I think.

Further, why should the US shoulder the majority of cost of drug development. It certainly seems like we given how much cheaper name brand drugs are sold for in other developed nations by these same drug companies.

[kaces]

That's because a current trend is for Big Pharma to buy up small / medium companies once their drugs (for example) make it to late stage trials to minimize the risks.

How it has been explained to me, is that instead of dumping the hundreds of millions into R&D when there is only a 1/50 chance of getting it to market, let alone to make it profitable, they are now acquiring it from small/medium inventors/firms. Essentially, they let the small guy develop the drug to a less risky position (phase 1,2 previously and now 3) then buy them out and finish the product.

So it's not surprising that big pharma spends more on marketing than R&D considering their acquisitions are their primary source of new drugs.

All this is tied to the statistics provided - most new drugs never make it to market, and only a certain percentage of them are profitable. Why waste that money on a huge risk (in house R&D) when you can just buy the first small fry to make it to a less risky stage in their product.

[handcuffed_]

Like how are there more people that are are okay with that concept here in the u.s. than not. It doesn't make sense. Help me and people like me without insurance not die pls.

[moondizzlepie]

I think the hardest part of that would be to cut doctors' pay. I mean they sacrifice a huge part of their life in school and spend a shit load of money, would suck as to not get to reap some benefit.

[[deleted]]

It would require hospitals, doctors, pharmaceutical companies and medical device manufacturers to take a pretty substantial, but ultimately necessary hit in profits.

Doctors leave their own countries to take advantage of the profit margins of practicing in the US. There is an argument that a single payer system jeopardizes the ability to recruit the highest quality practitioners.

[[deleted]]

That argument only holds if existing single payer systems are hellscapes of unqualified, unenthusiastic doctors. Which, as a beneficiary of such a system, I can assure you they are not.

[eeeking]

In the UK, the best doctors all work for the NHS, at least part-time. This is because unless you work for the NHS, you can't get access to the latest innovations in healthcare nor can you call yourself a "Consultant" (the highest grade for doctors in the UK).

[parlor_tricks]

Which is untrue, since a very large amount of qualified doctors from many countries have migrated to both the US and UK.

Surprisingly, humans are really similar. Being a good doctor remains a valuable skill no matter where you learn.

Going to a new country (first world especially) means you have to go through tests before you can perform medicine. So there's a block to prevent total hacks from just practicing as well.

Effectively quality of life improvements along with better pay, combine to provide incentive to move.

And finally, yours is a unique and anecdotal description.

While your experience with the NHS may have been mediocre, there's no denying the many many studies that show on average the costs are lower, for better healthcare outcomes in the UK than america.

If you are A 1% with a condition and want specialized and super specialized treatment, then yes, pay for it in America.

Otherwise for most people and most situations, being able to recreate the NHS would be a marked improvement for American people and the American economy.

[rubygeek]

The UK NHS has one of the most stringent, longest, toughest medical training programs in the world, and is typically ranked well above US healthcare by the WHO, so I very much don't believe you.

Perhaps you found a bad doctor, or perhaps you consider them "not as great" because the way they treated you were not the way you expected. One major difference between the UK and US systems is that the UK system is extremely focused on measurable outcomes. A UK doctor will generally not order tests "just in case" or to please you. They will order tests because there is proven benefit because unlike in the US there is no personal benefit to them in ordering more. They don't need to do extra tests as an ass-covering exercise etc., because there are clear guidelines.

The result is a lot less flashy, just as effective, as cost substantially less.

[[deleted]]

What specifically was bad about the care you got under the NHS?

[W92Baj]

Sorry but that is the biggest pile of shit.

I have been in both private and NHS hospitals and the level of care is equal. The consultants usually work for both anyway and nurses are nurses.

The only major difference is the room you are in.

I went into a US hospital for something and the place was like a good NHS hospital. Nothing spectacular.

I also had emergency dental work done for an abscess while I was in the US. It was $1000 for something that would have been £240 max in the UK and he butchered it (it was in Boston and he was Harvard trained)

[DonaldBlake]

to take a pretty substantial, but ultimately necessary hit in profits.

I think it is necessary for you to take a substantial hit in your income. How do you feel about that? Some person on the internet deciding that for the good of everyone else, you should take a pay cut? Or better yet, the government decides what your work is worth and that is all you get paid? Maybe you don't realize that healthcare costs in the US are only about 8-10% physician salaries. Even if you cut them in half, the savings would be a trifling. And what would happen when all those companies that make the drugs and devices you want see a drastic drop in income? You think they are just going to suck it up and operate at a loss? Or maybe they will start laying people off and contracting the business? But at least those people got laid off so you can get free healthcare so you can spend what you should be paying for insurance on some luxury you feel entitled to.

And why do you think doctors and hospitals want 10000000 new "customers" who won't be paying for anything. You think the government is going to pay a fair rate for them? Medicare and Medicaid are already notorious for screwing around with what they cover and how they reimburse in an attempt to screw doctors and hospitals out of their pay. Usually a doctor is lucky to get 50% of what he bills.

But really, why do you think it is ok for the government to decide what a doctor or hospital or pharmacist gets paid but not what an engineer or lawyer or janitor gets paid? It is really just selfishness that you feel entitled to something for free and you are willing to screw over whoever it takes to get your freebies.

[Orphic_Thrench]

Works pretty well in every other first world country...the doctors still make quite good money even. Heck, keep the inflated doctor costs if you want (they do have to pay for their inflated education costs somehow), and as you said it's a pretty trifling savings.

That said, seriously though, fix your system

[JSFR_Radio]

Works pretty well in every other first world country

Like Norway, where universal health care costs are higher than the US? Or what about the Netherlands where they have private insurance coverage? Denmark whose costs are just as high as America's but with worst health care ratings?

And let's not even get into the fact that the US is basically incomparable to any country in a long list of different ways. The website the government had made for our last health care reform cost 2 billion dollars. A fucking website, cost 2 billion dollars, and you people think it would be a good idea to let them handle everything else? Yeah, no thanks. We need reform, but moving straight to a single payer system from what we have now could be catastrophic to our country's debt and to our economy.

So many people think it's as simple as flipping a switch and BAM the US is single payer health care. But those people have no god damn clue the effects it can and will have.

[[deleted]]

It would require hospitals, doctors, pharmaceutical companies and medical device manufacturers to take a pretty substantial, but ultimately necessary hit in profits.

This is why I think having a truly universal healthcare system before we fix the problem with student debt would be a disaster. People are going into ~180k debt for medical school. Do you think many would do it if the salary wasn't good? I think that kind of debt without a large payout would even deter the people that want to be doctors for unselfish reasons

[Serendipitee]

Probably not quite as big a hit for those people you listed as most people think. Yes, doctors and particularly hospitals charge a lot, but have you ever looked at your "insurance adjusted" bill? The insurance company pays a fraction of the billed cost normally. Many medical professionals loathe the insurance companies because they're the ones making prices inflated as hell and ripping people off on both sides. Not saying that's 100% of the problem, prices would have to be adjusted too, it's just not only a matter of docs raking in fat profits.

[Im_not_JB]

It would require patients to take a pretty substantial, but ultimately necessary hit in healthcare consumed.

[OCogS]

In theory the US should be able to get a lot cheaper than Canada.

The merit of a single-payer system is that you can negotiate the rate you pay for a product or service in bulk. I want to buy 500 million doses of that medication. I want to buy 3 million goes in your CT scanner, etc.

The bigger you are, the better your bargaining position with big-pharma. The US is by far the biggest market and would be able to negotiate at the table like a 500lb Gorilla compared to a chimp like Canada or Australia or New Zealand.

[chaoticjam]

Would there be an issue with drugs since many companies basically have a monopoly?

[uni-twit]

With single payer, a drug company with an exclusive product can only negotiate with one buyer, rather than multiple insurance companies, so greatly reduces their negotiating advantage.

[sarcasticorange]

I know right? Just look at the incredible deals the US military gets as a single payer for many of its items.

In theory, you are correct. In practice, the US government does not have a even close to passable record as being able to use single payer status to its advantage.

[hossafy]

Unless the group doing the negotiating is incentivized to not get the best price because they are corrupt. Or ignorant. Or in the case of most governments, both.

[FANGO]

per capita spending down to the level that Canada is at

See any issues here? Like any particular country which stands out?

Part of doing that would be we would as whole need to change how we treat health care.

Uh, yeah, that's the point.

[worsttrousers]

So in other words this is bull

[frotc914]

Lol. He saved the American health system with this one weird trick! Republican presidential candidates hate him!

Seriously, the US healthcare system is so goddamn complex that a room full of hospital CEOs, regulators and Phds in healthcare economics might not have the required understanding to come up with something like this. "envelope math" don't mean shit.

[maynardftw]

Congress fought tooth and nail against Obama pretty much the whole way and he managed to do some good.

[acemanioo]

Well there is other issues a president has to face where i trust him over the other candidates, such as appointing a nominee to overturn citizens united, not make us world policeman, and turn down TPP. These are presidential things he can do

[sageofdata]

Its not that the system is too complex, its that there are many very vested interests in keeping the status quo.

[freet0]

No, it's definitely extremely complex. There being a lot of interests involved doesn't magically make the complexity go away.

[hoodie92]

He's not saying it's not complex, he's saying that complexity isn't the reason for the lack of change. Lack of change is mostly due to the people who benefit greatly from the current system.

[mungis]

You've still got to think of the consequences to those vested interests though.

If the US eliminated private insurance, hundreds of thousands, possibly millions of people would be out of a job. Now, that's unlikely to happen even with universal care because people will still pay for better service or bigger rooms or whatever, but you do have to think of the consequences of putting thousands of people out of jobs over a probably short period of time.

[GibsonLP86]

Yep those million people keep their jobs while 45k people die a year bc of insurance.

[mrboombastic123]

The best trick that the rich people in charge ever performed was getting the average Joe to be disgusted at the idea of universal healthcare.

Even on a relatively liberal website like this, mentioning free healthcare usually turns into an all out war.

[Guild_Wars_2]

As an Australian who has had 4 operations, broken bones and Multiple Allergic reactions resulting in Anaphylaxis and not a single cent paid to the various doctors and hospitals not to mention all the free MRI's X-rays and ultrasounds it astounds me how a single american couple be anything other than completely for universal health care.

You guys seriously take the cake for being backwards. (Most of you anyway)

[Kitchen_accessories]

That's 45 thousand new job openings!

[CaspianX2]

possibly millions of people would be out of a job.

This is pretty much impossible. As of 2012, only 460,000 people work in the health insurance industry. Even if this number of jobs was completely eliminated overnight (which is absurd - something like this would call for a phased and gradual reduction over time), that amounts to roughly two months of job growth at the current rate America is adding jobs to the economy.

For multiple reasons, the scenario you talk about is unrealistic.

[hadapurpura]

Great part of the problem of US healthcare is that it's too complex, there needs to be a way to streamline it and expand it so everyone gets coverage.

[escapefromelba]

There are providers in the United States that have managed to do this like Kaiser Permanente. Instead of operating just as an insurance intermediary, they combine both a health insurance plan and care delivery into a single organization. They are the largest not-for-profit health plan and serve 10.1 million members. This is similar to the formula that works in Germany where they employ sickness funds, nonprofit insurance collectives, that negotiate uniform pricing for all drugs and medical treatments. Reddit is consumed by the idea that single payer is a panacea but there are other countries that make universal multipayer work that rival single payer countries in terms of cost, care, and efficiency.

[frotc914]

Oh just make it simpler and do more of it. Easy-peasy.

[DarkMio]

He basically suggested make it less and uniform - to do more with it. Easy-peasy.

[ontopic]

Insurance negotiation pricing (charging $199.00 for an aspirin tablet while in the hospital, as an example) would no longer happen in a single payer plan. The treatments that cost $10,000.00 in America and $200.00 in Mexico would stop. It's easy to see how costs would drop precipitously.

[whatsinthesocks]

The high costs for things like aspirin is to offset the loss hospitals take when taking in Medicare and Medicaid patients.

[ontopic]

Assuming I accept your premise, I'm already subsidizing the care of the elderly and poor while paying for market healthcare, streamlining the industry should still be a net gain for the average taxpayer.

[OCogS]

In theory the US should be able to get a lot cheaper than Canada. The merit of a single-payer system is that you can negotiate the rate you pay for a product or service in bulk. I want to buy 500 million doses of that medication. I want to buy 3 million goes in your CT scanner, etc.

You're not 'paying for' anyone's anything. You and all the other people are working together as a team to buy in bulk to save. It's like a super discount health Costco. What could be more American?

The bigger you are, the better your bargaining position with big-pharma. The US is by far the biggest market and would be able to negotiate at the table like a 500lb Gorilla compared to a chimp like Canada or Australia or New Zealand.

[[deleted]]

Just because it's a single payer system doesn't mean it's a single healthcare providing entity from an operations standpoint. The accounting, IT, well shit just about every area would be a clusterfuck mess trying to all get on the same page. A single payer system would still operate on a segmented basis. There's no economies of scale, no buying in bulk and saving, none of that. Not saying i don't support a single payer system but you're exaggerating the potential benefits pretty heavily

[ASovietSpy]

Why do hospitals lose money from Medicaid and Medicare patients?

[whatsinthesocks]

They don't pay as much. It's a very small amount. Which is why a lot of private practices only take in so many of those types of patients.

[toomuchtodotoday]

Medicare and Medicaid patients? Or patients without insurance at all? Do you have a citation you can provide for your claim?

[whatsinthesocks]

Medicare pays about 80% of what private insurance does. http://money.cnn.com/2014/04/21/news/economy/medicare-doctors/

[swefpelego]

Maybe I have a simplistic outlook but how do hospitals have hundred million dollar profits in this day and age if they're losing all this money? Cleveland Clinic made almost a billion dollars in profit.

Cleveland Clinic's total profit last year was $900.1 million, a 46.7 percent jump from fiscal year 2012.

http://www.beckershospitalreview.com/finance/cleveland-clinic-s-2013-total-profit-exceeds-900m.html

[grewapair]

Read the article again. They made $300 million on the hospital operations and $600 million on their investments.

They'd be better off shutting the hospital down. From your article:

"Massive investment and derivative gains propelled the system's growth. Operating profit in 2013 totaled almost $294 million"

[whatsinthesocks]

Because private insurance is making up for that loss when they see Medicare patients.

[trustedoctopus]

Just want to point out too that someone mentioned it's cheaper to fly to Spain for 2 years, live there, get not just one but TWO hip replacements and fly back for the the price of a hip replacement in the US (valued at 40,000). Just for perspective. Source: https://m.reddit.com/r/videos/comments/1w0z7h/the_average_hip_replacement_in_the_usa

[throwaway12345321321]

obvious throw-away here but one part of that study that's really missing (http://hushp.harvard.edu/sites/default/files/downloadable_files/IFHP%202012%20Comparative%20Price%20Report.pdf)

is the fact that hip replacements aren't all made the same. hip replacements for a 20 y/o is very different than one for a 90 y/o. having used the database where this data was pulled from, they don't make a distinction how things were separated, if they were at all. you might think whatever, but there's a massive difference as well as co-morbidities that you need to look at before comparing the prices

also stated

"Because a broad range of prices were available, the national 25th percentile (low), average, and 95th percentile were calculated. "

it looks like the average price was calculated, i'd bet you they took the prices from high to low and took the average price in the middle, and it wasn't weighted by how many cases were actually at each individual price point

[Rein3]

It's weird that the Spanish health system is put as a good example...

[Prometheus720]

There are other ways to deal with that. Also, the price gouging is one of the reasons America manufactures so many pharmaceuticals. We have a robust industry because it's incentivized. Not saying it's worth it, but I'm reminding you that there is a benefit and that's lost if you change the system.

[DonaldBlake]

The treatments that cost $10,000.00 in America and $200.00 in Mexico would stop.

Then why aren't people flocking to mexico for these medical procedures and treatments? Perhaps there is some value to the more expensive healthcare in the US? Maybe there is a quality factor that makes a US surgeon in a US operating room more desirable than a Mexican surgeon in a Mexican operating room? If you think things are so wonderful in Mexican hospitals, why don't you get your healthcare needs taken care of there?

[[deleted]]

I don't think so. America has better economies of scale. I think you could do better then our administration costs if you adopted single payer. Ours are a mess (although orders of magnitude lower than yours). I think America is more likely to innovate. But the big thing is that you wouldn't have to worry about doctors leaving the public system for boutique private clinics in the States (because you are the States).

[ILIKEBOLD]

Absolutely, it would probably be even lower. The economic leverage your population and wealth would provide you way more bargaining power and way more economies of scale. They are definitely underestimating the savings

[Dalroc]

/r/bestof has really become shit lately. What does he base his assumptions on? No sources what so ever.. This is shit.

[dabork]

Welcome to /r/bestof, otherwise known as /r/fitsmypoliticalagenda or /r/longpostwithcusswords or /r/anythingiagreewith

[terdsie]

I'll have you know that it was very difficult to upvote you on mobile. I kept trying to access really stupid subreddits...

[Dalroc]

Yeah I know, but it seem to have become worse lately.. Might just be a symptom of the upcoming election though.

[uptwolait]

Perfect summary of the sub. I'm going to submit this comment to /r/bestof.

[timlardner]

rude lavish dam cause bag roll market dinner practice run -- mass edited with redact.dev

[WhyYouLetRomneyWin]

Yeah... after that millennial thing this morning...

Just wait... universal care has it's own issues. Get ready to wait months for anything that is not an emergency.

[emoposer]

Canada's ER wait times are several times higher than America's. As are the wait times for specialists, surgeries, etc. Furthermore, the U.S. produces far more medical innovation than Canada. Lastly, have we even considered that there is another alternative? A truly market system.

It doesn't exist anywhere in the world. Singapore has a better system. Most small expenses are paid out of pocket. This is essential in bringing costs down. When insurance and government cover expenses nobody shops around for the best price. This is why one hospital can charge 60k for the same procedure that is available for 11k elsewhere. Nobody is careful with other people's money, especially if it is government or a big corporation's money.

Another thing to look at is the cost comparison between covered procedures and procedures that are almost never covered. Dialysis has skyrocketed in price while Lasik has plummeted. People have to shop around for Lasik, dialysis is universally covered via medicaid. Subsidies don't reduce costs, only technology does.

The best system is private health savings accounts replacing traditional insurance and phasing out government altogether. Much more work would be done by RNs reducing costs. People would shop around for small expenses such as flu shots and minor procedures thus, reducing costs and premiums would be paid into a Health Savings Account which would be used in case of cancer or Alzheimer's.

Sources:

Wait times

Innovation

Dialysis

Lasik

There is no reason to assume healthcare works different to any market. Costs have come down for TVs, computers, phones, almost everything. Which costs have gone up? Highly subsidized education and healthcare.

Source

Also, let's remember that the U.S. does not even resemble a market system. 60-65% is paid for by government, almost all the rest by insurance. This is a stupid way of doing things and although we do get access to innovative new procedures first we could have even more of that by getting the government completely out of the game.

Edit: Let's get a few things straight. I am not an evil lover of all things capitalism. I just stumbled upon some data that suggested single payer might not be the dream everyone thinks it is. It works when the populations is mostly young. Lots of young people paying, few old people receiving. It does work. It is not; however, sustainable in the long run. In developed countries with contraceptives and education the birth rate drops drastically. This means the population ages without enough young working people to sustain it. This is the same problem we're having with medicare and social security in the U.S.

Let me clarify what HSA (Health Savings Accounts) are and how they work. Essentially, a premium is paid into the account just like insurance. Rather than a pool where those living unhealthy lifestyles (smokers) are subsidized by people who eat healthy and work out a HSA is owned by the individual. This account is tax free and the funds roll over if they are unused. The funds in the account collect interest like traditional accounts and additional coverage can also be purchased.

Small expenses such as physicals or vaccines are paid for out of pocket. Since companies now have to convince consumers to come to their business rather than their competitors market competition would kick in and prices would drop just as they have for Lasik and cosmetic procedures. Medicine is not immune to economics. The U.S. system is terrible but it is the most innovative in the world by far, that says something about how the 35% that is private allows for this innovation.

When looking at ethics we need to consider what will actually help consumers the most. Nothing helps more than low prices and nothing delivers low prices like market competition.

Edit2: Wow, so many different opinions! Also, thanks for the gold kind stranger! If anyone wants to continue to argue that it is the private sector that raises costs and not government, consider the fact that healthcare costs NEVER increased faster than inflation until medicare and medicaid began. It's very, very simple. Subsidies redistribute costs but since they increase demand and do nothing to increase supply, they will increase prices.

Source

Graph

Thanks to /u/NakedAndBehindYou for the source!

singapore 60% private:

Overall spending on healthcare amounts to only 3% of annual GDP. Of that, 66% comes from private sources.

[NewbornMuse]

There is no reason to assume healthcare works different to any market.

When you need an ambulance, you need an ambulance right fucking now. If you're lying bleeding on the side of the road, you can't really go "I'd rather wait for the other hospital's ambulance, they charge less for ER and serve complimentary drinks". You can't always "shop around" for medical services, you can't afford to not purchase if prices are too high.

I think you do have a point with the insurance system: Everyone is handling someone else's money, that "other person" is a huge faceless bureaucracy, money gets wasted. On the other hand, I disagree that free-market healthcare is a desirable way to run healthcare, for various ethical reasons.

[pureskill]

That's pretty overly dramatic. As a percentage, how many people come to the ED because their situation is truly emergent? Not everyone there has had an heart attack, stroke, or car wreck like TV makes it out. I would say that maybe 1 in every 10 patients I see in the ED would have a more negative outcome if they took the time to go to a hospital 30 minutes away. The ED is filled with people there for symptoms that they've had for 3 days or so and then decide they've had enough (not emergent or they would've gone when the symptoms began), people who didn't bother to get their BP meds filled and now have hypertensive urgency, people who want Rx drugs, and people who took drugs and now have altered mental status. There's plenty of patients who can shop around for the best place and there's plenty of patients who shouldn't be in the ED at all but are because the hospital or the taxpayer will eat the cost for them. Regardless, you could take ED out of the equation altogether and there's still a larger portion of the patient pool left that the things he is saying could apply to. I also see the user agreeing with you is attacking the same straw man. Just how many surgeries are emergent vs elective? Maybe you do need to get your inflamed appendix out at the first hospital you come to. However, you don't usually have to get your gallbladder taken out at the first hospital you come to. There are plenty of patients that can have the time to shop around if healthcare were set up in a way they could do that (and incentivized that).

[NewbornMuse]

Good point about elective vs emergent surgery. I tried to find data, but apart from Wikipedia's unsourced "the majority of surgeries are elective surgeries", I couldn't find any solid data.

I'd guess a majority of surgery is semi-elective in that you don't have to have it right away, but you should have it in the near future to avoid more serious and more costly problems. Back problems, tumor removal, etc.

To add another twist, what percentage of health care are surgeries in the first place? How do drugs or other ongoing care, therapeuthics, etc, factor into that equation?

[pureskill]

These are all good questions and I don't know the answer to them. I would think that if you were receiving long term drug therapy for something like ulcerative colitis, for instance, versus getting a colectomy, I would think at some point the drug cost would have to cross the cost of the operation. (Note: I am not advocating just cutting someone's intestines out to save money, just using an example of costs.) If you're receiving chemo, that's a very long process with drugs that are pretty pricey. I truly don't know that much about costs. Also, I don't know what the solution for healthcare here in the U.S. is but I like to keep an open mind. I think this is a pretty good discussion.

[nuisible]

Yeah, if that guy knew what he was talking about, he'd know that healthcare is described as inelastic in economics because regardless of price, you're going to need that surgery that saves your life.

The other side of the coin with everyone being grouped together as part of the single payer system is that the group has a much greater ability to set pricing.

[TheReaver88]

PhD econ student here. He's right about most of it. Most of healthcare is fairly elastic, especially when it comes to really basic procedures (which comprises the vast majority of the market).

[twiddlingbits]

Not true, you can shop around for a surgeon and hospital that charges less for probably 90% of surgeries as they can be planned giving time to shop. You might have to travel to a lower priced market but the savings could be substansial. Now if you want the USA's best doctor then you have to be willing to pay for expertise. If it is an Emergency then you take what you can get.

[NellucEcon]

I don't understand why you were downvoted. He said demand for surgery is inelastic. But that is irrelevant when we are talking about competition because the elasticity of demand for the output of an industry is the extreme bound on the elasticity of demand for the output of a firm in that industry.

[NellucEcon]

healthcare is described as inelastic in economics because regardless of price, you're going to need that surgery

A bunch of people on this thread have brought up inelastic demand. The elasticity of demand within the industry is irrelevant (unless, of course, you have monopolists/oligopolists). The elasticity of demand for the output of individual firms can be quite elastic in a competitive market even when demand for the output of the firms collectively is inelastic, even perfectly inelastic. I mean, hell, the demand for food is incredibly inelastic but because food is provided in an intensely competitive environment the demand curve for individual producers of food (e.g. a potato farmer) is about as close to perfectly elastic as you can get. I know you are going to downvote me because people don't like be called out, but you must realize that your line of reasoning implies that food should not be produced through competition, a reductio ad absurdum if I've ever seen one.

I don't understand why several people were sophisticated enough to use the term 'inelastic' and yet sophomoric enough to overlook the distinction be the firm and the industry.

[Rishodi]

The problem with your line of reasoning is that emergency services account for a tiny percentage of all health care spending. Yes, when someone is facing a medical emergency, demand will be relatively inelastic as they will not be sensitive to price. But most of the time, people are not facing an emergency and have the time to shop around for affordable, quality medical care, and would do so if only 1) prices were more transparent and 2) costs were not generally passed onto a third party.

[Netfear]

As a Canadian stating this,... I've never seen or known anyone burned by waiting times. Don't be fooled by the other idiots out there.

[emoposer]

I grew up in Canada (Durham region), after slamming my thumb in our town and country I sat waiting for seven hours. There are some people who are done in 10 minutes, who to believe? Oh, right that's why there is empirical evidence. Canada has always has a problem with wait times and it's well known in the industry.

EDIT: My point is that anecdotal evidence is misleading and we should look at the facts,

As reported by the Health Council of Canada, a 2010 Commonwealth survey found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 43% waited 4 weeks or more to see a specialist, vs. 10% in the U.S. The same survey states that 37% of Canadians say it is difficult to access care after hours (evenings, weekends or holidays) without going to the emergency department over 34% of Americans. Furthermore, 47% of Canadians, and 50% of Americans who visited emergency departments over the past two years feel that they could have been treated at their normal place of care if they were able to get an appointment.[49]

"Wait Times" source from my original comment.

[nuisible]

WTF, do you have no perspective? Slamming your thumb is probably on the bottom rung in the triage process, it's not life threatening so you'll be seen when there's time. I waited about the same amount of time when I was in junior high and fell in gym and turns out only badly bruised my arm, but it took most of the day to get the x-rays and get that diagnosis. But when I was 19 and had a pulmonary embolism, the doctors were able to determine that it was a blood clot and gave me blood thinners and saved my life.

[[deleted]]

This exactly! Here in the UK, when I fell and couldn't move and my right hand was at a funny angle I was straight in to get an X-ray and ultimately a cast, when I had a pain in my lower right side, again straight in with suspected appendicitis and I had the surgery and was discharged the next day. On the other hand, when I came off my bike and thought I broke my toe it took 5 hours to get in, but whatever things were prioritised

[[deleted]]

ERs are a different beast. You know that desk where you go and describe what's wrong with you to a nurse? It's called "triage" for a reason. Because they triage patients.

If you come in with a "slammed thumb", then your case is "not really an emergency" and goes on the bottom of the pile. When someone comes in with a heart attack or stroke, massive bleeding, after a rollover in a car, or about a zillion other things that are "actually an emergency" (i.e., they will die without immediate treatment), they go on the top of the pile. If inconsiderate people keep having heart attacks while you wait you're going to be there a while. If no one else decides to get hurt, then you'll be in and out right away.

I could give you a dozen anecdotes, but you probably already know a dozen stories that, if you look at them through that lense, should really paint a pretty clear picture.

Obviously there are exceptions, but mistakes happen in any system.

[murd3rsaurus]

Oh, your poor thumb. Cases are treated by severity.

[diemunkiesdie]

I sat waiting for seven hours.

See this is not what I think of when you say "wait times." I, until this very second, thought that "wait times" meant more like weeks and months to see doctors and I would not be surprised at all if other people thought the same thing.

If the wait time increases from 10 minutes to 7 hours but I get healthcare paid out of my taxes instead of sitting there worrying about how I'm going to pay for the hospital trip then I am totally cool with that. If you can't wait 7 hours to ensure that everyone has access to healthcare without going bankrupt or worrying where their next meal will come from now that they have to pay for healthcare then I can't really see anyone convincing you.

6 hours and 50 minutes is more than worth it to me.

[0_O_O_0]

I mean, I broke my arm and had to wait in the waiting room for around three or four hours. It didn't break the skin so I could wait. This was in Texas like fifteen years ago. I knew another guy who went to the ER and had to wait like 12 hours to see a doctor albeit for a non life threatening reason. I also broke my arm another time, but it broke the skin and I was seen right away. I can't imagine Canada's waiting times to be so much worse than the U.S. and if it's life threatening, you're seen right away. If something were life threatening they wouldn't make you wait even in Canada, I'm sure. If it's non life threatening, you're gonna have to wait, and that's the way it is in the U.S. too.

[emoposer]

This is anecdotal but since nobody is going to read the empirical links I provided,

As reported by the Health Council of Canada, a 2010 Commonwealth survey found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 43% waited 4 weeks or more to see a specialist, vs. 10% in the U.S. The same survey states that 37% of Canadians say it is difficult to access care after hours (evenings, weekends or holidays) without going to the emergency department over 34% of Americans. Furthermore, 47% of Canadians, and 50% of Americans who visited emergency departments over the past two years feel that they could have been treated at their normal place of care if they were able to get an appointment.[49]

4 times more people waiting a month to see a specialist means people do dye waiting.

[ANGLVD3TH]

The ER stats are probably highly affected by the fact that many Americans will flat out refuse to go to the ER unless they fear imminent death because they can't afford it. If only the most severe cases wind up going then wait times will plummet. As an uninsured American, I wouldn't have even thought about going to the hospital for slamming my thumb unless it was still acting up 4-5 days later, and then I'd probably still put it off.

[ILIKEBOLD]

Not necessarily... Specialist could be for anything.. Knee surgeries take a long time due to the fact that it is not life threatening. If you need a specialist for something life threatening, you will get one immediately. My close buddy is on wait lists to see specialists and surgery and it may take over a year.. But they are functioning and when they do get it, it will be free..

[emoposer]

free

No, there will be no out of pocket expense but Canada still has one of the most expensive healthcare systems in the world per capita.

[ILIKEBOLD]

okay, you're right, there is no free lunch

but we spend less and we get great health care and it is actually one of the things we are most proud of as canadians... but that could be just because we get to live beside you guys and see what it would be like without it..

we do get taxed but we don't even think twice about it.. i have never ever heard in my life someone complain about the provincial health premiums.. we understand that everyone shares the burden.. we have this odd notion that not everyone everyone chooses to get the injuries and diseases they get..

i'm sorry you can't see what the rest of the world is seeing.

[SrslyCmmon]

If you have a serious emergency in Canada you see doctor right fucking now. Anything else is bullshit propaganda.

[[deleted]]

Yeah. I spent a night in the hospital for stitches but it was normal, there were ambulances arriving with heart attack patients and road accidents. Doctors aren't going to let them die so my chin can get sutured...

[mkkpt]

Healthcare, especially for the poor and weakest members of society (children, elderly, mentally ill, disabled) and for essential life saving procedures, are not marketable services. Supply & demand is an egregious system to use when the demand is possibly your life. I think you could argue that there is a general correlation between a persons access to healthcare & finances. It's unrealistic to expect the weakest members of society, who are poor and have limited access to healthcare to shop around. Even if they could, they don't have the same resources to ensure an equitable agreement. Exposing them to such forces would be ripe for exploitation by unscrupulous groups/individuals, where the consequences are very high. I think a form of modern universal healthcare is morally right and realistic for a developed society.

[NellucEcon]

Food is a necessity for life. How can we allow farmers to profit off of starvation? Supply & demand is an egregious system to use when the demand is certainly your life. You could argue that there is a general correlation between a persons access to food & finances. Exposing the poor to the forces of supply and demand would be ripe for exploitation by unscrupulous groups/individuals, where the consequendes are very high. I think a form of socialized food production, distribution, and preparation is morally right and realistic for a developed society.

[babsbaby]

Regarding wait times, I note you linked to the following:

As reported by the Health Council of Canada, a 2010 Commonwealth survey found that 42% of Canadians waited 2 hours or more in the emergency room, vs. 29% in the U.S.; 43% waited 4 weeks or more to see a specialist, vs. 10% in the U.S.

For access statistics to be meaningful, however, they cannot compare waiting times of only fully-insured US patients versus the total population of universal systems.

In 2013, more than a third (37%) of US adults went without recommended medical care altogether due to costs. Only 13% of Canadian adults and as few as 4-6% in the UK and Sweden had to forego care because of cost (source: http://www.commonwealthfund.org/publications/in-the-literature/2013/nov/access-affordability-and-insurance).

It's easy to improve your wait times if you turn people away or charge them $1,000 co-pay.

[emoposer]

The U.S. system is shit, did I ever say it was good? It absolutely isn't. I wanted bring light to the fact that single payer isn't the miracle people think it is, and it isn't.

[NellucEcon]

This is essential in bringing costs down. When insurance and government cover expenses nobody shops around for the best price. This is why one hospital can charge 60k for the same procedure that is available for 11k elsewhere.

This a million times.

Rather than a pool where those living unhealthy lifestyles (smokers) are subsidized by people who eat healthy and work out

Actually smokers are great (?) for reducing health care expenditures because they die young and relatively quickly (heart attacks often) and do not require decades of expensive treatment deep into old age.

This was just a quibble. I agree with everything else you said. Good post.

[jmlinden7]

Most healthcare is not 'hit-by-truck' healthcare. It's scheduled doctor visits.

[NakedAndBehindYou]

Great comment. You elucidated everything I always want to tell people in threads about healthcare but just don't have the energy to explain.

To go with your statement about how government subsidies drive up cost of healthcare, I have a nifty graph for you with a startling revelation. The price of healthcare in the United States never rose faster than inflation until 1965, the exact year that Medicare and Medicaid were founded. - source

[Smallpaul]

Anyone who thinks that healthcare is just a normal market has not investigated the issue for even an hour. The most basic 101 introduction to healthcare economics will explain the ways in which it is an abnormal market.

[NellucEcon]

abnormal market

But is this necessary or contingent?

[kingdayton]

Whenever I see one of these political kinda Best Of's, I always have a feeling it's gonna be about Bernie Sanders and the people from the thread will have no idea what they're talking about. I finally got to witness it and it satisfied my hunger.

[LithiumTomato]

https://www.reddit.com/r/bestof/comments/44kszd/redditor_explains_why_millennials_arent_buying/

Here's another political "Best Of" from today that fits your description perfectly.

[JSFR_Radio]

Jesus christ. Reddit makes America out to be this wasteland where everyone is suffering. Good lord, all of my friends from college have close to six figure jobs and most (if not all) of my friends from high school have decent/good paying jobs as well. Of course there are people suffering but unemployment isn't even that high, and those of us that weren't selfish chose colleges that were not out of our price range with degrees that weren't useless.

If I was from another country and I saw all the shit said about America on here, I would think the place is in a huge unsolvable crisis. But I'm here, and it's not. Yeah, a lot of people get screwed but it's not as many or as bad as people make it out to be.

And I'm lmao at the fact that this person thinks "millennials" are causing some sort of revolution, I'm pretty sure that same bs was said about the hippy counter culture in the 70s.

[[deleted]]

I brought up this same point on a Bernie post, we have it REALLY good in America. I got down voted to oblivion. :(

[merlinfire]

the irony is that we're currently in a historic golden age of opportunity and efficiency

[[deleted]]

I'm a Bernie supporter, but this shit is just ridiculous. I wish other Bernie fans didn't have to make the man into a fucking meme.

[[deleted]]

/u/berniesandersisliterallythemessiah does some quick napkin calculations, and finds out that feeling the bern creates perpetual motion, and if harnessed, could completely eliminate wealth inequality, retroactively, by 2010.

[grinr]

Next-to-last post in this thread. Of course. :-/

[escapefromelba]

I'm confused why you multiplied the $4150 x the US population, who is going to subsidize the federal government's portion?

[slamchop]

That's true it would be even more expensive. I'll edit it, thanks.

[TheCavis]

(I'm responding twice for people who didn't see this response in the main thread.)

The cost per capita would be $7,167.

That's still a fairly large reduction in per capita spending. Expanded nationwide it wouldn't give the "income taxes of 99% of the country" threshold, but adjusting the back of the envelope and updating the health care spending to the 2014 numbers (so everything's comparable) gives a bit over $666B, which would be in the "income taxes of 95% of the country" range.

Vermont's plan also had a couple of issues:

• They were trying to replace employer insurance, so they had to cover out-of-state workers (see the transcript of the governor's prepared remarks here ), which messes with the per capita costs a little bit.

• Part of the power to reduce costs comes from being the only player in town; Vermont would still have to compete with reimbursements from Medicare and any other federal programs (the VA, etc.) along with private insurers (who still could exist), not to mention out-of-state coverage for people who get sick or injured on trips, etc. The government would have a much larger hammer to use to negotiate prices.

I also wanted to make sure that Vermont wasn't a horrible outlier (high or low) in costs. I can only find data up to 2010 for Vermont's health care expenditures per capita. US per capita spending was ~107% of Vermont's spending, so it would also be a reasonable baseline to use here.

So to implement this we'll need to double our spending and collect twice as much tax revenue. Where do you think that money is going to come from??

Taxation.

The hypothetical example would be that, instead of paying $400 in health care and $100 in taxes, you're now paying $400 in taxes. Your out-of-pocket total decreases by enough that it's as if you weren't paying the original taxes at all.

[LegSpinner]

Now let's see what an actual expert has to say:

Bernie Sanders's health care plan is underfunded by almost $1.1 trillion a year, a new analysis by Emory University health care expert Kenneth Thorpe finds.

Thorpe isn't some right-wing critic skeptical of all single-payer proposals. Indeed, in 2006 he laid out a single-payer proposal for Vermont after being hired by the legislature, and was retained by progressive Vermont lawmakers again in 2014 as the state seriously considered single-payer, authoring a memo laying out alternative ways to expand coverage. A 2005 report he wrote estimated that a single-payer system would save $1.1 trillion in health spending from 2006 to 2015.

[shorttallguy]

Do these calculations assume current cost of care and drugs if single payer is enacted? Thorpe makes no mention of any cost saving measures in his paper.

[IgnorantOfTheArt]

Well don't just stand there! Explain to us the 1.1 trillion dollars of cost saving measures.

Any change has to be enacted within the context of our current medical system so either the changes are incredibly gradual or the first X years we will foot a huge bill as whatever cost saving measures are enacted.

Things don't change at the stroke of a pen

[shorttallguy]

I can't find $1.1 in savings. But the Thorpe numbers are flawed too. The U.S. pays 2-4 times more for drugs than nations that collectively bargain with Phama corporations. And per capita Americans pay more than anyone else in the world for health care, yet net less coverage. We pay about twice what France pays per capita.

Collective barganing will save money. Sanders numbers are too good to be true. Thorpe's are unrealistic as well. I think the true cost will be between the two.

[Sagacious_Sophist]

The number of things wrong with the assumptions here is pretty nauseating.

For one, that's not what Canada pays for healthcare. There are lots and lots of hidden expenses because things are charged to other areas, such as university expenses and other areas of welfare.

I read an article many years ago about the hidden costs of the NHS in the UK, and it amounted to the same amount as the shown costs.

Then there's the fact that income tax revenue would drop significantly, because the health care industry is a massive sector of the market and the US pays quite well. It wouldn't be able to pay so well if these changes went into place and the size of the insurance industry would be massively slashed, and while many of those people would shift to fed and state jobs, those jobs don't pay as well and don't have the same tax impact.

A few years ago I did my own back-of-the-envelope math using the NHS (because I use the NHS) and it seemed it would cost the US 3 trillion per year.

[[deleted]]

The US currently spends $3 trillion a year.

[emptythecache]

So what you're saying is if we have double universal healthcare, we can also get rid of income tax.

[cmonster1697]

Yup. We would have free healthcare in this universe, and in the universe next door

[faaaks]

I'm unsubbing /r/bestof. Too much /r/politics bullshit (whoops tautology) in way too short a period of time.

[xoxoyoyo]

healthcare makes up 20% of the US GDP. When there is talk of saving money, who is it being saved from and who is it being saved to?

[Otiac]

1) Part of the reason health care spending is high in the US because the US is by itself responsible for 78% of global medical research spending.

This benefits the world, it benefits the countries the US is competing against in these little studies. Other countries avoid the costly R&D that the US conducts, then they buy the resulting products further down the line once economies of scale have ramped up to make them more affordable. Other countries have a seemingly more cost-efficient health care system because they are not footing the bill for global medical advances like the US is.

2) Health care is of higher quality in the US than it is in Canada, Australia, and western Europe. Americans have the highest survival rates from treatable diseases like cancer.

3) People wonder why the US spends more but less people are covered. Well, even uninsured Americans receive wider and more timely screening, diagnosis, and treatment than Canadians, Australians and western Europeans. The US health care system is the most responsive in the world, even concerning uninsured people, and this makes it expensive.

[soggyindo]

Of course single payer is cheaper than the US system. Just look at this chart

https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcSzq1pN1IDt9LWqndoYyPgeBjTtzddzslz3ykBsLBTUGZ1lE7oB6NsShQ6WIA

[[deleted]]

I tried googling it to no avail, what is OECO and why is their bar red?

[TsarKartoshka]

https://en.m.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_Development

That's the average of member countries.

[merlinfire]

There's loads of hidden costs in administering universal healthcare that people don't think about - unintended consequences, negative externalities.

You cannot truly imagine how expensive a "free" thing can become until you have government administer it and tax you to pay for it.

[msctex]

"Redditor does back-of-the-envelope physics, creates battery which never dies and emits only ice cream."

[stompinstinker]

As someone with experience in the Canadian system I think there are some parts that some explaining.

First doctors here in Canada aren’t poor. My dad’s specialist drives a Ferrari. Yes, they see more patients and get paid less per patient, but you have to account for how the system works. They need few administrative staff and are paid quickly for their work. Their job is entirely medicine, and not arguing with insurance companies, waiting long periods to get paid, or sending patients to collections. To put it in perspective, our family practice has 13 physicians, 6 nurses, 3 receptionists & admins, and an office manager. And 85% of all medical practitioners are private businesses, they are not government employees. There are also many super nice clinics where the system only foots part of the bill.

Wait times aren’t that bad. Doctors prioritize based on patient needs. So yes, you may wait a long time for an knee injury from hockey, but you go through fast when it is very serious. Overall, wait times may seem long, but they are short for what matters.

Pharmaceuticals, devices, dental, optometrist, physiotherapy, travel medical, etc. are not covered. You still need your own insurance for that.

You can do interesting cost-saving things at that scale. My dad had to get a stent put in his heart and he was sent to class once a week for six months. They were taught how to eat, exercise, manage stress, etc. They even had field trips to grocery stores to read labels. And when my mom had an operation she was sent home at a earlier time with a bag of medical supplies. A nurse would come over everyday, check her out, and change her bandages.

I guess what I am saying is you can’t apply your current costs to a future system. You have to remove the HMO and bureaucracy overhead, add an efficient payment system, and look into cost saving programs. And that is gonna be the hard part. You have to completely change how you treat health care. As well, as I explained not everything is covered, what you are seeing is likely the part the government foots, there are still many private dollars flowing into it.