The “easy” solution is to try and remove profit as much as possible from the equation. Pretty much every other high GDP country in the world has single payer healthcare.
Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one.
Two people I know who moved to the US from countries with single payer healthcare said that in their previous countries they would have to wait a long time for certain operations, but in the US can get them almost immediately.
Depends on criticality. Yes, the US beats Canada for example on wait time in a lot of cases, however, as a Canadian I can walk into a ER and not have a co-pay.
I had my appendix out a few years ago, I walked into the ER at 2PM, had the surgery done by midnight, and was able to be discharged by 9AM the next day. The only cost was my parking, because I drove myself over. Meanwhile, I've also had friends in the US who were clearly quite ill, and made the conscious decision to not go to the ER because it would have cost them hundreds of dollars.
It's all a balance, but I'm happier with my single pay system, because for the most part, health decisions aren't at the whim of my bank balance being too low. I personally wouldn't be as disappointed in the US system, if the reason someone can get a surgery immediately didn't balance out with something like UnitedHealthcare's 32% rejection rate, because someone wanted a $10MM / yr salary or a $40MM yacht.
The US has a law that 80% or 85% of premiums needs to go to healthcare. So if an insurance company is already up against the limit, increasing the rejection rate will actually decrease salaries and yachts (because less money will be spent on healthcare, thus premiums need to be reduced, and the 20% available for employee salary becomes smaller).
Although, if increasing the rejection rate allows the insurance company to decrease individual premiums, which causes a lot more people to sign up for coverage due to low cost, that could increase total premium income, total spent on healthcare, and salaries.
From what I understand, wait time can certainly be an issue with single payer healthcare. However, there's people in the US who have effectively infinite wait time because they can't afford treatment at all.
I have an excellent insurance plan and ready access to a large US hospital system. The wait to see a dermatologist as a new patient is ~6 months. Definitely not unique to single-payer systems.
Also, this wait times in many part of the US are in line with the single payer countries. The quality of care in the US is heavily dependent on location.
Some problems in those countries are also caused by for profit healthcare existing in America. The shortage of doctors in Canada is not helped by the appeal of making much more money down south.
Not to mention Canadian expats are generally the ones who would be able to afford the American healthcare costs.
Also sounds like Canada isn't paying their doctors enough, which isn't to say America's healthcare is better, but it is something to take into account.
Canadian doctors are extremely well paid by Canadian and international standards, just not by the standards of American doctors (who have to repay massive medical debt). Increasing their wages is not really feasible, outside of a few underpaid specialties.
Dutch and Swiss healthcare systems are entirely private (more so than in the US since there are no Medicare or Medicaid equivalents) yet they are highly regulated and profits are limited.
Why can’t the US just copy paste them? It’s not like single payer is the only option..
> Dutch and Swiss healthcare systems are entirely private (more so than in the US since there are no Medicare or Medicaid equivalents)
and Swiss doctors are paid very well compared to let say German ones. There is long waiting list of German doctors that would like to practice in Switzerland.
Waiting time increases with accessibility and aging population. Most developed countries with universal healthcare amd the hospitals are full with elderly. The developing countries are often much better due to younger population. Places like Turkey are incredibly accessible and cheap compared to the develped countries.
When you remove profit from the equation, you also remove the incentive to increase supply. That's fundamentally what profit is: a reward for fulfilling the needs of consumers. If you can fulfill those needs better or more efficiently or at a larger scale than your competitors, you get more profit.
>>Would you go to work without being paid? I wouldn't.
Do you think doctors and nurses work for free in countries with socialized healthcare?
They do get paid. A lot if you're a specialist too - it's a very lucrative field to be in. Admittedly, not for everyone - nurses and junior doctors usually don't get paid very well, but it's my understanding that in US it's not like these professions make bank either.
>>if there was a ton of people who wanted to found, fund, and work at nonprofit health insurance companies.
That's the whole point that Americans are missing - you don't need the insurance companies in the first place, if the entire system is owned by the public. You go to a hospital, you get an operation done and that's it, at no point is there anyone sitting there are processing your "claim" - if the operation is one allowed by the system(and it almost certainly is) then it's just done and the system pays for it from general taxation budget. No one negotiates rates with the hospital, argues about your excess or premiums or in or out of network coverage. Health insurance is something you get for travelling abroad, like if you have an accident while skiing and need a helicopter to get you out, not for visiting a doctor or a hospital.
Im responding to a comment that thinks the following is crazy and wrong.
>When you remove profit from the equation, you also remove the incentive to increase supply.
Yes, socialized system countries have doctors because they pay doctors, ensuring supply. This proves the point above.
If you pay people to do something, you get more of it.
Health insurance companies dont provide healthcare. They dont stich you up or manufacture pills. They are in the business of vetting and denying claims to ration healthcare provided by others.
>No one negotiates rates with the hospital, argues about your excess or premiums or in or out of network coverage. Health insurance is something you get for travelling abroad, like if you have an accident while skiing and need a helicopter to get you out, not for visiting a doctor or a hospital.
It works different in various socialized systems, but there is always someone negotiating with the hospital, the workers, and the manufacturers. Sometimes this is the government, sometimes it is private insurance.
I dont know which country you are talking about, but almost every country has some sort of Health Insurance. What differs is the level of involvement by the citizens in selecting it.
A classic example would be Germany, which is a multiple payer system with both government and private insurance. 85% percent of people have the government health insurance, which is paid by employers and employees and mandatory. the government manages and negotiates rates for this plan. You can opt out and get private insurance instead, and those insurers have sperate negotiations and offer different services. There is also supplemental insurance, also private, also negotiated separate.
From my understanding Germany is an outlier among countries with socialized healthcare because their system is either straight up reliant on insurance or is modelled after insurance-like systems. My experience is based on Poland and UK. And sure in the UK you pay for "national insurance" which partially funds the NHS, but the point is that it's almost irrelevant to your coverage - as long as you live in the UK legally you are entitled to treatment, whether you pay NI or not. Again, the difference(imho) is that if you go to a hospital and a doctor there decides you need an operation done, it only goes through a cursory check to make sure the operation is covered and then it's carried out. It doesn't go to some central office where someone checks if you as a person X are entitled to have this done or not, it's not a "claim" like a one you would make with an actual insurance company.
And yes, of course you can supplement that with private insurance if you wish, but vast majority of people don't.
And yes, of course the government negotiates with providers - but when you get treated that's not something that affects you. You don't get a bill that says "your treatment was £10k, but the goverment will only pay £5k, cough up the rest". In fact no one(patients) gets any bills ever.
I'm pretty sure that UK is the outlier, where healthcare providers are state employees. Wikipedia says the NHS is the largest employer in Europe with 1.4 million employees.
I think the vast majority of countries have some sort of a situation with the government as at least one of the payers, and Private health care providers.
I completely agree that the US is an outlier in how involved the patient is in the payment of their healthcare, and the fact that they can be left with the bill instead of the provider if the insurance is denied.
On a psychological level, I think people are more frustrated by being offered care that they can't afford and dealing with uncertain coverage then not being offered the care at all.
I'm a huge proponent of healthcare reform in the US. That's sad, I think one of the biggest problems with getting it past is unreal expectations. Americans have a caricature of European healthcare in their mind that is totally inaccurate.
It’s still an insurance system though, whether it’s publicly owned or privately. There are still bureaucrats who decide what is covered and what is not, and they make that decision for the entire population. Things like cutting edge cancer treatments (often developed in the US) are many years late arriving to public healthcare systems. And many expensive treatments are simply not covered, or covered as second or third line (eg. immune therapy), when patients in the US with appropriately good insurance receive them as first line with far better outcomes.
> No one negotiates rates with the hospital
No one negotiates period. Coverage decisions are made unilaterally by government officials, and services that those officials deem too expensive are simply not offered. The same issue exists with medical equipment. The wait time for an MRI is absurd in eg. Canada because government only funded so many machines. In the states there are simply more machines, because supply was more elastic, and more freely
able to meet demand.
Sure. Don't get me wrong, I'm sure American healthcare system can be amazing in certain cases, and like you said, in specific instances the "market demand" is able to solve issues that socialized systems struggle with. But the same is true in the opposite direction - plenty of stories of people being denied lifesaving care because insurance companies decide it's not worth it. People who have their cancer treatment stopped because their employer changed the insurer and the new insurer has to do a full re-evaluation before they approve the treatment to continue, so in the meantime you get no cancer drugs for months while they do their process. And so on and so on. We could both do this I'm sure.
>>when patients in the US with appropriately good insurance receive them as first line with far better outcomes.
The problem I have with that is basically you're saying the quality of the treatment depends on what insurance you have. In socialized healthcare everyone gets the same treatment.
And in fact this is reflected in the average quality of care received on average, with outcomes in US being much worse than elsewhere. US has mortality from "preventable causes" twice as bad as Australia, Japan or France(paragraph 5). So in US few people get amazing care better than anywhere else. And most people get worse care than anywhere else.
>>Things like cutting edge cancer treatments (often developed in the US) are many years late arriving to public healthcare systems.
Obviously it's hard to make a general statement on this because every country has varied policies around this. But to share an anecdote - my own dad was enrolled into an experimental programme at a leading oncology hospital in Poland because he had a very rare and ultra aggressive cancer which had no known treatment other than a brand new(then) Glivec, which wasn't even approved for that cancer yet, but he had the whole course of his treatment fully funded under our socialized healthcare. In those very very rare cases where regular treatment is not available there are avenues to explore experimental treatments, and they then serve to direct general treatment plans for the rest of the population. Again, this is a specific example from one country.
You would concede that, as a consequence of imposing involuntary obligations on their citizens, socialized systems are less free? And you would also concede that reasonable people can disagree about the priorities of their values, and that valuing personal autonomy over collective well-being is a reasonable position?
> people being denied lifesaving care because insurance companies decide it's not worth it
You get what you sign up for. Like in any business transaction, doing your due diligence and understanding the details of both parties obligation is table stakes. We also have courts precisely for cases when such disputes become intractable.
> so in the meantime you get no cancer drugs for months while they do their process.
No one is stopping you from paying for the drugs yourself. Insurance will reimburse you once they validate your claim. Bureaucracy takes time.
> the average quality of care received on average
And the quality of care on the upper end is markedly worse in many ways. Wealthy people from all over the world travel to the US for their medical procedures for a reason. You're effectively arguing that net-contributors to society (people who pay a lot of taxes) should accept an increase in their tax burden for the privilege of a degradation in their personal access to and quality of care, in order to bring up the average. I hope you appreciate just how directly this opposes the interests of this class.
> From each according to his ability, to each according to his needs
You can't have a system like this in a free country. I want the freedom to associate (in an insurance pool) alongside other people with a similar risk profile to myself (eg. no drinking/drugs/smoking, daily exercise, good sleep, healthy body composition) to the exclusion of others. I want my insurance company to carefully scrutinize its applicants and claimants, on my behalf, to ensure that my interests are being well-represented. Insurance does not mean absolution from personal responsibility.
The government still negotiates. Refusing to buy a product/service at X rate is a negotiation, and there is a back and forth with providers/manufacturers.
Same for state employed healthcare professionals, which have salary set by the state.
What other incentive is there? There might be some willing to go deep into debt in medical school so they can work for free out of the goodness of their hearts, but that's a vanishingly small number of people.
And yet apparently countries all over the world have to artificially raise the bar for med school because so many people want to be doctors for incentives aside from just the money.
People don't go bankrupt at anywhere near the rate Americans do for medical reasons. People don't constantly bring up dealing with insurance as the #1 burden during medical procedures.
> Pretty much every other high GDP country in the world has single payer healthcare.
This is just completely not true. Take France and Germany for example.
> Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one.
So anesthesiologists should be able to ask for any amount their heart desires and the insurance is the bad guy if they don’t want to pay it? Anesthesiologists have a profit motive too, you know.
> All French citizens are required to have health insurance, and there are three main health insurance funds. The funds are non-profit and negotiate with the state on healthcare funding.
> Does Germany have free public healthcare? Yes, all Germans and legal residents of Germany are entitled to free “medically necessary” public healthcare, which is funded by social security contributions. However, citizens must still have either state or private health insurance, covering at least hospital and outpatient medical treatment and pregnancy.
Neither of those are single-payer systems, which you can see by the fact that both of your quotations involve multiple payers. Google "does france have single payer healthcare" or "does germany have single payer healthcare" for more info
Naturally they would not wake you up mid-procedure for payment, nor ask you for payment later. What anthem wanted to do was put a cap on the number of billable hours per procedure, and have anesthesiologists accept payment based on that cap as "payment in full", meaning they would not expect additional payment for the extra time they spent after a procedure went long, either from the patient or the insurerer. This would have resulted in anesthesiologists making less money (as well as having less opportunity for fraud), which is why they didn't like it.
But it was presented in popular media as if the insurance company was trying to shift the cost of overlong procedures onto the patient, rather than onto the anesthesiologists. Thankfully there was a public outcry and the anesthesiologists won, well-deservedly so considering they must be barely scraping by on a median income of $470,000/year.
> What anthem wanted to do was put a cap on the number of billable hours per procedure, and have anesthesiologists accept payment based on that cap as "payment in full", meaning they would not expect additional payment for the extra time they spent after a procedure went long, either from the patient or the insurerer.
The policy even had a path for the anesthesiologist to justify the overrun so that portion could be covered too. No doubt Anthem would scrutinize the justification closely and reject cases where they detect abuse, and the incentives are for Anthem to be too strict, but there was nothing wrong with the policy on its face. These sorts of things are absolutely necessary in order to drive healthcare costs, which are absolutely obscene, down.
And pretty much every one of those countries also has widely used private insurance because the public one most definitely has price caps, longer waits, and lesser service.
No system could afford to spend unlimited amounts for anyone wanting it. You get triaged since resources are not infinite.
Pick your favorite system, say the UK, and google UK healthcare rationing to find state policy on what limits people face.
Any medical system inevitably has limits of what they can spend per patient. Do you prefer the limit to be set and enforced by the government that is amenable to political process, or anonymous profit-seeking insurance company board members, like in the sibling comment case https://news.ycombinator.com/item?id=42375998 ?
That comment was about a person on Medicare Advantage, which is extremely heavily regulated by Medicare, the epitome a of govt medically regulated cost per procedure system.
Here is the govt Medicare page about Medicare Advantage Plans, with references to all the pages of legislation and Medicare rules such plans must comply with.
For example, select “What should I know about Medicare Advantage Plans?”
It states, among other things, “ Medicare Advantage Plans provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) benefits (also called “Original Medicare”), including new benefits that come from laws or Medicare policy decisions”.
Note in particular Medicare advantage will provide any PT where Medicare would.
If you look at peer reviewed research, MA outperforms M in outcomes and satisfaction by a slight amount.
These are reasons why forming or reinforcing beliefs on anecdotes and not understanding the truth is a bad way to make claims.
So now that you see this outcome was medical care “set and enforced by the government” and not the outcome from “anonymous profit-seeking insurance company board members,” will you redirect your outrage?
Guess how many people get told their anaesthesia won’t be covered for their full surgery. That shouldn’t even be a question, and yet the US system makes it one.