Universal healthcare in the US
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30-03-2017, 02:22 PM
Universal healthcare in the US
Many here, including me, would like to see some kind of universal healthcare implemented in the US. The best way to do that is probably a single payer system administered by the government similar to what they have in Canada, Australia and (most of?) the EU. The problem with this is we simply can’t afford it without significant reductions in the cost of US healthcare.

Last year the US spent $3.3 trillion on healthcare. That’s a per capita rate of about $10,335 which is more than twice as much as most EU countries. A significant percentage of the US population didn’t get much in the way healthcare because they couldn’t afford it. If they had our per capita cost would be even higher.

The government paid about $1.1 trillion of the bill with funds raised through taxes leaving another $2.2 trillion to come out of our pockets. That means the government would need to raise at least another $2.2 trillion in taxes just to pay for what we have now. According to Full Circle’s tax spreadsheet raising that much revenue via individual income taxes would mean an average tax increase from 19.1% to 48.8% across all households in the US. A 29.7% increase. That’s 48.8% on top of 15.6% in payroll taxes, whatever state and local taxes we pay, and sales taxes. The total average tax burden for US households would have to go to somewhere in the neighborhood of 70%.

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The tax could be structured differently than how I did it on the spreadsheet, but the bottom line is you can’t drop the lower bracket much below 40% and still raise the required amount of revenue without pushing the upper brackets above 100%. Lower income families simply can’t afford tax burdens in excess of 60% and still be able to pay for food, housing and other necessities much less nice to have things like college education for the kids.

The bottom line is we can’t get there from here without significant reductions in the cost of healthcare here. The question is how do we do that?

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30-03-2017, 02:36 PM
RE: Universal healthcare in the US
Is the problem with the insurance based system that the care provider can charge pretty much whatever they like, as long as the insurance covers it, so there is really no incentive to provide better value?

Obviously things are very different here in the UK so I'm not sure what regulates the cost over there. Over here since the NHS is funded by the taxpayer, that provides the incentive to keep costs down (doesn't mean there aren't problems with that though).

As I understand it, the quality of care in the US is top notch, better than the UK (for the NHS anyway, we do also have some private hospitals and private health insurance pays for it), but far far more expensive. Would US citizens be prepared to compromise on quality in order to pay less? Or a two tier system of a low cost 'standard' service, and a higher cost 'premium service'?

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30-03-2017, 02:37 PM
RE: Universal healthcare in the US
(30-03-2017 02:22 PM)Popeyes Pappy Wrote:  The bottom line is we can’t get there from here without significant reductions in the cost of healthcare here. The question is how do we do that?

You sound like you know a lot more about this subject than I do. What about letting Medicare set the costs across the entire system?

Huh
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30-03-2017, 02:43 PM
RE: Universal healthcare in the US
Ok, so I usually don't believe in simple solutions to complex problems, but here are a few ideas to start:

Cut the military budget (no one except the lobbyists will notice, not even the generals)
De-couple healthcare from employment (the Repubes will never go for this: how else are they gonna keep their indentured serfs?)
Eliminate the middleman and the profit motive: mandate that all primary, secondary, tertiary care facilities become not-for-profit (screw the bloodsucking health insurance industry: they can offer cadillac top-up plans if they want, but basic health care should be a right for everyone).
Expand medicare and medicaid and pay for it by aggressively taxing the top 1% back to 1950s levels!! (what? didn't Idiot-in-Chief say he wanted to make america great AGAIN? Where are all those millionaires and billionaires gonna move to anyways?)

(I could go drastic and say "Threaten to revoke the U.S. citizenship and deport anyone who opens a personal offshore account", but I haven't really thought it through)

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30-03-2017, 02:43 PM
RE: Universal healthcare in the US
Very interesting breakdown.

Big for-profit Pharma says it takes hundreds of millions to take a new drug to market, between research, trial, marketing etc. Many drugs never make it so the ones that do must subsidize the cost of the ones that do not.

Hospitals are for profit enterprises. The talented doctors who have spent 10-15 years in school to practice medicine and leave with student loans in the hundreds of thousands might have never gone into medicine if the payout wasn’t there.

The question becomes how to change the entire system. How do you motivate Big Pharma to invest the kind of money it requires to do the research and the doctors to sacrifice so much time and money to become doctors without a payout?

I’m not defending the system here, I’m posing questions that I think need answers.

So far it has been a nightmare for my family. Our premiums are $1,700 a month, you read that right. We are self-employed so we carry the full burden. We make too much to receive any subsidy. We have an ongoing conversation on should we self-insure, that is go without insurance and set aside the premium money in an escrow account in the event of hospitalization or catastrophic illness, but then we see what those bills can amount to and we just can’t take that chance. So we continue to pay the crippling rates. Those rates are on top of our $5,000 deductible per person!

It is fucking insane.

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30-03-2017, 02:45 PM
RE: Universal healthcare in the US
(30-03-2017 02:37 PM)Jay Vogelsong Wrote:  
(30-03-2017 02:22 PM)Popeyes Pappy Wrote:  The bottom line is we can’t get there from here without significant reductions in the cost of healthcare here. The question is how do we do that?

You sound like you know a lot more about this subject than I do. What about letting Medicare set the costs across the entire system?

Huh

Basically because it would bankrupt most of our healthcare providers. Medicare pays less for services, but the providers make it up by charging the insurance providers and individuals more.

Profit margins in the healthcare industry aren't as high as many think. Only 18% of American Hospitals operate as for profit enterprises. 20% are government facilities, and 62% of American hospitals operate as non-profits. So in 82% of our hospitals there are no profit margins to cut. The 18% that do operate as for profits average a little less than a 9% margin. That means the most savings you could see cutting the profits of hospitals would be 1.62% of the total. Reality is it would be a lot less than that because hospital revenue doesn't account for 100% of the total cost.

Insurance companies operate at a lower margin than hospitals. According to some sources as low as 3.3%. But once again health insurance revenues aren't even close to 100% of the total so zeroing out those margins altogether might save another 1.6% of the total. Best case scenario we'd probably be looking at a 3% savings by getting rid of hospital and health insurance profits. Maybe none at all if the government can't manage billing and payments at least as efficiently as the for profits.

Drug company margins are another cost reduction target. One that could pay some substantial dividends since US pharmaceutical companies averaged a 23.5% margin last year. But once again drug costs account for less than 10% of total healthcare expenditures so at the most we'd be looking at a 2.35% savings off the bottom line. Add all those profits together and we'd be looking at a maximum savings of maybe 6%. That would have brought last years per capita healthcare expansive down from $10,335 to $9,715. It is something but not nearly enough to make universal healthcare available in the US. We still have to find other areas to cut costs.

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30-03-2017, 02:48 PM
RE: Universal healthcare in the US
(30-03-2017 02:22 PM)Popeyes Pappy Wrote:  The problem with this is we simply can’t afford it without significant reductions in the cost of US healthcare.

If you cut out the middle man, aka the profit oriented insurance companies, the costs will reduce itself.

The US ranges at number 31 when it comes to life expectancy and spends much more than other countries that range higher.

https://en.wikipedia.org/wiki/List_of_co...expectancy

The money ends up in the pockets of some corporate suits and isn't spent on bettering the health of the population.
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30-03-2017, 02:53 PM
RE: Universal healthcare in the US
(30-03-2017 02:43 PM)Full Circle Wrote:  Very interesting breakdown.

Big for-profit Pharma says it takes hundreds of millions to take a new drug to market, between research, trial, marketing etc. Many drugs never make it so the ones that do must subsidize the cost of the ones that do not.

Hospitals are for profit enterprises. The talented doctors who have spent 10-15 years in school to practice medicine and leave with student loans in the hundreds of thousands might have never gone into medicine if the payout wasn’t there.

The question becomes how to change the entire system. How do you motivate Big Pharma to invest the kind of money it requires to do the research and the doctors to sacrifice so much time and money to become doctors without a payout?

I’m not defending the system here, I’m posing questions that I think need answers.

So far it has been a nightmare for my family. Our premiums are $1,700 a month, you read that right. We are self-employed so we carry the full burden. We make too much to receive any subsidy. We have an ongoing conversation on should we self-insure, that is go without insurance and set aside the premium money in an escrow account in the event of hospitalization or catastrophic illness, but then we see what those bills can amount to and we just can’t take that chance. So we continue to pay the crippling rates. Those rates are on top of our $5,000 deductible per person!

It is fucking insane.

Things definitely need to be fixed. The ACA addressed some issues, but there is still so much broken about our healthcare system. I don't foresee the Trump administration actually working to fix the real problems with the ACA, so the US is still fucked on that score for at least another 4 years. Angry
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30-03-2017, 02:57 PM
RE: Universal healthcare in the US
(30-03-2017 02:43 PM)Reducetarian Wrote:  Ok, so I usually don't believe in simple solutions to complex problems, but here are a few ideas to start:

Cut the military budget (no one except the lobbyists will notice, not even the generals)
De-couple healthcare from employment (the Repubes will never go for this: how else are they gonna keep their indentured serfs?)
Eliminate the middleman and the profit motive: mandate that all primary, secondary, tertiary care facilities become not-for-profit (screw the bloodsucking health insurance industry: they can offer cadillac top-up plans if they want, but basic health care should be a right for everyone).
Expand medicare and medicaid and pay for it by aggressively taxing the top 1% back to 1950s levels!! (what? didn't Idiot-in-Chief say he wanted to make america great AGAIN? Where are all those millionaires and billionaires gonna move to anyways?)

(I could go drastic and say "Threaten to revoke the U.S. citizenship and deport anyone who opens a personal offshore account", but I haven't really thought it through)

According to FC's spreadsheet if we cut the defense budget to zero and spent all those funds on healthcare it would lower the average federal income tax required to raise the remaining revenue from 48.8% to 41.8%. Poor people would still loose half their income to taxes.

Oh and BTW, we'd still be running an annual deficit of about a trillion dollars a year. That hasn't been factored in at all yet.

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30-03-2017, 02:57 PM
RE: Universal healthcare in the US
(30-03-2017 02:53 PM)Emma Wrote:  I don't foresee the Trump administration actually working to fix the real problems with the ACA, so the US is still fucked on that score for at least another 4 years. Angry

In my opinion the US is fucked until money is thrown out of politics. As long as corporations are allowed to bribe politicians on a large scale, nothing will change.
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