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by toolcombinator 1610 days ago
Yeah, the US has a problem with spending more on healthcare than any other country, but it isn’t a “profit” or “administrative overhead” problem.

(Insurance companies have legally limited profit margins on health insurance.)

Does multiple private insurances add a little administrative overhead? Sure, but nowhere near as much as you see in the OECD figures.

There are many reasons why US healthcare is so expensive.

Some of them have to do with litigation: Skyhigh insurance premiums and a medical “Cover your ass”-culture with unneeded tests and MRIs done on a regular basis.

(In Canada, there is a legal ceiling on how much in damages you can sue a doctor/hospital for. This would be a good idea to implement in the US.)

Another added expense is free riders: All the people that show up in the ER, whether because of the flu or a gunshot, get treated/operated on, and never pay their bill.

Another issue is that the US has some of the best doctors in the world, and new, prohibitively expensive treatments are often introduced here first.

Many, very expensive treatments simply aren’t done (or done very rarely) in countries where the public (fully or in part) pay for treatments.

Waiting lists are another way of limiting costs in European countries. (Waiting lists that can be over a year long, but their healthcare systems are arguably cheaper to run.)

I could bring up some new medicines that in the US cost thousands of dollars per week (Crohns medication for example.) In European countries those medications simply aren’t available, or are only available on an exemption: Meaning that your doctor need to apply to have the cost covered, and is usually turned down.

Another example would be something like SRS surgeries.

These can be extremely expensive, and are covered by insurance, which of course increases the costs of coverage for everyone.

In European countries you’d either face a very long waiting list to get the operation covered, or you wouldn’t be eligible for it. Or only eligible after jumping through extensive hoops.

1 comments

As someone who lived both in USA and am from EU (can only speak about Slovenian and German system) and I have preexisting condition (asthma and ankylosing spondylitis )

Sure you can find problems in any healthcare system. Because there is no upper limit on spending. There is always something more that you can do.

If you are proper rich* (dozens of millions or more) USA has the best health care system.

Fore everyone else, EU health care is better.

For instance right now I was at my pulmonologist and he wants me to take CT of my chest. As it is not emergency I could wait for a week (and it will be free), or I can have it today in private clinic, where I copaid 40 EUR*. If it were serious I would have it done for free today.

I got yearly prescription for Berudual, fosters, spiriva and Singular for free.

Bottom line is yes, sometime there is waiting time, but outside few pathological cases they are quite reasonable.

In USA I had more than double of my current pay, but with rent and my preexisting condition the way that they are, I am actually left with slightly more each month.

And there is another big difference between our system and US. Everyone is insured (weather it's public or private). So there is no fear of ever going to the doctors or calling ambulances.

Private clinics are getting paid by my insurance (I could get free CT at the same clinic a week later), 40EUR fee is just convenience (I don't want to wait) fee. And normally It wouldn't take a week, but with covid and flu season in full swing it takes a bit.

> or I can have it today in private clinic, where I copaid 40 EUR

it seems to me that this is how public healthcare keeps private healthcare honest, by existing.

i.e. you have, and I have also, paid a double-digit sum for the privilege of being seen _today_. But that is not the same as paying for the privilege of being seen _at all_.

The BATNA is very different for the patient. A private doctor can get away with charging a fee for the convenience only, but since it's not the only game in town, they cant gouge to extremes, and charge a huge fee when you need to be seen by a doctor at all costs.