We'll never be rid of it. It's politically impossible to get rid of. And I don't mean "political" as in D vs R.
The amount of money we spend on healthcare in excess of the OECD average is more than we spend on the military. 10% ish of that is the entire yearly profit of the healthcare industry. The other 90% is raw inefficiency. And where does that 90% go? Mostly to salaries. Eliminate our inefficient system, and you eliminate millions of middle class jobs.
No politician will do it. They may talk about it and campaign on it knowing it won't happen. But they will never pull the trigger because it would be political suicide.
This is such a crazy take. "Because the waste is so huge, it's impossible to do anything".
It's not like any individual reform is going to suddenly end all that waste and put everyone involved out of a job. Iterative small improvements make a real difference in people's lives, and won't provoke an immediate giant supply-side shock.
I don't pretend to have the answers to the question of "what reforms should we do?" but throwing our hands up and saying "nothing!" is not the answer.
How do you reduce inefficiencies and cut costs without compromising care?
You cut jobs that are redundant. America spends an insane amount of money on administrative overhead. 4x the average of other wealthy nations [1]. This is largely in part because our fragmented insurance system leads to excessive redundancy in administrative roles
So meaningful reform means cutting jobs. Or you do the shitty political move and preserve these useless jobs for the sake of keeping people employed because our social safety net is a joke and the cost cutting you do make is at the expense of compromising care and vulnerable populations (eg cutting Medicare and Medicaid benefits). Then you get more clinician burn out and struggle to fill key clinical roles/staffing issues, scheduling issues and longer appointment waiting periods, more deaths and complications from a lack of preventative care, more mental health issues and drug abuse in communities, etc. all of which is happening in the USA.
While I agree with you on this bleak outcome, it's more that it's a progressive vs conservative issue. Progressives make up a minority of the democrat party and 0 of the republican party.
The only way to really change this is voting for progressives when possible, though it's hard to convince others that this is what you need to do.
If you are in a blue state, vote in the primaries for the progressive candidates. If you are in red states, that's voting for democrats in general and the most centrist republicans in the primary.
The absolute worst thing to do is to not vote and let the most conservative candidates run wild.
This is not a D vs R / lib vs con issue. It is not a progressive vs centrist Democrat issue either. It's a healthcare industrial complex issue. The US spends 16.6% of GDP on healthcare. The OECD average is 9.7%. (https://stats.oecd.org/Index.aspx?DataSetCode=SHA). That 6.9% difference is $1.5 trillion! That's 2x defense spending!
That 6.9% of GP is supporting millions of jobs, and to remove an inefficiency like that would put them all out of work. It is not possible to do that in a democracy.
Solid take. It'd be much more fine if that 90% could convert over to something useful in times of crisis. But recent public health events have suggested otherwise.
I think the government could make progress by focusing on just cutting costs or just reducing inefficiencies. When the two are conflated and attempted at the same time, the incentives don't actually line up so nothing happens.
I've lived with Swedish, German and now Czech healthcare in addition to American (with very good health insurance). I'd choose any of them over the American system. I find other Americans' fear of change to such a terrible and expensive system very confusing.
Imagine any single one of those companies being the single payer insurance you are forced into. They (government included) become far worse. Rationing care, deciding who lives or does, underpaying doctors and nurses till the best ones quit and the remaining have any care burned out of them. That’s what’s happened in other countries and regions and every time there is a surge or a more complicated care you and loved ones are left to die or deprived of care options.
Yet we have examples of nationalized health care across the world that isn't this system you are describing. The US stands alone in it's terrible health care (and the price we pay for it).
We already ration care, it's based on what you can afford. We already underpay doctors and nurses like crazy, just go talk to one. We already drive them to burn out, because the current health care system is prioritizing admin pay over quality care.
The hellscape you imagine is the american system. It literally could not be done worse if we tried.
Compare the cost of living of Spain to the US (food, rent, public transit) my friend. What makes the cost of CARE cheaper is less administrative agents/overhead.
Hypothetically then places with high concentration of beneficiaries covered by a single-payer system (Medicare) should have markedly cheaper medical care, lower overhead costs and all.
1. Medicare only covers the most expensive in terms of health care costs demographic. Knowing nothing else I’d expect having more people on Medicare to correspond with higher costs per capita. We make 25 year old men who statistically have nearly no healthcare costs buy insurance while providing it to their 90 year old grand parent.
2. Medicare was not allowed to negotiate drug prices until this year. Drug comonies basically got to wr8te themselves checks. In some ways the Us taxpayer subsidizes drug development for the whole world.
I suspect demographics are part of why Florida hospital costs are so high.
The youngest state in the USA is Utah. The state has a median age of just 31. They have some of the least expensive hospitals in the country.
And type of nurse. Big difference in pay between an rn, Lpn, msn, crnp, but one might colloquially refer to all as a “nurse” (except maybe the crnp). Position matters too. A travel er nurse is going to make significantly more than an outpatient primary care office nurse
Exactly why the entire system should be nationalized instead of outsourced. Further, nationalized healthcare promotes political engagement on a basis of material necessities that politicians must be accountable for.
The dumpster fire is happening because the conservative government there is running it into the ground by cutting funding at every turn possible and closing down hospitals.
And even then, I've experienced NHS care and it's 1000% better than the experience I've had with american care. It's not perfect by any means, but it's insane how much better it is than what we have here.
They aren't necessarily cutting funding. They are cutting the amount of funding for nationalized services while increasing the amount of funding for outsourcing contracts.
I've heard this narrative over and over again yet every time I look at it the NHS budget has been consistently increasing year over year for a long time.
And proportionally even more of that budget goes to the pockets of politicians' donors who own the companies that displace the nationalized NHS. Again, the argument is for nationalization, which is the opposite of the direction the NHS has been heading in.
My argument is for nationalized healthcare. The NHS is increasingly not nationalized, so you're only proving my point if anything. Outsourcing the NHS has ruined it.
>Rationing care, deciding who lives or dies, underpaying doctors and nurses till the best ones quit and the remaining have any care burned out of them
This is literally happening under the current system now. My cancer treatment plan, should I ever get it while I'm living in America, is to blow all my cash and buy an exit bag on credit.
A lot of countries have both nationalized care and the fast track. Many people buy private insurance to cover what the national system does not.
Maybe it's not the best of both worlds, but it's at least a far better safety net than the US provides, and that's the most critical piece. Both for the most affected individuals, and society as a whole (even in terms of cost! An ounce of prevention is worth a pound of cure, and all that.)
There are medical company systems in the US that operate similarly to a nationalized system (insurer and provider bundled, I’m not mentioning the name) and have similar downsides - cancer care or any advanced care is sub-par and mental health is hard to impossible to get. The funding to physicians within is distributed on political instead of performance grounds so best ones leave. I’ve lost several friends who used that insurance.
In Bulgaria where I have many friends and family, the system has always been nationalized, barely funded by the government. I don’t know a single Cancer survivor there.
With USDA captured by agricultural interests, and FDA by pharmaceutical lobby, what’s to prevent the regulatory capture of this new single-payer agency?
So the answer to "rent seeking vampire insurance companies" is a rent seeking vampire government agency?
No thank you.
The answer to government created problems isn't a government created department.
All you have to do is look at all of history to see the results of increased government power. Look at the lies of the unaffordable care act. look at the fact that things the government promises as "free" become unaffordable and worse.
I'm very anti government / anti bureaucracy. But in this case it is hard to argue with results. The European system is simply more efficient at delivering healthcare. Here's a really long and detailed report showing why I'm right: https://www.mckinsey.com/~/media/mckinsey/industries/healthc...
But you don't need to worry, it's politically impossible to get rid of the healthcare industrial complex which is 5x the size of the more frequently cited military industrial complex.
Free market options with reasonable government regulations.
What we had when this country had great healthcare options.
You know... the stuff that was replaced with "Keep your Doctor", "keep your plan", "save $2500 a year" and other lies used to pass the unaffordable care act (and similar).
There's a reason "Free Healthcare" can only pass with lies - and it's because government options/UHC/etc are lies for those who don't look at... well... history.
The amount of money we spend on healthcare in excess of the OECD average is more than we spend on the military. 10% ish of that is the entire yearly profit of the healthcare industry. The other 90% is raw inefficiency. And where does that 90% go? Mostly to salaries. Eliminate our inefficient system, and you eliminate millions of middle class jobs.
No politician will do it. They may talk about it and campaign on it knowing it won't happen. But they will never pull the trigger because it would be political suicide.
Also, if you want to know more than you ever needed to about the US healthcare system and why it is so expensive I highly recommend this report: https://www.mckinsey.com/~/media/mckinsey/industries/healthc...