> Doesn't America alone already spend 2 or 3 trillion a year on healthcare?
There's a huge difference between "paying for healthcare" and "paying a healthcare provider" here in the United States. Oftentimes the latter has 2 or 3 additional zeroes attached.
Sure, but Congress invariably pretend to say the former but mean the latter. You're asking for single-payer instead of privatized health insurance, they will sooner bankrupt the country than switch to sanity. Congress and its funding sources are now captured by privatized health insurance:
In 2023-4, Health came #7 in total political donations, #8 is Lawyers & Lobbyists; the combined "Finance/Insur/RealEst" is #1; would be useful to see "Insurance" broken out by health insurers vs non-health (can anyone cite a more granular breakdown?). [https://www.opensecrets.org/elections-overview/sectors]
It's not single payer vs privatized insurance. Why is this myth so persistent in US?? There are many different options for public healthcare, of which single payer is but one, and it's not even the most popular worldwide. Many European countries are not single payer, including e.g. Germany.
That would just be just reopening decades of debate in the US.
For whatever reasons, the consensus in the US after decades of talking comes down to single payer vs privatized insurance. Congress isn't going to implement single-payer, so the menu reduces to either we choose good or bad regulation of privatized insurance.
We don't have time for yet another decade of debate, since health insurance premiums (net, post-tax-credit) in the US are about to jump this November open enrollment by median 18% overall, or 114% for people on ACA due to the expiration of enhanced premium tax credits [0]. Expect that to feature prominently in the news cycle by Thanksgiving.
(Germany's multi-payer system (government + mandatory statutory contributory insurance + optional private insurance) would in theory be fine if US Congress was ever incentivized to implement such a thing. But it very clearly isn't, since the 1950s - look at the lobbying money trails. Let the good not be the enemy of the perfect. The ACA was the closest the US (briefly) came to mandatory statutory contributory insurance, but the federal mandate was abolished back in calendar 2019 by the "Tax Cuts and Jobs Act of 2017").
Have you considered that those decades of debate haven't resulted in a public healthcare system precisely because single payer is what was pushed by the pro side, and many people in US (rightly or wrongly) have a problem with the notion of government telling them that they can't pay money for better healthcare?
I have done a lot of research into this area. Obesity and other self inflicted health issues are definitely a factor, but not, by far, the whole picture.
Our cost per service is 2-4x or more, and the larger reliance on specialists creates significant complexity and even more costs. So, we do spend 2x, but we get 1/3 to 1/4 of "care" per dollar. In other words, we get less actual care. And the care is biased to fixing things as opposed to preventing things. And it is also biased to those who are wealthier.
Some of the cost drivers:
- Administration is 25% of costs, far less in other countries. Insurance company profits and complex administration with confusing and overlapping methodologies that obfuscate costs and comparisons.
- Capital costs are 25% of costs, far less in other countries. Multiple, private, and overlapping hospitals demand more capital and private capital with its expected returns
- Doctor compensation is 2x to 4x more, nursers 2x. Specialists here get truly rich, not true in other countries.
So, quite a lot of the extra spend is not efficient, and goes to insurers, owners of hospitals, and doctors.
I also have personal experience. To get a simple ultrasound, you are talking about $450 for a primary care visit to get a referral for a $650 specialist to get a $1000 ultrasound ($800 scan plus $200 reading), to get a $650 follow-up visit with the specialist to discuss the results. That is almost $3,000 of actual out of pocket costs to me, with a good insurance plan ($2K per month for a couple), the "claimed" costs were significantly higher. MRI and CT are even higher. Similar for a broken ankle, which cost me over $4000 out of pocket.
I am, relatively speaking, well off compared to average, and was able to do this, but that hurt, and significantly disincentivizes me in the future.
Our health system is broken, and pumping more money into only makes it worse.
It's neither, your outcomes are poorer because access is not uniform. If you can afford it, US healthcare is the best in the world, but if you can't you basically don't get it (or at least, you don't get it until the problems are bad enough it's an emergency and you get saddled with life-crushing debt for the bare minimum to stabilise you from the ER)
There's a huge difference between "paying for healthcare" and "paying a healthcare provider" here in the United States. Oftentimes the latter has 2 or 3 additional zeroes attached.