Where would you like your tax dollars to go?

[popeyespappy]

In Portugal, every medical procedure is on a table together with its cost. This cost is, of course, agreed with the medical order, but the table is set by the government and those costs cannot be unreasonable as they are used for the annual health budget on public hospitals and clinics.

From what you say, pappy, it seems to me that these procedures are somewhat more expensive in the US than elsewhere.
What's the reason for such an extra cost?
From my uninformed POV, I think it has to do with the fact that American hospitals are private for-profit companies. Couple that with the existence of insurance and the hospitals end up charging almost whatever they want.... regardless of the actual cost of each procedure. The insured patient only has to worry about having that particular procedure covered.
Who is insured? mostly workers that have insurance as part of their income... and rich people...


With a table set by the government, for use in public hospitals, you get to apply only reasonable prices to the required procedures.
This cost is mostly covered by our Social Security budget.
It's not a perfect system, but it helps regulate healthcare prices.

I don't know how that could be translated to the US reality... but I do believe that it would require a massive restructuring of healthcare... do you guys have public hospitals at all?

I've already mentioned a couple of the big additional cost drivers in liability insurance and education costs.

Profits of health insurance and health providers are of course another target for cost reduction. But those profits are probably not as big a portion of the overall cost as many assume. For one thing 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 supply healthcare to Americans that don't currently get any without raising the overall cost.