Where would you like your tax dollars to go?

[pocaracas]

I see those numbers and have no cause to doubt them.
But something must be wrong somewhere, because it's obvious the US is spending much more on healthcare per capita than most other countries, while leaving a large swath of the population unable to access medical care.
The money is going somewhere... somewhere it doesn't go on this side of the Atlantic.
Maybe there are redundancies in place that double or treble the actual cost of procedures?
Maybe the non-profits are doing some creative accounting?
Maybe something else, or a messy combination of many bits and pieces?...
You guys tell me.

Nonprofits earn extra money they just can't pay it out to investors. Most of it is reinvested in the nonprofit or used to fund charitable activities.

Yes a messy combination of many bits and pieces. I don't know how to fix it, and as far as I know no one else does either. As I said, I'm open to suggestions.

I'll ask those of you with single payer systems this. What you have now is apparently working now, but is it sustainable? What will your per capita costs for healthcare be in another 30 years?

According to this here (https://data.oecd.org/portugal.htm), Portugal spent, last year (2016) $167USD per capita on Healthcare.
The UK (https://data.oecd.org/united-kingdom.htm#profile-health) spent $3163USD per capita last year.
The US (https://data.oecd.org/united-states.htm#profile-health) spent $4672USD per capita.

From my point of view, the Portuguese system is, at the hospital level, similar to the UK one. At the pharmacy, it's very different as the British pay a flat price for their medicine (I think £7.5), while in Portugal we pay what the pharmaceuticals agree with the government and it obviously depends on the medication, with some medicine costing over 50€ for a weekly dose, while others cost less than 1€ for a full treatment.
On both countries, no one is denied healthcare, and no one needs to rob a bank to pay for it. It's virtually free.


In the US, the expenditure is greater and still...
I think the root causes for this disparity must be found and taken care of...

[vorlon13]

Emergency Auxiliary Backup Cat #2 would like to suggest some federal relief for his (perceived) lackluster care level here.

[popeyespappy]

Nonprofits earn extra money they just can't pay it out to investors. Most of it is reinvested in the nonprofit or used to fund charitable activities.

Yes a messy combination of many bits and pieces. I don't know how to fix it, and as far as I know no one else does either. As I said, I'm open to suggestions.

I'll ask those of you with single payer systems this. What you have now is apparently working now, but is it sustainable? What will your per capita costs for healthcare be in another 30 years?

According to this here (https://data.oecd.org/portugal.htm), Portugal spent, last year (2016) $167USD per capita on Healthcare.
The UK (https://data.oecd.org/united-kingdom.htm#profile-health) spent $3163USD per capita last year.
The US (https://data.oecd.org/united-states.htm#profile-health) spent $4672USD per capita.

From my point of view, the Portuguese system is, at the hospital level, similar to the UK one. At the pharmacy, it's very different as the British pay a flat price for their medicine (I think £7.5), while in Portugal we pay what the pharmaceuticals agree with the government and it obviously depends on the medication, with some medicine costing over 50€ for a weekly dose, while others cost less than 1€ for a full treatment.
On both countries, no one is denied healthcare, and no one needs to rob a bank to pay for it. It's virtually free.


In the US, the expenditure is greater and still...
I think the root causes for this disparity must be found and taken care of...

According to your link you're looking at less than half the cost of US healthcare. The $4672 number is government expenditures only. When you add what individuals and employers pay the per capita rate goes to $9451.

[Thumpalumpacus]

It can't be done without lowering costs. Removing profit margins from the equation wouldn't be enough by itself to make it workable either so we have to find other areas to reduce costs. I'm open to suggestions on how to do that...

A big driver for medical costs here in America are malpractice insurance premiums driven by lawsuits. I don't know how much, by percentage, that might be, but tort reform could probably help cap our costs.

We can talk about big pharma after that.

[Aroura]

It can't be done without lowering costs. Removing profit margins from the equation wouldn't be enough by itself to make it workable either so we have to find other areas to reduce costs. I'm open to suggestions on how to do that...

A big driver for medical costs here in America are malpractice insurance premiums driven by lawsuits. I don't know how much, by percentage, that might be, but tort reform could probably help cap our costs.

We can talk about big pharma after that.

That's a myth, driven by lawyers and big business.

https://www.forbes.com/sites/rickungar/2...5e70902ff5

A new study reveals that the cost of medical malpractice in the United States is running at about $55.6 billion a year - $45.6 billion of which is spent on defensive medicine practiced by physicians seeking to stay clear of lawsuits.

The amount comprises 2.4% of the nation’s total health care expenditure.

And the majority of that is on "defensive medicine", healthcare and testing "done only for the purpose of avoiding lawsuits".  But even if you got rid of all of that, it would barely dent the costs of medical care. 

As for the cost of malpractice insurance, it's not terribly high for doctors either.

http://truecostofhealthcare.net/malpractice/

And tort reform doesn't have a terribly large affect on the outcome of malpractice suits. Medical malpractice costs have been dropping throughout the US, and tort reform is not the driving factor of that reduction, though it has had some effect.  All it does is limit the amount of money legitimate victims can receive, while protecting mostly large corporations (like insurers, not the individual doctors).

[Thumpalumpacus]

Given the slim reductions possible, don't you think every efficiency ought to be brought to bear?

[Aroura]

Given the slim reductions possible, don't you think every efficiency ought to be brought to bear?

Is there enough inefficiency there to worry about it?  Studies don't really support that idea.
There are a lot of places to cut the fat, and victim compensation for legitimate injuries hardly seems the place to start. Do frivolous lawsuits exist?  Yes, but they are already rare, and there are already laws in place to punish those who bring those to bear.  Tort reform only hurts actual, legitimate victims, not frauds.

So to answer your question, yes.  Every efficiency ought to be bought to bear. However, this area is already pretty efficient (and steadily growing better over time, not worse) and doesn't seem to need more trimming atm.  

Our efforts would be much better spent on things like reducing outrageous drug costs, increasing preventative care (in order to reduce expensive emergency visits), normalizing costs (so that it costs the same to get an MRI in southern NY as it does in southern Arizona, not 6k in one place and 90k in the other) among other things.

[popeyespappy]

It can't be done without lowering costs. Removing profit margins from the equation wouldn't be enough by itself to make it workable either so we have to find other areas to reduce costs. I'm open to suggestions on how to do that...

A big driver for medical costs here in America are malpractice insurance premiums driven by lawsuits. I don't know how much, by percentage, that might be, but tort reform could probably help cap our costs.

We can talk about big pharma after that.

I talked about the potential savings of tort reform earlier. I didn't put any numbers to it, but as Aroura pointed out the potential savings probably aren't as big as some might think. Although I can't believe lowering an OB/GYN's $34,000 annual malpractice insurance premium wouldn't help some. How many freaking annual exams does a doc have to do to pay that bill? I'm not really in love with how .gov has rolled out tort reform myself. What they have done so far reduces financial risk for the providers by increasing the financial risk of consumers.

I also talked about profits of hospitals, insurance providers and pharmaceutical companies as a target for potential savings earlier. My rough calculations say the maximum potential savings from completely zeroing out the profits from these three segments of the industry is 6% of total cost.

Another target for savings is executive compensation. There would be some obvious savings from limiting multi million dollar salaries and bonuses of industry executives. Probably not as much as many would think though. The thing to keep in mind here is that much of the compensation these executives receive comes in the form of stock options. Stock options have very little effect on the bottom line of the companies because the companies usually don't have to pay anything for them.

A couple of things I haven't seen mentioned yet are the costs of regulation compliance and compromised IT security. For the former HIPAA compliance costs healthcare companies a fortune. Failure to comply with HIPAA regulations can cost an even bigger fortune. For the latter ransomware has become a big problem for the healthcare industry, and hackers accessing systems for the express purpose of fucking with provider and insurance company billing codes is rapidly becoming another. The indications are the people fucking with the billing codes work for foreign governments. If true then part of the reason our healthcare costs are rising so quickly is international espionage.

[Thumpalumpacus]

I've clearly got a lot to learn about this. Thanks to both of you for being so clear. I probably won't have too much to add here, but I'll definitely continue reading.