Friends, This week we examine health inequality in America — and what can and should be done about it. Just click below. Among the questions I’ll be addressing are: Why and how are inequalities of income, wealth, power, and race related to health? Next, assuming that good health care is a limited resource, what’s the best means of allocating it — through the so-called “free market,” through rationing, through government subsidies, or some other means?
The situation has gotten much worse in the past few years. Private equity firms have gotten into healthcare and are having a feast on whatever is remaining of the carcass. And since they have seen blood, they're not going to let go of it so easily...until nothing remains. This affects even those who have insurance, so I don't understand why people are so opposed to any form of a government system. Also, it irks me that whenever someone...Bernie...talks about universal healthcare, people talk about the cost, or more specifically, an increase in their taxes. I just don't understand how people think that they can get things for free. Besides, most of us already pay an enormous sum of insurance premium anyway. Why can't they realize that the insurance premium they already pay is a form of tax?
We have the most expensive and least effective health system because of the health insurance industry. Money which should go to hospitals, medicine, and health care providers goes instead to health insurance stock holders and employees.
In UK we hsve msny problems but we so proud of our FREE NHS the envy of the world. Yes we have shortage of nurses doctors but if I'm ill I know ilk be treated the same as a millionaire. Why can't US hsve free care?
My wife and I retired to France, and we are ecstatic that we did so - partially because of the excellent and inexpensive healthcare here. Just as an example, I recently had a cataract operation, and the cost to me was less than 100€ - and most of that was a surcharge for a private room. They even paid for my taxi ride home. To get nearly 100% coverage, my wife and I pay insurance premiums of about $350 a month for both of us - and we're both in our late 70s. Included in that is full dental, eye, hearing, surgery, all doctor visits (including having a doctor come to our home), physio therapy, and all prescriptions. If we're in the US visiting family, we're still covered. Don't pay a dime to Medicare.
Absolutely single payer health care! Having lived and worked in Belgium 1989- 2016, I can attest to the fairness and quality of this system. A single mother friend with a part-time teaching job never worried about how she would pay for her and her son’s health care. I had a hip replacement that cost me zero - the waiting time was normal, a couple of months. My GP was always available for appointments on a day’s notice. Insulin, Epipen and other life-saving drugs are free to everyone under the mandatory national insurance.
People like Lindsey Graham seem to think that all of Europe is functioning like the stressed NHS - couldn’t be further from the truth, each nation has its own system! The NHS used to be a model of excellence until it became more privatised - and, it wasn’t originally set up for some of the more complex modern operations that have increased demands on the system. But apparently Lindsey doesn’t realise that there are many nations to the south and east of the UK who are managing their health care just fine? My European friends just look at me in disbelief when I tell them about the dysfunctional US “system” - as I’m sure is the reaction of many Americans now reading my comment! US friends always counter with “but you pay much higher taxes than we do!” Yes. And every European I know agrees that the health care of their friends and neighbors is worth paying for. It’s absolutely worth the investment that saves money in the long run, and benefits everyone - including yourself!
'Healthcare' in America has become another example of corporate greed. Medical schools are pretty much 'owned' by big pharma. Medical practices are mostly affiliated/controlled by large hospital complexes regardless of existing in other building addresses. Private practice is mostly a misnomer now, not what it once was. 'Best' doctors with generosity of spirit, time to listen, etc., are often found to be from and educated in another country.
There is a list of reasons healthcare is more expensive in the U.S. Each contributor to high healthcare costs argues it is "not their fault". However, the sum of the (bad) parts and bad actors lead to high prices. The reasons for high cost of healthcare include:
- Health care salaries in the U.S. are enormously higher than in other countries, including in advanced economy countries (example: Most physicians in Germany earn less than well-trained nurses in the U.S.).
- The American Medical Association makes it extremely difficult for a trained Dr. outside of the U.S. to practice medicine in the U.S, even if they have immigrated and become citizens. That leads to an unbalanced supply and demand for well-trained Drs. One of the reasons the AMA is protectionist is in the next point.
- Tuition for medical schools in the US are so high that Drs. feel they are entitled to high salaries, and restricting international Drs in the US maintains high salaries due to lack of competition. The AMA does not want to bankrupt Med Schools that would need to reorganize. In many countries there is either a very low or in some even no tuition for medical school training, so that the most talented get trained.
- The ability to sue for enormous sums for of money is unique to the US. This results in all kinds of added bureaucracies and expensive malpractice insurance for physicians. The government needs to make it very difficult to sue for large sums and to cap sums (many lawyers would see reduced income).
- Insurance companies add staff and bureaucracies, just to reject medical claims (part of the reasons are listed above and below).
- Last year’s bill passed stabilizing the cost of many medications. But all medications need to be open to competitive bidding from outside the U.S. (like Canada)
For each of the above points there is a lobby protecting the incomes of their stakeholders. Which politicians will have the courage to make changes?
A big part of the solution might be to by pass most of the above system. For example, initial consultation through enhanced telemedicine with Drs in other countries and shipping medical tests (blood etc.) to testing sites in the U.S. Being treated for expansive procedures outside the US. I imagine there will be insurances interested in these options. Congress needs to allow important of cheaper meds for all meds (e.g., from Canada). That could lead to a rapid competitive reduction in prices in the US. US medicine needs to be open to price competition up and down the ladder.
As an adjunct at the Sage Graduate School, I taught a course entitled "Comparative Health Care Systems" in the Health Services Administration Masters Program.
For 12 years, students compared nations around the world, and found that many nations have longer life expectancy, far lower infant mortality rates, and per capita costs 50% lower than the United States.
They also learned that Obamacare was not a step toward universal health care, but rather universal health insurance -- including all the limits and disincentives to provide care that come with it.
I am helping a student from Iran giving her room and board and making her part of our family. Last week she had an accident and I took her to the emergency room. She has a broken arm. The bill was $ 8,100.- They gave her a temporary cast. Next week she will be operated.
My wife had a mini stroke in Germany. I took her to a hospital where she had an emergency operation, she was in great danger. She was in the hospital for a week. There was never any question about insurance until after the operation. The bill was $ 25,000.- which I paid with my credit cards.
After returning to the US I was told by experts at UCSF that the operation and hospital would have cost in SF a minimum of 250,000.- Dollars meaning 10 times the cost in Germany. The UCSF neurosurgeon was impressed by the quality of work. It was apparently a very risky procedure.
My wife is on Medicare and Medicare does not reimburse for overseas costs even though it is much cheaper than healthcare costs in the US. Many older US citizens would love to live overseas where Social Security goes a long way for good living. The fact that Medicare does not reimburse health related costs overseas is a big obstacle even though costs are way cheaper as illustrated in my wife’s case.
Because Doctors run the health plans and the hospitals and there goal is make the most money from our illnesses. If we let the AMA (in charge of of polio we would have chrome plated iron lungs that came with TV and cellphones but no cure for polio .
America is all about Rentier - class opulants extracted the blood from ordinary Americans. 4 TRILLION PLUS - that is the yearly drain on our society. As much as 40% gets drained off by "insurance". Oh, they know how to fix it
But INSTEAD, they all dip their spoons in and get as much Sugar as they can. Medicine makes defense spending almost seem managable.
Socialized medicine exists in the US and has for quite some time. Kaiser and military medicine are excellent examples. Both systems are "brick and mortar" HMOs. Both systems operate exclusive of private insurance (although the insurance companies are desperately attempting to insert themselves in these systems)
Kaiser and Military medicine have very little administrative overhead. They are nearly 100% vertically integrated, owning their buildings, pharmacies, labs etc.
These systèmes do not file claims, they do not appeal denied claims.
Most of their money goes into the exam room, as it should.
The HMO act was a great attempt to control costs. Kaiser and a few other Brick and Mortar HMOs fit the need perfectly.
Not to be outdone, all the private insurance companies added "HMO" to their names. This should not have been allowed. I will call them "Paper HMOs" (PHMO)
Fact is, the PHMOs are just fee for service.
Insurance company red tape does nothing to improve health care. Red tape only adds expense.
The US should gradually grow the Military medicine model, or the Kaiser model.
Both Kaiser and the Military have excellent quality. We can all cite examples of poor outcomes, but poor outcomes are universal to every system.
Kaiser and Military, because they are "free" to the user, encourage easy access to care, which has been proven to lower the cost of care as problems are solved before they grow.
The US must replace private health insurance with the proven quality of true HMOs such as Kaiser, or the socialized medicine of the Military health system
If you live in the U.S., don’t have a major illness or a major surgery before Medicare kicks in, even if you have employer-provided insurance.
I had a heart attack and abdominal surgery when I was 62 and 63, respectively. At that time I had employer-provided health insurance. They delayed paying providers up to the time I reached retirement age at 66 1/2.
When one reaches retirement age at the company I worked for, one is called in and told to provide a retirement date *that month*.
OF COURSE that’s illegal and unethical. Does anybody here believe companies are going to behave legally and ethically? If you believe that, I have some oceanfront property I’d like to show you in Kansas.
After I was “retired”, the company said I was no longer employed and refused to pay any health claims which were incurred while I was employed, leaving me with scores of thousands of dollars in medical debt.
America already HAS “death panels”. They’re called HEALTH INSURANCE COMPANIES.
The situation has gotten much worse in the past few years. Private equity firms have gotten into healthcare and are having a feast on whatever is remaining of the carcass. And since they have seen blood, they're not going to let go of it so easily...until nothing remains. This affects even those who have insurance, so I don't understand why people are so opposed to any form of a government system. Also, it irks me that whenever someone...Bernie...talks about universal healthcare, people talk about the cost, or more specifically, an increase in their taxes. I just don't understand how people think that they can get things for free. Besides, most of us already pay an enormous sum of insurance premium anyway. Why can't they realize that the insurance premium they already pay is a form of tax?
We have the most expensive and least effective health system because of the health insurance industry. Money which should go to hospitals, medicine, and health care providers goes instead to health insurance stock holders and employees.
I live in Australia where we find American policy insane on too many levels to comment. Health policy being a number way up there though.
How is a person productive if they are not healthy enough to contribute to production. It aint rocket science.
In UK we hsve msny problems but we so proud of our FREE NHS the envy of the world. Yes we have shortage of nurses doctors but if I'm ill I know ilk be treated the same as a millionaire. Why can't US hsve free care?
My wife and I retired to France, and we are ecstatic that we did so - partially because of the excellent and inexpensive healthcare here. Just as an example, I recently had a cataract operation, and the cost to me was less than 100€ - and most of that was a surcharge for a private room. They even paid for my taxi ride home. To get nearly 100% coverage, my wife and I pay insurance premiums of about $350 a month for both of us - and we're both in our late 70s. Included in that is full dental, eye, hearing, surgery, all doctor visits (including having a doctor come to our home), physio therapy, and all prescriptions. If we're in the US visiting family, we're still covered. Don't pay a dime to Medicare.
Absolutely single payer health care! Having lived and worked in Belgium 1989- 2016, I can attest to the fairness and quality of this system. A single mother friend with a part-time teaching job never worried about how she would pay for her and her son’s health care. I had a hip replacement that cost me zero - the waiting time was normal, a couple of months. My GP was always available for appointments on a day’s notice. Insulin, Epipen and other life-saving drugs are free to everyone under the mandatory national insurance.
People like Lindsey Graham seem to think that all of Europe is functioning like the stressed NHS - couldn’t be further from the truth, each nation has its own system! The NHS used to be a model of excellence until it became more privatised - and, it wasn’t originally set up for some of the more complex modern operations that have increased demands on the system. But apparently Lindsey doesn’t realise that there are many nations to the south and east of the UK who are managing their health care just fine? My European friends just look at me in disbelief when I tell them about the dysfunctional US “system” - as I’m sure is the reaction of many Americans now reading my comment! US friends always counter with “but you pay much higher taxes than we do!” Yes. And every European I know agrees that the health care of their friends and neighbors is worth paying for. It’s absolutely worth the investment that saves money in the long run, and benefits everyone - including yourself!
Because the US is terrified of liberal socialism!
'Healthcare' in America has become another example of corporate greed. Medical schools are pretty much 'owned' by big pharma. Medical practices are mostly affiliated/controlled by large hospital complexes regardless of existing in other building addresses. Private practice is mostly a misnomer now, not what it once was. 'Best' doctors with generosity of spirit, time to listen, etc., are often found to be from and educated in another country.
In a deregulated capitalist society like America there is no money to be made from the poor.
The rules of American capitalism:
1) Underpay the workers so they can barely survive.
2) Extract what little money the workers have to further enrich the 1%.
3) When the workers get sick let them die once all their money has been extracted.
4) Rinse and repeat. (Actually repeating isn't necessary but it uses more product.)
In the U.S., despite our high-flown rhetoric, people don't matter. People with money matter; and people with lots of it.
As the "card player" said to Sundance in the opening scene of "Butch Cassidy and the Sundance Kid", "you can die; you can both die..."
There is a list of reasons healthcare is more expensive in the U.S. Each contributor to high healthcare costs argues it is "not their fault". However, the sum of the (bad) parts and bad actors lead to high prices. The reasons for high cost of healthcare include:
- Health care salaries in the U.S. are enormously higher than in other countries, including in advanced economy countries (example: Most physicians in Germany earn less than well-trained nurses in the U.S.).
- The American Medical Association makes it extremely difficult for a trained Dr. outside of the U.S. to practice medicine in the U.S, even if they have immigrated and become citizens. That leads to an unbalanced supply and demand for well-trained Drs. One of the reasons the AMA is protectionist is in the next point.
- Tuition for medical schools in the US are so high that Drs. feel they are entitled to high salaries, and restricting international Drs in the US maintains high salaries due to lack of competition. The AMA does not want to bankrupt Med Schools that would need to reorganize. In many countries there is either a very low or in some even no tuition for medical school training, so that the most talented get trained.
- The ability to sue for enormous sums for of money is unique to the US. This results in all kinds of added bureaucracies and expensive malpractice insurance for physicians. The government needs to make it very difficult to sue for large sums and to cap sums (many lawyers would see reduced income).
- Insurance companies add staff and bureaucracies, just to reject medical claims (part of the reasons are listed above and below).
- Last year’s bill passed stabilizing the cost of many medications. But all medications need to be open to competitive bidding from outside the U.S. (like Canada)
For each of the above points there is a lobby protecting the incomes of their stakeholders. Which politicians will have the courage to make changes?
A big part of the solution might be to by pass most of the above system. For example, initial consultation through enhanced telemedicine with Drs in other countries and shipping medical tests (blood etc.) to testing sites in the U.S. Being treated for expansive procedures outside the US. I imagine there will be insurances interested in these options. Congress needs to allow important of cheaper meds for all meds (e.g., from Canada). That could lead to a rapid competitive reduction in prices in the US. US medicine needs to be open to price competition up and down the ladder.
As an adjunct at the Sage Graduate School, I taught a course entitled "Comparative Health Care Systems" in the Health Services Administration Masters Program.
For 12 years, students compared nations around the world, and found that many nations have longer life expectancy, far lower infant mortality rates, and per capita costs 50% lower than the United States.
They also learned that Obamacare was not a step toward universal health care, but rather universal health insurance -- including all the limits and disincentives to provide care that come with it.
I am helping a student from Iran giving her room and board and making her part of our family. Last week she had an accident and I took her to the emergency room. She has a broken arm. The bill was $ 8,100.- They gave her a temporary cast. Next week she will be operated.
My wife had a mini stroke in Germany. I took her to a hospital where she had an emergency operation, she was in great danger. She was in the hospital for a week. There was never any question about insurance until after the operation. The bill was $ 25,000.- which I paid with my credit cards.
After returning to the US I was told by experts at UCSF that the operation and hospital would have cost in SF a minimum of 250,000.- Dollars meaning 10 times the cost in Germany. The UCSF neurosurgeon was impressed by the quality of work. It was apparently a very risky procedure.
My wife is on Medicare and Medicare does not reimburse for overseas costs even though it is much cheaper than healthcare costs in the US. Many older US citizens would love to live overseas where Social Security goes a long way for good living. The fact that Medicare does not reimburse health related costs overseas is a big obstacle even though costs are way cheaper as illustrated in my wife’s case.
Because Doctors run the health plans and the hospitals and there goal is make the most money from our illnesses. If we let the AMA (in charge of of polio we would have chrome plated iron lungs that came with TV and cellphones but no cure for polio .
J.
America is all about Rentier - class opulants extracted the blood from ordinary Americans. 4 TRILLION PLUS - that is the yearly drain on our society. As much as 40% gets drained off by "insurance". Oh, they know how to fix it
But INSTEAD, they all dip their spoons in and get as much Sugar as they can. Medicine makes defense spending almost seem managable.
Socialized medicine exists in the US and has for quite some time. Kaiser and military medicine are excellent examples. Both systems are "brick and mortar" HMOs. Both systems operate exclusive of private insurance (although the insurance companies are desperately attempting to insert themselves in these systems)
Kaiser and Military medicine have very little administrative overhead. They are nearly 100% vertically integrated, owning their buildings, pharmacies, labs etc.
These systèmes do not file claims, they do not appeal denied claims.
Most of their money goes into the exam room, as it should.
The HMO act was a great attempt to control costs. Kaiser and a few other Brick and Mortar HMOs fit the need perfectly.
Not to be outdone, all the private insurance companies added "HMO" to their names. This should not have been allowed. I will call them "Paper HMOs" (PHMO)
Fact is, the PHMOs are just fee for service.
Insurance company red tape does nothing to improve health care. Red tape only adds expense.
The US should gradually grow the Military medicine model, or the Kaiser model.
Both Kaiser and the Military have excellent quality. We can all cite examples of poor outcomes, but poor outcomes are universal to every system.
Kaiser and Military, because they are "free" to the user, encourage easy access to care, which has been proven to lower the cost of care as problems are solved before they grow.
The US must replace private health insurance with the proven quality of true HMOs such as Kaiser, or the socialized medicine of the Military health system
If you live in the U.S., don’t have a major illness or a major surgery before Medicare kicks in, even if you have employer-provided insurance.
I had a heart attack and abdominal surgery when I was 62 and 63, respectively. At that time I had employer-provided health insurance. They delayed paying providers up to the time I reached retirement age at 66 1/2.
When one reaches retirement age at the company I worked for, one is called in and told to provide a retirement date *that month*.
OF COURSE that’s illegal and unethical. Does anybody here believe companies are going to behave legally and ethically? If you believe that, I have some oceanfront property I’d like to show you in Kansas.
After I was “retired”, the company said I was no longer employed and refused to pay any health claims which were incurred while I was employed, leaving me with scores of thousands of dollars in medical debt.
America already HAS “death panels”. They’re called HEALTH INSURANCE COMPANIES.