Remote work will probably only expand, and I should be able to handle that well into my 70s and 80s if I make it that far. Medical issues caused by chronic computer use probably won't be that bad compared to laborers a few generations ago (and if we're lucky, I'll just plug something into my brain 10-20 years from now or replace my arms with some Deus Ex stuff). There's going to be some new tech to learn. They'll need people to know that tech.
I got a decent chunk of cash and got lazy about getting a job because tech is still in such high demand and I can fall back if I have to, and to be honest, having nothing to do feels exactly what I imagine retirement to be, and it's fucking boring.
The only way this changes is if I get hit with a mental disease like Alzheimer's or get in a paralyzing accident. Then I'm getting an exit bag for myself. Or someone starts a nuke war.
It feels difficult to envision retirement to me because I can't even imagine technology 5 years from now. We're advancing rapidly and our rate of advancement is only increasing. This includes healthcare technology (although I imagine Epic and Allscripts will still be around).
Not to get too bleak, but I could imagine a future where people upload their consciences to some server to continue work indefinitely. Your conscience could move from code base to code base ad infinitum.
But why bother with some average Joe's consciousness if you can clone a couple Carmacks, patch them to remove copy protection / willpower / whatever, and get "10x output"
You could even get them to do boring grunt work by telling them it will lead to a promotion, then reset their memory so they don't realize the promotion never comes...
It's hard to envision any good outcome with the current system. But if we pass a universal healthcare like Medicare for all, and forgive student loans, and a number of other measures like girding against climate change, then for the first time in long time I could a positive trend for the majority US residents.
The “majority of US residents” have private healthcare and don’t have student loans. That majority will pay more taxes to make life better for the minority of people who don’t have those things.
I’m in favor of universal healthcare, but billing it as something that will help the majority is disingenuous. This is the most likely outcome. Costs stay the same or go down a little bit, but nowhere near what it would take to make costs competitive, even as a percentage of GDP, with Europe. That means taxes will have to go up, and by a lot because our public sector is so inefficient compared to Europe. (It costs is 7 times more to build a mile of subway than France, why on earth would you expect building a hospital to be any different?) These taxes will have to be paid by the middle class—because that’s how it’s done in Europe. It’ll be totally unfeasible to have much higher capital gains or corporate taxes than France. (Which has low business taxes and pays for universal healthcare through regressive taxes.) At the end of the day, the middle class household making $80k/year will pay a lot more taxes, and their out-of-pocket healthcare spending won’t go down by much, because they had employer-paid healthcare to begin with.
But the hourly workers and those folks will be able to see doctors! And that will be a good thing. But it will also be quite unpleasant for the majority of people who we’re doing okay under the current system.
A friend of mine studied healthcare management for his thesis. One of the hidden costs in US Healthcare is the waste and duplication that comes from competition. His example was a town with enough population to support a single CT machine. They are expensive to maintain, but there was enough use to justify it.
One hospital bought a CT machine. Doctors who are the most important customers for any commercial hospital, began to sign contracts with that hospital because it made access to the CT machine for their patients easier. The other two local hospitals had to compete and bought their own. Now there were three machines and only enough patients to support one of them. That didn't reduce the maintenance costs. The cost inevitably is passed on to all patients. This is only one example from hundreds where competition led to unnecessary cost from duplication. Add to that the overhead for people who specialize in insurance billing because the competing companies are different and very complex, add to that the profit for the investors in the hospitals, the profit for the investors in the insurance companies and that's not even touching the similar stack for pharmaceuticals and supplies. That's not even adding in the cost of delayed and emergency treatment due to lack of preventative medicine for the uninsured and the under insured. All of that adds up to the $99 bag of $0.99 saline that comes out of your pocket one way or the other.
It would be difficult to create a more wasteful or expensive system if you set out to do it on purpose.
CT scanners and all the shit you need to run them don't cost that much.
The insurance I used to have negotiated with the hospital to charge ~$2000 for a five minute CT. The radiologist charged like $30 to interpret it. You can a buy a brand new machine every year with 5 or 6 patients a day.
The anecdote may have been true in 1982 or something.
Meanwhile, no one else can buy a CT because the state regulates who gets to own one.
Actually the maintenance costs less than $60 per patient and most of it is in autoinjector, some in coolant and checks. You're being gouged. Source: in Poland, checked the costs.
The cost of a new full size CT machine with surrounding equipment is quarter of a million USD though. Some are more expensive than others, but you can get a new good one for this much.
USG costs few tens of thousands, and maintenance is super cheap, mostly consumable gel, some $8 per patient.
MRI machines are more expensive at half million USD and $120 per patient. (cooling costs)
This includes salaries.
Hospital bed is like $12 per night, staff included.
Germany and Sweden have even better healthcare, mostly due to larger number of doctors and nurses. Not that much more expensive too. Our education and salaries don't keep up.
I‘d like to know the source of your numbers. For reasons I buy Ultrasonic gel quite regularly, and it costs me about 1€ per litre, delivered to my doorstep. If you use it for its intended purpose, I highly doubt that you use more than 0.10€ worth of gel.
Oddly enough, it seems like tech is closer to doctors in Germany than in the US. Just about every Hausarzt (general practitioner) and every internist and ob/gyn has an ultrasound machine in their practice and uses it themselves. When I've been in the emergency room, the doctor does the ultrasound, not a technician, though nurses set up and run EKGs.
And it's all amazingly cheap compared to the US, even as a private pay patient. An overnight hospital stay is about 200 EUR, including the attending doctor's fee.
That's interesting. In the US, these things go for $10K or so. Maybe they lease them? At $500/mo if it got used every day, that's be under $20 per use.
Yeah, in the tiny town I grew up in we only had a single hospital and still had a (private) radiography clinic that was shared between the public hospital and private surgeries.
> One of the hidden costs in US Healthcare is the waste and duplication that comes from competition
Sure the problem is lack of information? Other industries do well with competition.
Almost all medical / dental procedure in Australia has an item number with a roughly known cost. Providers know they can't charge much more than that without losing customers.
The general complaints I read are about the lack of specialized equipment. E.g. https://reason.com/2017/01/25/virginia-certificate-of-need-h... about the lack of neonatal care units (in southwest Virginia). It seems hard to argue that there should only be one hospital per town that offers common services such as delivery, but the only other solution is buying more units since the lack of neonatal units leads to substandard care.
And of course competition leads to unnecessary duplication, inefficiency is a well-known criticism of capitalism. But this inefficiency is like the inefficiency that comes from using Python instead of C; it is slower and uses more resources, but it actually gets things done, unlike health care where the inefficiency seems to come primarily from government regulation and lack of transparency.
It works pretty well here in the uk in each major town you get specialist hospitals with a number of general ones that don’t have the specific equipment specialists need.
It does mean you sometimes have to travel further but it works out better for everyone, even for you as the specialist care is within one “centre of excellence” (whether it is excellent is a different point but they could potentially be)
Man, I just don't think that 'the majority' of people are 'doing ok'. The majority of people are not sick. The current healthcare model only works for people who are healthy, if you have an extended hospital stay, or god help you something like cancer, you could still be in deep shit (even with insurance)
With our current system epipens are like a thousand bucks
with our current system insurance can say no to treatment.
I am one of the luckier ones, with a good healthcare policy that pays for a lot of shit, and I still would prefer universal healthcare to the current system.
I don't want to run my care by my insurance company. I don't want to get 5 forms every time i visit, 4 that say 'this is not a bill' and one that looks the same as those but IS the amount i should pay.
I don't want to factor in what its gonna cost when i go to the doc. Just go to the single-payer model, take it out of my taxes instead (it'll probably be the same in taxes as my monthly insurance premium) and make it simple for me to get the care i need.
PS. my health insurance goes away when i retire, unless i wanna pay something like 1.5k or 2k a month to keep it going. My retirement plan currently is 'try to die quickly'
You dramatically underestimate how many people have decent employer paid healthcare. The average out of pocket healthcare expenses in the US are less than a couple of hundred dollars a month higher than in most European countries, far smaller than the difference in taxes. See: https://www.commonwealthfund.org/sites/default/files/2018-12... (page 3; $1,100 per year out of pocket in USA, versus $690 for Germany.)
Also, you appear to have a very warped view of what single payer healthcare is like. The UK NHS for example, is extremely aggressive in “saying no to treatment.” They reduce it to a calculation of cost per quality adjusted life year. Service rationing is an intrinsic part of any healthcare system.
> You dramatically underestimate how many people have decent employer paid healthcare.
> $1,100 per year out of pocket in USA, versus $690 for Germany
I don't think these numbers are being interpreted properly or they are they just hand-waiving away your employer contribution (which ultimately is part of your employee compensation). I've been self employed in both countries so I can tell you first hand the actual price of health care in both.
In Germany your public health insurance premiums scale with your income. It maxes out at around 700 EUR per month for family coverage. You pay extra for prescriptions (not that much though) but there is basically no such thing as a co-pay or a deductible. My daughter had part of her kidney removed, was on chemotherapy, had club feet treatment, tons and tons and tons of treatment, AND physical therapy. Zero extra charges. We even got a free 4 week vacation in the Black Forest "for families with children who have a severe disease". So, total out of pocket cost for me was 700 EUR per month.
Now back in the US my own company's health care plan, which isn't awesome but it's also not terrible, costs my company $1300 a month for my family. And on top of that we have a $1500 per person deductible with a $7000 out of pocket maximum. Physical therapy here also costs $40 per session.
So, the math is pretty simple. By far Germany is way way way way more affordable. And this isn't even counting how much time and energy you spend in the US dealing with your fucking insurance and billing.
Yeah, I also don't know how you'd square the "Healthcare Costs as Percent of GDP" chart with the argument that Americans pay only a couple hundred dollars more than Europeans. We pay drastically more than Europeans.
I didn't say we pay only a little more than Europeans. I said that, accounting for employer-paid healthcare, we pay only a little more on average out of pocket. That means that the average voter whose employer already provides health insurance is facing significant uncertainty if private health insurance was replaced with public health insurance. Their taxes would go up a lot, and their out-of-pocket expenses would not go down that much.
>The average out of pocket healthcare expenses in the US are less than a couple of hundred dollars a month higher than in most European countries
Probably, but nobody in Europe is afraid to call an ambulance because they'll go bankrupt. First time I read on Reddit about people in US with "Don't call ambulance" bracelet, it really blew my mind a little bit.
There was political pressure on the NHS a few years back to say "yes" more often. This led to the introduction of the Cancer Drugs Fund to increase access to unproven cancer treatments. The disaster was as big as everyone predicted: a billion spent with nearly no clinical benefit. They should have listened to the bureaucrats at NICE.
Unproven? There were plenty of proven cancer drugs the NHS said “no” to, not because there was no data, but because they said the cost wasn’t worth it. You’ll live another 6 months? No we won’t pay $50K for that.
That actually makes a lot of sense, in that if there is a limited amount of funding then that 50K should go to a treatment that will give someone another 10 years. Under the US system, private insurance is just as quick (if not quicker) to deny that treatment.
Of course, under either system, if you come up with the 50K, then the treatment is all yours.
As someone who has worked in the US system, private insurers often pay for treatment quite quickly after approval. Unless the evidence is quite shaky, it’s usually paid for.
Now whether that’s a good thing is a separate question.
> Under the US system, private insurance is just as quick (if not quicker) to deny that treatment.
It’s hard to find data on this, but I haven’t seen any basis for concluding that private insurers are “just as quick” to deny treatment. In the past, private insurers tended to have lifetime limits. They’d let you blow through the lifetime limit, and then deny care. In the NHS, the cost benefit of care was more carefully scrutinized from the outset. There is a lot of coverage of the NHS denying hip replacements and cataracts surgery, which is almost universally covered in the US: http://www.telegraph.co.uk/science/2016/04/27/hip-replacemen.... The US also does quite a bit better in cancer survival rates, suggesting that insurers aren’t just denying treatment to cancer patients: https://qz.com/397419/the-british-seem-less-likely-to-get-ca....
The ACA eliminated lifetime limits, but also limited insurer profits to 20% of expenditures. So now, insurers really have no reason to deny care.
The hip replacement issue is known as the "little old lady problem" in NHS circles. Hip replacement is not urgent, you'd like to concentrate the limited funds where lives are at risk. Unfortunately, little old ladies are fodder to enemies of public healthcare and always rolled out in this context.
Take every man over the age of 50 and then give them prostate screening, and then don't do anything else at all. Don't test any of the prostate cancer that you find.
Your 5 year cancer survival rates go up, because most prostate cancer is slow growing.
But this situation isn't what happens. The US screens a bunch of men, and then treats the cancer they find. Does this reduce all cause mortality?
It's my understanding is the U.S. is especially aggressive with screenings, which might have some impact on % of cancer deaths, but has an even larger impact on cancer survival rates.
Ex. If a cancer will kill you in 5 years and there is no treatment. Catching it year 2 vs 3 will prolong your lifespan 50%.
> The Cancer Drugs Fund (CDF) has not “delivered meaningful value” to patients with cancer and may have exposed them to “toxic side effects of drugs,” an analysis has found.1
> The CDF was established in 2010 in England to provide “patients with faster access to the most promising new cancer treatments” and to ensure “value for money for taxpayers.” It funded drugs that were not available through the NHS because the drugs had not been appraised, were in the process of being appraised, or had been appraised but not recommended by the National Institute for Health and Care Excellence (NICE). The fund was overhauled last year.
Erm, the apples to apples comparison here is “private” plus “out of pocket” which ends up as $5000 per year in the US and $800 in Germany. Private seems to refer to the premiums, and out of pocket the expenses. Premiums are crazy high.
And Poland is even cheaper, but you might have to wait for a bed unless it's urgent. Private don't do everything because some of it is not profitable. Public takes the slack, but even paying out of pocket likely won't bankrupt you unless you're very poor.
On the other hand, nurses especially are too few and underpaid. Not enough doctors too. They still do a great job and are achieving some raises via protests. Polish healthcare is not rich. German is. Buildings and some facilities here need some refurbishing, which is happening slowly over time.
Why shouldn’t we consider “employer paid” healthcare the same way we consider a tax?
The last time I checked, the total cost of family health care at my last job (including what the employer paid) was $12,000 a year. Even at $100,000 a year - $40K more than the median income - that’s still around 10% of total compensation.
Average out of pocket expense is not what this story about. How about you look at the tail, say 80th percentile. These are the people that are getting screwed.
Please stop making arguments that are easy to shoot down, you're just fighting for the side you're trying to oppose.
> With our current system epipens are like a thousand bucks
No, they're not. One brand name EpiPen or EpiPen Jr. package (which contains 2 auto-injectors) will cost roughly $650-$700 if you are paying cash. Plus, you should be buying a generic, not the brand name.
> with our current system insurance can say no to treatment.
If they couldn't, then a lot of people would be getting the "super expensive experimental buy unlikely to help treatments". Sure, insurance companies turn down things they should not, but they also turn down things they should. Don't push for them to never be able to say no. Instead, push for them to only be able to say no when it makes sense.
If you're going to make arguments for universal healthcare (or even better healthcare), then do so in a responsible manner. Otherwise, you're just hurting the overall effort.
>> > With our current system epipens are like a thousand bucks
> No, they're not. One brand name EpiPen or EpiPen Jr. package (which contains 2 auto-injectors) will cost roughly $650-$700 if you are paying cash. Plus, you should be buying a generic, not the brand name.
These two? [0] and [1]? Maybe as a point of reference from outside the US: Both seem to be USD 10.40 with a doctor's prescription here in Germany (which some people could get exempt from), and retail price seems to be 103 USD.
I wasn't saying that epipen's aren't over-priced. They are, as are the generics. And it's horrible.
However, if you're going to make an argument for the US healthcare system having problems, then don't use numbers that are trivially shown to be false. Because then your entire argument (which could be compelling with real numbers) can be discarded offhand as false.
Don't sabotage your own argument with invalid numbers.
I'm "doing okay" as you put it under the current system, but I also feel like a slave to it. As the sole W2 employee with a family to take care of, there is no way I could or would untether myself from a certain kind of employer, even if I wanted to, because the incredibly expensive health insurance I have is so massively subsidized. Personally, I'd gladly pay more tax to get rid of the worry the current system causes. I'm sure I'm not the only one.
Honest question: do you think there is a different solution that would work to prevent situations like these people in VA?
I feel like one of the responsibilities and benefits of living in a modern society is that you should be sheltered from these kinds of problems, and that comes with a cost, as you note, in higher taxes. It sounds like you don't feel that way, and that's fair, but I want to make sure there is not another solution you think would work where the OP recommendation would not.
But, I look around most US major cities and see the rampant homelessness and drug addiction and (often the same people with) mental health crisis, and it scares me for the future of our country.
I did not see any of that in Europe a few weeks ago, even in cities like Barcelona and Greece, situated in countries that have "bad" unemployment and "bad" economies.
I’m in favor of higher taxes for more public services. Then again I’m a high income professional living in a blue state, so my taxes are already at European levels. (Maybe not France but probably Germany or the Netherlands.)
At the same time, the left is trying to pull a fast one on the American public. They are acting like universal healthcare will be this win-win situation. But lots of people will lose. Our neighbors, who have solidly middle class jobs but good health insurance benefits, will end up paying more in taxes than they will save in out of pocket health expenses. (Back when I had an entry-level engineering job in Atlanta, I made about $60k per year with full benefits and no premium contribution. Circa 2008 me would be worse off under universal healthcare.)
Even at the aggregate level, the idea that savings on premium contributions will offset the increased taxes is a fantasy. It assumes our costs will go down to European country levels. I have zero reason to believe that will be true. The US public sector is fantastically inefficient. The New York MTA spends twice as much to move a passenger one mile as compared to London, and building a mile of subway costs seven times as much. The US spends more on social welfare than Canada per person already, and that doesn’t even include universal healthcare. It is pure fantasy to assume we can get universal healthcare without European level taxes—20% payroll tax, 20% VAT, the works—on the middle class.
I think it’s worth it, because I think providing for the most vulnerable trumps having more TVs per capita. But it’s dishonest to pretend like it won’t require a major hit to material standard of living.
The CBO estimates it will cost $3 trillion a year to provide universal healthcare. You will notice that no Democratic candidate has proposed raising taxes sufficiently to come anywhere near raising the required revenue. That is very telling.
Realistically, if the employer doesn't have to pay out for healthcare, won't they have funds available to give the employee a higher salary to make up the differences in taxes? Ideally I'd like to see universal healthcare taxed similar to current FICA -- employee pays a share, and the employer pays a share. But since the employer typically covers about 80% of premiums now, it would make sense for them to do the same with the higher taxes.
> It is pure fantasy to assume we can get universal healthcare without European level taxes
Agreed, but is anyone really arguing this? The US has very low overall taxation rates (as a % of GDP), well below the OECD average. It should come as no shock to anyone that in order to get Euro-level services, we need a higher tax burden. High earners have the most to lose so it's also not a huge surprise it's an especially concerning issue for them. Most Americans (including those that would benefit most from these changes) are not high earners and they will pay a more measured amount.
I'm not an expert in health care cost containment but there are many doctors, administrators, and number crunchers in the industry who think we can get there if we want it badly enough. Over one third of our total health care expenditure is on administration. By some estimates, we'd drop 15% of the cost (in the trillions) overnight with a single payer system. It's a good start.
No you don't pay less in tax. Sweden does it with 7% of total tax being cost of healthcare. Poland scrapes by with 5% PKB being 26 billion USD. US pays more than 10% from tax and much more on top privately. Your taxes are not that much smaller to account for the difference, while the country is bigger.
Yes, a single payer would have huge negotiating power to drop these silly costs you pay.
> It should come as no shock to anyone that in order to get Euro-level services, we need a higher tax burden.
This isn’t really true with healthcare. We spend 2-3x what Europeans do on healthcare per capita. We even spend about the same in taxes as they do, PLUS our immense private spending.
We also spend more to get less than Europeans on many other dimensions. There is no reason to believe that we'll be able to cut costs to European levels when we can't do anything else for European levels of spending either. (For the same price as Maryland is spending to build a suburban light rail, Denmark is building a fully automated subway line underneath downtown Copenhagen with more track miles. The notion that just making the public sector handle healthcare will bring costs down to European levels is utter fantasy.)
At the very least, I think you have to assume we won't be more efficient than Europe in terms of getting healthcare spending down to a lower percentage of GDP. If we get healthcare spending down to 11.3% of GDP like France, we still have to find about $2 trillion per year in taxes to cover that cost.
> At the very least, I think you have to assume we won't be more efficient than Europe in terms of getting healthcare spending down to a lower percentage of GDP.
At the same share of GDP, we’d still be vastly less efficient per capita.
> If we get healthcare spending down to 11.3% of GDP like France, we still have to find about $2 trillion per year in taxes to cover that cost.
No, you only have to find a bit under $0.8T, because public healthcare spending is already a little over $1.23T of the $2T it would be under that model. And I think people would be happy to lose ~$2.3T in private bills for ~$0.8 in additional taxes.
Everyone is arguing this. None of the Democratic candidates who have proposed Medicare for All have proposed corresponding European-style taxes. Nobody has proposed a VAT, which averages 20% in the OECD. Sanders has given a "menu" of options, none of which raise anything close to the required revenue. The closest thing in Sanders' plan is a 4% employee + 7% employer payroll tax. That's less than what Germany or France assess in payroll taxes to fund their healthcare systems. All of Sanders' proposals put together only raise about $13 trillion of the projected $30 trillion over the next 10 years: https://www.sanders.senate.gov/download/options-to-finance-m....
> It should come as no shock to anyone that in order to get Euro-level services, we need a higher tax burden. High earners have the most to lose so it's also not a huge surprise it's an especially concerning issue for them. Most Americans (including those that would benefit most from these changes) are not high earners and they will pay a more measured amount.
Actually, middle income earners "have the most to lose." Again, look at how Europeans actually pay for their universal healthcare. Here in Maryland, the top marginal income tax rate is 42.75%, as compared to France or Germany's 45% rate. The top marginal rate in New York or California is higher than in France or Germany. What pays for the healthcare is not higher taxes on "high earners" but higher taxes on middle income people. In France, the 41% tax bracket kicks in at $83,000. In Maryland, the marginal rate on that income is just 26.75%. (In Texas, it's just the 22% federal rate.) Capital gains is higher in France, which is unusual among even European countries in taxing capital gains like ordinary income, but there's not much capital gains income to tax. ($650 billion or so in the U.S.). Germany's and Sweden's capital gains rate is 30%, about the same as Maryland. Corporate taxes in both France and Germany are comparable to or lower than the U.S. (after Trump's tax cut).
To fund universal healthcare, we need to raise another $3 trillion per year in taxes. The total income of the top 1% is 2 trillion. Raising taxes on those people to French or German levels won't raise much more money. This is obvious from Sanders' proposal: https://www.sanders.senate.gov/download/options-to-finance-m...
Sanders proposes to raise the top bracket to 52%, above France's or Germany's. It proposes to treat capital gains as ordinary income, like France but unlike Germany, Sweden, etc. Even raising taxes on the rich to levels higher than France only raises $1.8 trillion over 10 years. The payroll tax proposal, by contrast, raises $7.7 trillion, four times as much. Going all the way and raising social insurance taxes to French levels would raise 5-6 times as much as raising taxes on the French to higher-than-France levels. So would a European style 20-25% VAT.
How other countries finance their health care is incredibly wide-ranging. The point is that revenue-raising tax policies are being included in proposals to close the gap, not that they mirror how Germany and France do it exactly. Some candidates have not put forth detailed tax plans but nobody is saying we won't have to significantly raise revenues to pay for it.
> projected $30 trillion over the next 10 years
This is a projection and there is much disagreement. If we spent as much per capita as Canada, the cost would go down by around 50%. Single payer is not feasible at the cost per person the US currently spends. Every other country in the world spends less (a LOT less). We have a lot of real examples to follow.
> Actually, middle income earners "have the most to lose."
You have a good point, here, but again it could vary significantly depending on revenue-raising changes that are enacted. The Sanders plan includes mostly progressive tax changes.
> but nobody is saying we won't have to significantly raise revenues to pay for it.
Actually I dislike this statement - the federal government will be collecting and disseminating a lot more money than it is today, but less money will come out of people's pockets. It is the case that taxes will go up, but "taxes + health insurance" today is more than "tax + health insurance" under medicare for all, the tax goes up, the health insurance becomes 0[1].
1. At least for primary care, it's highly probable that a lot of "extra" medical care wouldn't be captured like vision insurance, dental and pharma.
"Our neighbors, who have solidly middle class jobs but good health insurance benefits, will end up paying more in taxes than they will save in out of pocket health expenses."
This will be influenced a lot by whether the employers give what they currently pay to provide healthcare back to the employees or if they just pocket the difference.
> The CBO estimates it will cost $3 trillion a year to provide universal healthcare.
That’s not $3T on top of what we currently spend, though. It just moves payments that go to insurers over into taxes. We already spend that $3T (and more!) on health care.
We know from the rest of the developed world that this is cheaper, too.
The single payer could force it to be cheaper. Much cheaper. In Poland we scrape by with 5% PKB which is 26 billion USD. But there's not enough doctors and nurses.
Our neighbors, who have solidly middle class jobs but good health insurance benefits, will end up paying more in taxes than they will save in out of pocket health expenses.
Someone is paying for insurance - that’s just a part of your compensation that is deducted from your paycheck. Theoretically, that means employers should pay you more. I think it would help the cause of universal health care if employers were not allowed to subsidize health insurance invisibly. They should increase everyone’s paycheck by the amount they are subsidizing the insurance and then have it as a line item deduction.
Yup, this is one of the biggest problems with American healthcare - a lot of people don't actually know how much it costs, because that cost is hidden in their employee benefits.
When Obamacare came around, I saw people complaining it'd cost them $1k, and comparing it to the $40/month they had to chip in on their employer plan, as if that was the total cost of it.
> The CBO estimates it will cost $3 trillion a year to provide universal healthcare.
You forget about the fact that universal healthcare will bring healthcare costs down as fuck. Ever looked at the price of a GP appointment before insurance in France and the US ?
> And The Times observed construction on site in Paris, which is building a project similar to the Second Avenue subway at one-sixth the cost.
This is an extreme example, but this is the persistent story of government programs in the US: they do far less while costing far more than in European countries. The US spends almost 30% more per student on K-12 education while getting worse results.
You linked to an article that takes care to mention that it is specific to New York and presented it as indicative of the entire US. That piece links to a blog post describing cost-per-mile of US rail in general [1]. That post demonstrates that NY is a huge outlier, with only London in a similar league. Our Central Subway here in San Francisco, as much of a mess as it is, has been nearly an order of magnitude cheaper per kilometer to build than the East Side Access in New York has.
The problem of excessive cost for rail, for the most part, is specific to English-speaking countries and Japan, not just the US. Quote: "Observe from the low costs of Italian subways that corruption alone cannot explain high American and British costs. High Japanese costs can be explained by strong property rights protections and a process that favors NIMBYism…"
There was a study that I can't find offhand that led to really interesting conclusions: despite the tendency of everyone to think that their own locale's government is uniquely inefficient, wildly late and over-budget public works projects are the norm everywhere. (Look at the Amsterdam North-South line in that blog post, now 2x over budget, for example.) Public support for most infrastructure megaprojects wouldn't be nearly as high if authorities were better at estimating costs. But that means that, if authorities were better at calculating costs in advance, virtually nothing would be built, including things that everyone now considers essential such as the Interstate Highway System (estimated at $25B over 10 years, actual $114B over 35 years [2]). The tendency of public works projects to be delayed and over-budget seems to be, paradoxically, what allows us to make progress in the first place.
I was thinking, it might be the cultural tendency to make really long work weeks / hours, but spend a lot of those hours slacking off (see also the thread about the boss-detector arduino thingy). As if they're paid for time, not work.
56% of Americans suffer from financial hardship due to medical concerns: Adults under 65 were more likely than their older counterparts to experience these effects.
We already have government provided insurance and it doesn't seem to be any more inefficient than the private health insurance we pay for. Our taxes will be go up, but our health insurance costs will drop by a similar amount except for the cost of extra medical care that people without health insurance aren't currently getting.
I mostly agree with the sentiment and ideas. Since the US Federal government is sooo inefficient I am not sure how it would work.
Using stats from another poster- ~34% are on medicaid/care. Another ~40% are covered by private insurance. Insurance companies have high-paid smart people negotiating prices. Government pays what it wants (pay by law mandate) regardless of costs. ~34% of hospitals patients therefor are losing the hospitals money- 10s of billions per year. They can go out of business and treat nobody, or jack up the costs on the one group available- self-pay uninsured.
The uninsured pay a lot because of government- they basically help subsidize these programs. If everybody moves onto a socialized programs that pays less than it costs hospitals to operate then hospitals close. Or taxes go up a lot to make it "free".
Don't get my wrong- as an uninsured person I don't like the way it is either. The only way I can think of is to make it all personal and private- get rid of employer deductions. Then add deductions/credits to cap medical cost at 10% of income or something. Anything above 10% is covered by taxpayers but individuals are responsible for shopping around and saving to make the market work as well.
2/3 of people who don’t have Medicare have employer-paid insurance. Or put another way 73% have either Medicare or employer paid insurance. (Obviously Medicare isn’t private healthcare, but the two groups are for the most part mutually exclusive.) The remained are for the most part covered by Medicaid or through direct purchase.
I don’t think you can reasonably include public insurance when considering if private insurance is widespread enough. Presumably the heath of the private system is based on people outside of the public one with vs without adequate insurance.
15 percent of the U.S. population get Medicare. 19 percent of the population get Medicaid. So, the government subsidies heathcare for ~34% of the population. And that’s excluding prisoners and VA which make up ~0.5% and 10% of the population, but may overlap with the above. Further the government also pays insurance for government workers and their families, or other special programs that subsidize heathcare costs like Ryan White or various rural heathcare initiatives.
Saying the majority as in over 50.01% of the population has insurance is a very low bar. What percentage of the population without healthcare is a sign of a well functioning system to you?
Second, what suggest public funds going to heathcare is a sign of a well functioning private insurance model?
Great punt, but that just means you don’t want to answer the question.
Also, significantly less than 50% of the population has completely non publicly funded heathcare. It’s a really odd system when you start breaking down the numbers. We have surprisingly close to a 50/50 public private system, but people get wildly different amounts of public funding.
Not really, Raynor said: 2/3 of people who don’t have Medicare
So he was excluding some but not all people who received government funded insurance. Which is why I was pointing out that was a very odd way of counting.
Sorta kinda, assuming co-pays were made quite reasonable then it becomes more a question of how to philosophically deal with the free-rider (from public bus) fame. Having a low fare, even an unreasonably low fare, decreases excessive use through weird psychological effects.
Sure, but that would require progressive policies implemented by electing progressive politicians. US voters seem to screw themselves over time and time again by voting for the status quo or in some cases regressive politicians. So long as people keep voting for those who promise no change, why would anyone expect anything to improve?
401k plans are fully exempt under bankruptcy law. I'm planning on moving to Texas to get even more exemptions - full exemption on IRAs, as well as primary residence up to 10 acres.
Things are a lot less nutso if creditors can't ruin your life in general - the healthcare crisis just means that everyone needs to be aware of how to handle a bankruptcy.
Just spent the weekend with my grandparents and their friends. Many of them are 90 plus, and are absolutely surprised to be alive - and have no plans or funding to keep going. Middle class background, high COL area. One will need memory care, no money for it though.
What an absolute nightmare. Hard to see this system being sustainable for more than a few more decades.
I think about this a lot. But then I remember that to do so is to project "business as usual" into the future -- the very trend that is spurring on ecological catastrophe and likely all kinds of social collapse. I'm afraid retirement will be the least of our worries.
Not just millennials. I'm late 40s and factoring medical expenses into retirement (over a decade off still) planning is the thing I'm most uncertain about.
If things don't change there will be radical political shifts. Both hard left socialism and hard right fascism are on the table from what I can see. We are in for interesting times.
An incredible number of boomers are going bankrupt due to medical expenses and have nothing for retirement.
I like to think we’ll have together in 30 years, but if the last 30 years is any indication, we’re in big trouble.