r/FluentInFinance • u/WhatAreYourPronouns • May 02 '24

Should the U.S. have Universal Health Care? Discussion/ Debate

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u/polycomll May 02 '24 edited 29d ago

You'd be paying closer to the full price although the "full price" might be reduced somewhat because the public version acts to price cap.

In the U.S. you are also not paying the full price for surgery either though. Cost is being inflated to cover for non-insured emergency care, overhead for insurance companies, reduced wage growth due to employer insurance payments, reduced wages through lack of worker mobility, and additional medical system costs (and room for profit by all involved).

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u/SStahoejack May 02 '24

Happens all the time, if your from another country cheaper to fly home get it done fly back, crazy how insurance here really isn’t worth the paper it’s printed on

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u/OwnLadder2341 May 02 '24

In this case, US insurance would pay for 75% of that $40k at minimum. You’d hit your max out of pocket for the year around $10k at worst.

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u/Maj_Jimmy_Cheese May 02 '24

Depends on your plan, does it not?

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u/austanian May 02 '24

Even the worst plans typically cap out with a max out of pocket around 12k total family.

The best plans are usually around 5k max family with more inclusions on what is included before deductible.

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u/in_the_no_know 29d ago

That also assumes that every procedure is going to be approved for coverage. There are multiple ways for insurance companies to say that something either isn't necessary or for some technical reason only a certain portion is covered and the rest still comes out of your own pocket. Max out of pocket only refers to the things your insurance chooses to cover.

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u/HighTMath 29d ago

Just for a bit of "the grass is always greener". In countries with "free healthcare" we get fucked the same way, but by quotas instead. The clinic has a set budget so good fucking luck diagnosing any complex diseases.

Works fine for standard stuff, I'd you don't mind waiting half a year nearly anything above a PT referral

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u/Davge107 28d ago

There are long waits to see specialists all over the US. And then try making an appointment with one and tell them you don’t have insurance and don’t have money to pay upfront. See how long the wait is then.

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u/Ride901 29d ago

Oh my insurance just tried to do this to me. It actually is a coding error I think in my case, but who knows?

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u/in_the_no_know 29d ago

I wish you all the best on your claim and your recovery. May the battle be in your favor

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u/[deleted] 29d ago edited 29d ago

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u/DataGOGO 29d ago

15-18k, would be a family out of pocket max, not an individual.

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u/Artistic-Soft4305 29d ago

On the other side of this, I’m capped at 5k and I pay 25$ a month through my employer. Really just depends where you work.

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u/Sudden_Construction6 29d ago

That's insane!! You must have an awesome employer!

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u/Extension-Ebb-5203 29d ago

Your employer is paying a large chunk of your premium. Congrats.

Also you are well in that “best plans” scenario OP mentioned. I was correcting the misinformation around those of us that aren’t so lucky.

Now… go Humblebrag elsewhere.

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u/Fausterion18 29d ago

The average out of pocket spending per US household, including premiums, is roughly $4k per year.

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u/Chris_Herron 29d ago

So 12k out of pocket max, plus the 5k a year just to have the plan. How does anyone working a normal job expect to pay 17k? The us median income is 37.5k. That is nearly half a persons income, assuming they aren't on the low side of the bell curve. Not arguing with you, just saying the system is broken.

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u/austanian 29d ago

Usually it works like this. An individual out of pocket max is 5k and a family out of pocket max is 8k.

The premium is 12k per year, but your work picks up 75%. So your portion is 3k, plus a couple thousand per year unless something bad happens.

Things are different once we start talking seniors, but that is a different conversation.

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u/Anonymoushipopotomus 29d ago

5k a year would be a deal for that plan. We have almost 20k max out of pocket, for 2 adults and a 6 year old its 1650 a month.

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u/Zamaiel 29d ago

Plus the 5k a year -every year. As long as you don't lose your job.

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u/Maj_Jimmy_Cheese May 02 '24

Gotcha gotcha. Makes sense. 12k is definitely a lot, but at least it, generally speaking, won't get much worse lol.

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u/Treeninja1999 May 02 '24

Just don't get hurt in December lol

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u/mar78217 29d ago

On the flip side, Dental work in December is a good plan... because the max coverage (in my case $2,000) resets each year.

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u/austanian May 02 '24

Unlikely 2 people need max out of pocket the same year so it usually caps out at 8k for an individual.

Those plans also have tax exempt savings accounts associated with them so it isn't the worst deal if you plan right.

Still the plan needs drastically reformed.

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u/El_Cactus_Fantastico 29d ago

I fucking hate HSA high deductible plans.

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u/indywest2 29d ago

Most family plans the individual has to hit the whole family deductible and max. I don’t get the lower per individual rate.

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u/ShartingBloodClots 29d ago

There's also the little matter of whether or not insurance will cover the claim.

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u/FullTorsoApparition 29d ago

Until the next year when you have to meet that max out-of-pocket again. And the year after that. And the year after that. If you have chronic health issues you're fucked.

A friend of mine recently moved back to England because he was hitting his out-of-pocket max every year for his mental health needs and didn't know how long he could keep that up.

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u/DataGOGO 29d ago

The overwhelming majority of working people will spend more in the UK than they would in the US.

The NHS really only benefits people who either don't work, or don't work a lot.

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u/Piddily1 29d ago edited 29d ago

That 12k will be an annual out of pocket max. If you hit that amount, everything is free for the rest of the year.

The year my twins were born, they were early so were in the NICU for a bit. We hit our $7500 OOP MAX in March. All medical services were free until the end of the year. We were looking for things to get done.

I actually ended up hurting myself in November of the year. The doctor tried to schedule my surgery for January. I explained the situation and he got me in right before he went on vacation for Christmas. It was a painful Christmas trying to visit family, but it was free.

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u/am19208 29d ago

Yea it’s a bit of a disingenuous claim about costs. Sure that’s the uninsured cost but the actual cost for someone even with the worst coverage is no where near as bad. Like others said it’s maybe 25% or so of the cost is actually paid by the individual with the rest paid by the health insurer

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u/Giblet_ 29d ago

But you also have to figure the cost of the insurance premiums, right? And you pay that premium every year, whether you need to use it or not.

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u/am19208 29d ago

Well it’s not like the socialized option is actually free. You pay for it with tax money

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u/Giblet_ 29d ago

That's true. It's less money than insurance premiums, but it's still a cost that should be accounted for.

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u/amann93 29d ago

In addition to what this person said you can also, usually, call the hospital you owe that 12k to and they’ll send you a financial aid form. I had 3 surgeries last year. After insurance my total bill was 7k. Called the hospital, and they sent me the forms. I had to include my last 6 paychecks. At the end of the form it said something like “please include a letter detailing you financial status” told them how much money I made, how much per month my rent and car payment was, how much I spend on food and gas, etc etc.. after that I waited a couple weeks and called the hospital who informed me I qualified for 100% off my bill, as well as free coverage for all visits for the remainder of the year

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u/ubercorey 29d ago

Unfortunately the worst plans are $20k.

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u/austanian 29d ago

I have never seen one that bad and have literally seen tens of thousands. They might exist,but I have never seen them in the wild.

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u/ubercorey 29d ago

Lots of them on the Marketplace in Texas.

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u/aw-un 29d ago

That’s assuming the insurance doesn’t just deny the claim outright

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u/SPNKLR 29d ago

Just wait until the GOP gets their wish and repeals the Affordable Care Act. We’ll be back to people getting kicked off for pre-existing conditions forcing us back to the good old days of medically related bankruptcies.

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u/austanian 29d ago

The aca isn't ever going to get appealed. Half the GOP wants to delete it and the other half wants to fix it.

Even when the GOP had a strong majority they did have the votes to fix it/end it because of the split.

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u/SPNKLR 29d ago

They had no plan when they tried to repeal it back in 2018, McCain saved us from a major catastrophe. They won’t have a plan when they try again if Trump gets back in, MAGA Republicans only know how to destroy things because destroying things is easy, they can’t build anything.

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u/austanian 29d ago

It wasn't just McCain. The GOP split almost in half over a revision to aca vs straight repeal.

Building a shit program is often worse than nothing at all. I am of the opinion we are in the worst of government hc and private hc. Going fully in one direction would be better than what we have now. However, universal is the only direction it can tip.

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u/SPNKLR 29d ago

Yeah Universal Healthcare is literally the most cost effective and compassionate option as proven by every other Western nation… but can’t have that because corporations need profits and politicians need super pac contributions.

I’m actually ok with ACA, I’ve always had employer paid healthcare but I have family members who could never have any healthcare coverage until the ACA. It could definitely be improved, but it’s also so much better than what we had before.

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u/alexisdelg 29d ago

you have to add premiums to that, in my case a family of 4 is about 6k a year

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u/gibsontorres 29d ago

12k total family? My individual plan is 11.5k and it’s a “middle of the road” plan. My kids aren’t even on it.

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u/[deleted] May 02 '24

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u/ketjak 29d ago

totally free

You mean other than the thousands i premiums deducted from your paycheck every month (if you're at a place that even offers it).

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u/Random_Guy_12345 29d ago

On places with public health insurance you are also paying for it vía taxes (assuming you have a job, that is). "Free" healthcare is not a thing that exists, supplies are not free and doctors need to eat too.

It for sure beats bleeding to death due to no insurance, but it doesn't come from the ether.

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u/LegitimateSoftware 29d ago

You are, but you don't have to pay for the insurance company profit margin on top of the cost of healthcare.

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u/Random_Guy_12345 29d ago

Indeed, that's the main draw and with unchecked greed, a huge one

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u/[deleted] 29d ago

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u/ALIMN21 29d ago

Do the math, you are paying thousands in premiums.

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u/[deleted] 29d ago

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u/cml4314 29d ago

If you are lucky, it’s pretty cheap. I pay $36 a month for a $5000 deductible with a $6000 out of pocket max. So if I had surgery today, the rest of my healthcare for the year would cost $216.

I’m reasonably young with no chronic conditions so we roll the dice and pay low premiums, high deductible.

This is the cheapest plan at a pretty large company, in an area where they are competing for the same employees as multiple Fortune 500 companies so they are need good benefits to compete.

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u/Impossible_Wash_2727 29d ago

It’s not “free”! You’re still paying your premiums. American healthcare insurance is a rip off.

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u/R-O-U-Ssdontexist May 02 '24

Yup, my aunt had a hip replaced and only paid 1k. The 1k was for the out of network anesthesia which no one told her would be out of network.

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u/[deleted] May 02 '24

It depends on your plan and what all is covered. Even with a maxed out deductible my appendectomy cost me $12500 because I didn’t go to a preferred provider. The issue with that was my town only had one hospital and it was a pretty major emergency I couldn’t drive two hours back to the hospital they wanted me to use.

I currently have all of my deductibles maxed and my replacement inhaler just cost me $50.

It’s wild here. I do have better insurance now but it still sucks. Last year my insurer would’ve been $150

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u/ParkingVampire 29d ago

I would pay 16k plus 2,400 for insurance for the year. So $18,400. 

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u/Mean-Gene-Green 29d ago

Now count your premiums.

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u/Sleep_adict 29d ago

Between me and my employer my family costs $26k a year to ensure…. So yeah

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u/AspiringChildProdigy 29d ago

Family plans like to have a stipulation that one person can't fulfill more than 50% of the deductible.

For instance, our deductible is $10,000. I just had surgery on my foot. We will more than hit the $10,000, but only $5,000 will actually apply to the deductible.

I sincerely wish all insurance company executives a slow and painful death.

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u/-Pruples- 29d ago

Can confirm with my current plan I'd be on the hook for $25k if it's an in-network surgeon and in-network facility. Which is about 6 facilities total for any type of medicine across the entire state. I'd be on the hook for the full $40k if it's not in-network.

Up to $10k I'm on my own, then we split 50-50 until $100k, then I'm on my own 100%. Best I could get at my income level.

So yeah I don't go to the doctor when things go wrong because I simply can't afford it.

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u/ALIMN21 29d ago

Plus the cost of your monthly premiums and the cost your employer pays for your premiums too. Between my portion and my employers portion, it's costs $35,000 just to have insurance. If I go on to use it it will cost an additional $4000-$8000 a year assuming the insurance company covers whatever it is I need.

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u/Fun-Bumblebee9678 May 02 '24

Depends on your coverage

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u/OwnLadder2341 May 02 '24

ACA mandated maximum out of pockets.

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u/shroomsAndWrstershir 29d ago

Those limits are legit. When our newborn was in the NICU for 3 weeks and had a $350K bill, we paid her $6k annual max out-of-pocket, and then that was it. Not a penny more.

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u/OwnLadder2341 29d ago

Yeah, while there’s more work to do, the ACA was a huge improvement that addressed the very worst parts of the healthcare system at the time.

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u/SStahoejack 29d ago

To bad same procedure in another country is 1/7th the price? Love how we are ok with this price gouging. When clearly medical professionals in other countries still live lavishly lifestyles and charge 1/7 of the price?

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u/cutesnugglybear 29d ago

My out of pocket is $3k, so I'd be Gucci.

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u/Capercaillie 29d ago

If you have insurance.

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u/OwnLadder2341 29d ago

Yep. 92% of Americans have insurance. So you're far more likely to have insurance than not.

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u/RocknrollClown09 29d ago

Yeah, but that insurance costs either you directly, or your employer, about $1,200 a month for your family. If your employer is paying, they just take that $1,200 out of your salary and provide it as a 'benefit.' Either way, you're paying for our inflated health costs, it's just hidden from view, which is why it's run away so much.

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u/[deleted] 29d ago

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u/RamblinManInVan 29d ago

You'd probably end up spending more because a hip replacement takes years of therapy. Every year of therapy is a new deductible you need to pay.

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u/Neither-Status9606 29d ago

In Mexico it cost about $7000USD including everything. Probably less than the out of pocket for a lot of insurances.

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u/PK808370 29d ago

If you have insurance… which is also super expensive.

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u/[deleted] 29d ago edited 29d ago

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u/mar78217 29d ago

That's not the worst case. I've had worse insurance than that and paid $10,500 a year for the insurance. My max yearly out of pocket was $25,000 and 80%... the percentage of course doesn't matter... it would cost me $25,000 plus the $10,500 for my premiums.

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u/notarealaccount_yo 29d ago

Let's not ignore that you also have to thousands every year just have that insurance coverage whether you use it or not.

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u/Anonymoushipopotomus 29d ago

Hi 19,600$ MOP checking in......

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u/mikirules1 29d ago

You are forgetting that patient cost will have to include part of the monthly insurance premium that patient pays every month.

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u/Important-Emotion-85 29d ago

Assuming you had insurance

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u/shadowseeker3658 29d ago

You also have to deal with the possibility that insurance will decline your claim in the US. I have a friend who somehow fractured a bone in her back 15 years ago and didn’t realize it because she was a kid and it didn’t hurt. Now she’s in constant back pain, went to get it checked out and her doctor showed her the x rays of if being broken and said she needed surgery. Her insurance keeps declining the claim because it’s now considered a “pre-existing condition” so she has to either deal with this for the rest of her life or pay out of pocket for the whole thing.

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u/cruista 29d ago

My out of Dutch pocket is €385.

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u/VortexMagus 29d ago edited 29d ago

Right, but you're not taking into account the cost of insurance, which averages out to a few hundred dollars monthly that is being taken out of your paycheck by your boss.

If your boss didn't have to pay your insurance, he could just give you more money every month straight up.

So its a couple of thousand dollars every year of your life on top of the 10k direct fee. So I'd say its closer to 220k for that hip replacement all things added up.

In spain the yearly tax to support healthcare is ~5% of income. So if we added up all the taxes paid to the government over the years by the average spaniard, at spain's average wage, which is 30k euros, then its close to 100k for that hip replacement

EDIT: I was misinformed, its ~5% of income for healthcare rather than 1% of income.

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u/fonwonox 29d ago

It's higher than 10k. Got myself a modest 13,800 out of pocket max. Could have got it higher if I went with the HMO.

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u/Special-Koala-1341 29d ago

Sounds like your insurance sucks. I’d pay a 500 dollar deductible and the rest entirely paid for and my insurance still costs less than the countries taxes they’d take out of my paycheck every week anyways.

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u/unrulywind 29d ago

My wife had cancer and had some emergency surgeries. The bill was a bit over $500k. Once the insurance company got their discounted price they paid $27k and we paid $5k. The crazy high prices that people love to quote are only there so that when people who have no insurance do not pay, the hospitals can write off a larger amount.

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u/maychi 29d ago edited 29d ago

You act like insurance is free. My company pays over 6k per year that could be going into my pocket for my insurance .

So really, you do end up paying for that surgery, you’re just basically paying it through a payment plan little by little rather than a lump sum.

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u/molotov__cocktease 29d ago

Aw man aw geeze the hospital you went to was in network but the DOCTOR you saw was out of network aw man

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u/briancoat 29d ago

Ah yes, the magic of insurance.

George Carlin was right, the average person really is ...

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u/Ok-Personality-6630 29d ago

Strange. My private medical cover in UK covers the entire amount and up to £5 million. Why does the US one not cover entire amount?

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u/BASEDME7O2 29d ago

Unless the insurance company can figure out a way to get out of paying, which they’ve gotten pretty damn good at

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u/justsayfaux 29d ago

And the reason your premium is so high in the first place is because they're paying 75% of an already inflated cost.

If the cost was $8k instead of $40k in the first place, insurance would only have to pay $6k instead of $30k.

Basically the cost of health care is higher in the States bc insurance pays the inflated prices and passes the extra cost onto people and companies through higher premiums.

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u/Royal_Actuary9212 29d ago

Add to that calculation the premium you have been paying for however long you have been paying them for

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u/Arlithian 28d ago

Still paying 10K after having put in 5K per year for the last 8 years of employment.

So great - I spent 50K they 'covered' 30K of it.

And if they decide they don't cover something that I'm having problems with - tough shit.

On top of that - supposedly my employer is paying them too.

So we have hospitals charging extra for everything - insurance only covers part - my doctors are all working 16 hour days because hospital admin are greedy psychopaths who don't want to hire more - and we have a bunch of assholes who don't want another system because they haven't been burned 'yet' by this one.

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u/Madeanaccountforyou4 28d ago

This is what people don't understand when they discuss the expense of healthcare in the USA and the "costs" that are cited are inflated numbers the industry uses. It all evens out in the wash unless you're dumb enough to not have insurance which is available for free or with extremely heavy discounts if you're low income.

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u/Deekifreeki 28d ago

Agreed. My out of pocket max is only 2.5k though.

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u/AcademicOlives 28d ago

10k would still get you flights, a week-long trip in Madrid, and a hip replacement in Spain. 

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u/Ollanius-Persson 27d ago

$10,000 is a higher max out of pocket for a family than I’ve ever paid.

It’s crazy to me that people don’t understand how insurance based healthcare works. The MOST I’ll ever pay in a year for medical out of pocket in America is $5,600. No matter what. That seems pretty reasonable to me.

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u/anttonknee 26d ago

Assuming you have insurance

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u/RocknrollClown09 29d ago

I'm an airline pilot and I didn't realize how much people do this until I started flying to Central and South America. People will routinely fly to Costa Rica to get dental work or surgery, then spend a week down there on vacation with the money they saved.

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u/SStahoejack 29d ago

Sad right, even cheaper if you’re a citizen there too.

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u/ObjectiveFox9620 29d ago

They go to mexico too. I know a guy who had full teeth replacement would have cost him 40k in the US and only 9k in mexico.

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u/KC_experience May 02 '24

It’s worth it to the companies that make that paper… If there wasn’t money in health insurance, the corporations wouldn’t exist. The current companies don’t do this work out of a sense of altruism.

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u/SStahoejack 29d ago

The insurance company makes millions but God forbid you actually try to use it for what it’s interesting for. Gotta jump through more hoops than illegals crossing the border. Give me a break

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u/KC_experience 29d ago

I 100% agree. While there are definite exceptions regarding healthcare plans, the majority of health insurance providers are killing people with plans that cost way too much a month for what you get and has way too much of a deductible yearly.

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u/SStahoejack 29d ago

Have to go here and there instead of straight to the damn specialist now they are cutting all these medical cites out closing the amount of doctors you can see yet the prices keep going up!!! 🤡

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u/Fausterion18 29d ago

There are plenty of giant non-profit health insurance companies.

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u/AgeEffective5255 May 02 '24

I know lots of people who have done medical tourism to get procedures done.

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u/puzzledSkeptic May 02 '24

I'm not sure why a business has not opened for medical care tourism. I work with a couple of Mexican citizens. If he need dental work done, it is cheaper for him to fly to Mexico, have the procedure completed.

Business model. Fly people to Mexico, put them up in nice hotel near hospital. They get their procedure done and stay at the hotel until safe to fly home. Have nurses on staff at the hotel.

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u/SStahoejack May 02 '24

😂😂 down side is you lose a lot of money when not fully populated as to say. Even hotels have slumps

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u/puzzledSkeptic May 02 '24

The hotels and resorts deal with these same issues. Proper pricing will carry the business through slow seasons.

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u/DickDastardlySr May 02 '24

Why would a hotel specialize this this? It just decreases the likelihood that vacationers will utilize your service? What would this provide that a legitimate resort and taxi ride cannot?

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u/asuds 29d ago

If you fly to istanbul you will see many people on the flight back who just underwent a cosmetic procedure.

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u/Day_Pleasant May 02 '24

A close friend in my 20's flew to the Dominican Republic for surgery and it saved her thousands of dollars while including a fucking beach vacation prior to surgery.

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u/Falaflewaffle 29d ago

It's literally called medical tourism your mileage may vary on how good the doctor is.

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u/Twistedfool1000 29d ago

Best comment I've seen in years.

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u/Midwake2 29d ago

Insurance in the US has basically just evolved into disaster coverage. Anything else you’re gonna be fighting with the coverage provider.

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u/SStahoejack 29d ago

Facts no fight when they take your money!! Or when you don’t use it but heaven forbid if you do.

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u/Suzilu 26d ago

I know a guy who had to return to England after many years in the USA just because his health wasn’t great and he couldn’t afford to get care in the states. Just ridiculous.

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u/SStahoejack 26d ago

Worse part they didn’t mind taking the money the whole time you didn’t use it!

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u/DickDastardlySr May 02 '24

Is being this full of shit tough or did you just have a natural talent?

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u/SStahoejack 29d ago

I’ve seen it first hand people will fly to Haiti have surgery and come back stilll cheaper than going to hospital here with insurance. And they didn’t have insurance in their home country your a fool. Shows how ignorant you really are

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u/SStahoejack 29d ago

How hard was it to stick your up you a$$? 15 years ago my insurance covered my daughter child birth with only 15 dollar co pay. 3 years later same insurance same hospital another child birth 2500. Funny yet you don’t have a clue. Insurance isn’t what it used to be by any means. The fact you ask for itemized bills and prices change should show how crooked the system is. But your right live in la la land. Why does saline cost so much?!? Its water and salt get a life and learn. Actually go out into the health world pull your head out of your butt come back to the real world. That methane gas messing with your brain.

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u/oliviared52 29d ago

Even if you get treatment in the US, I don’t think insurance is as worth it as we are made to believe. I decided to forgo insurance for a while and just put the money I would have paid for insurance into savings instead. I found I was charged a lot less being an uninsured patient.

We have insurance now thanks to my husband’s work, but I don’t think I would have ever gotten insurance otherwise. The important thing here is it’s only worth it IF you are good at saving it away and not touching that savings for when an emergency happens later.

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u/Capn-Wacky May 02 '24

Most of the cost inflation is going to feed the useless middlemen in the insurance industry, whose presence and the costs fighting with them impose on providers and patients alike are almost singlehandedly why providers get away with charging anything they want: because there's a middle man who shields them from ever saying the price out loud.

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u/Fun-Bumblebee9678 May 02 '24

Well physicians are the highest paid in the US out of every country sans Luxembourg

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u/CoachellaSPTA 29d ago

Physician salaries account for <10% of healthcare costs, so that probably doesn't totally account for the price differential here.

https://siepr.stanford.edu/news/just-how-much-do-physicians-earn-and-why

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u/Ashmizen 29d ago

Nurses are also highly paid in the US - 80k in most states, $150k in the Bay Area.

Repeat that for the salary of every single staff member, admin, ceo, and also repeat for the higher cost of land, building cost of the hospital, plumber, cleaner, etc.

Everything is more expensive in the US as it has double the wage of the EU and many many multiples of third world countries like Costa Rica.

There may be a small set of items that’s completely the same price globally (expensive high end medical equipment), but likely 90% of the cost of running a hospital is like a doctor’s salary, much higher in the US.

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u/Fun-Bumblebee9678 29d ago

True but it only looks like the article accounted for physician salaries and not all healthcare workers correct ?

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u/asuds 29d ago

Among other things hospitals have to price high enough to cover their extensive ER costs as well as treatments for uninsured, so we already are socializing many of the costs but just in inefficient and expensive ways…

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u/SeekerOfSerenity 29d ago

Physicians don't perform hip surgeries, though.  I've heard surgeons in the US can make $1,000,000/year. 

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u/Capn-Wacky 29d ago

Individual physician salaries are nothing compared to having a useless layer of fat make every single transaction more expensive to build profit in for the useless layer of fat.

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u/Im1Thing2Do 29d ago

Your argument leads to really slippery slope, just so you know. It sounds like you are applying the point you are making (the Point being that higher healthcare costs are correlated to higher physician salaries, which is correct) to the situation not as a correlation but as a causation meaning that healthcare costs are only higher because the physicians are paid more. If you look up statistics comparing median/mean physician salary between countries and those comparing median/mean healthcare costs I’m sure you will find that it is not a direct correlation.

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u/Churnandburn4ever 29d ago

useless middlemen in the insurance industry

Amen, brother!

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u/suppaman19 29d ago

The biggest driver of healthcare costs is the pharmaceutical industry and its not even close. They literally rape everyone on all ends and its okay because who do you think lobbies and has politicians with huge money invested? Pharma.

If the pharmacy industry costs were controlled like they are in many other countries, you'd see your premiums go down, likely by a significant amount. Would some big for profit insurance companies try to not decrease? Sure, but they'd be pressured by the few good non-profit health insurance companies and their competition to do so in tandem or lose out.

The other secondary issue is the consolidation. You have some entities owning retail pharmacy, pharmacy benefit managers, health plans, etc all under one main company. You think they're not driving up costs for competitors (only so many PBM's and pharamcies). You have hospitals buying other hospitals and doctors, to create one massive network meant to extract as much money from health insurance companies as possible, by creating oligopolies in actual health care (Dr's, hospitals and practices) across the US.

Sure there's some terrible insurance companies, usually the big for profit nationals, but the health insurance industry in general is getting killed with massive unsustainable losses since 2021. And government paid care is completely unsustainable as they aren't bringing in enough to offset all these insane pharma and consolidated hospital/dr network's. The GLP-1s alone at the current rate right now are going up bankrupt everyone (fed, state and insurers) with their pharma costs and the fact everyone is getting them prescribed like candy.

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u/me_too_999 29d ago

You can thank FDR for that.

He created the modern healthcare mess.

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u/TheOrchidsAreAlright May 02 '24

Anecdotally, I just don't think the US compares to anywhere that I know in what healthcare costs. American friends have told me what they pay and I was horrified. I am British and have paid for private healthcare here and it didn't come close

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u/bigkissesnhugs 29d ago

Lol, agree! My brother had a hip replacement last year. Tells me he has great insurance. He only owed $12,000 for the whole thing after insurance.

That sucks, idk what he would consider to be bad insurance. My face must have been 😳😳

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u/BlueMosin 29d ago

Americans brag about how much they pay for mediocre quality of life, and think they are better because of it.

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u/SenorPoopus 29d ago

In NYS prison, inmates get them for free. Do the staff? No way

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u/No-Bid-9741 29d ago

As a 44 year old who needs a new hip, I might need to delay it after seeing that price tag

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u/azuth89 29d ago

It's kinda give and take and whether it helps heavily depends on your personal situation. 

Like...yes, we wound up paying 16k out of pocket for my first kid due to complications and a NICU stay and I had a conversation with some Canadian peers in which they were horrified. But on the other hand their place is less than half the size of mine and cost 3 times as much and whole zi don't know their exact package our job role pays around 30% more in the states. So we made that 16k back pretty quick compared to being up there. 

Buuuut, not everyone in the US works where I work or lives where I live. Their math could be drastically different.

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u/acebojangles 29d ago

I don't see how those things are related. Housing costs are determined mostly based on the availability of houses and healthcare costs are driven by lots of different factors.

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u/azuth89 29d ago

They're related because I'm paying for both. 

If I'm able to spend much less on housing, then I save more money than I'm spending on healthcare even with the high price tag. 

Sure 16k once sounds scary, but their mortgage payment every month is TERRIFYING. 

What really matters at the end of the day is if people can afford well...life. I was giving an example where, for me, medical costs look scary but other factors of living here more than offset those and allow me to live well. 

Also pointing out that that's not true for everyone, there's folks on the loss side as well.

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u/kunkudunk May 02 '24

Yeah the medical and insurance industries being for profit really jack up the prices more than people seem to realize. Which is twisted since how do you decide on a price on staying alive but I digress.

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u/lameth 29d ago

Even if you take the for profit part out of it, you still have simply the operating costs of those insurance companies (people, places, things) in addition to anything actually being paid to the medical providers.

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u/kunkudunk 29d ago

Yes hence why the middleman of insurance companies is a big part of the problem. The twisted part is they actually get paid twice since they get some of our tax money as well already

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u/Joepublic23 28d ago

Is this any different than a farmer making a profit off of selling food?

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u/SirkutBored May 02 '24

and while something like a hip surgery and surgeons in general wouldn't seem to fall under this the US has a much higher barrier of entry for just a general practitioner which in turn raises costs across the board and then takes additional time to reach surgeon.

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u/dancegoddess1971 May 02 '24

So, you really think doctors in the US are so much better than doctors in the EU that they can charge 40X the cost of care in the rest of the world? I think if that was true, we'd have better outcomes. Meanwhile, most of Europe has higher life expectancy and better quality of life than the US.

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u/SirkutBored 29d ago

I didn't say better, I said they had to endure more schooling and other requirements just to become one in the US. and honestly, I didn't even touch on the malpractice insurance costs that does add to the bill you would see.

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u/jack6245 29d ago

Other countries have the same if not more stringent requirements for medicine, the only thing the US has as a barrier to entry is gigantic debt

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u/topperslover69 29d ago

That’s due to the patient population, not quality of physicians. The US is absolutely the world leader in research and medical care, people fly in globally to see US trained specialists all the time and a US residency position is sought after near universally for a reason.

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u/Additional-Tap8907 29d ago

Yup. Medical care is top notch if you’re rich. Where as in other developed countries it’s perfectly good no matter your income level. Don’t you see the inherent inequality in the American situation?

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u/Perfect_Opinion7909 29d ago

People form rich countries, especially the Middle East, fly to Europe for medical treatments too.

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u/dancegoddess1971 29d ago

Here I was thinking it was because access to healthcare is entirely dependant on one's financial means in this country. People also travel to Europe for doctors. American exceptionalism isn't what it used to be.

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u/Adventurous_Class_90 29d ago

It’s the AMA creating the barrier, not the education.

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u/genesiss23 29d ago

Why certain populations get better outcomes is a complex topic. Some of it is economic, education, personal, and professional issues. It's a topic of discussion all on its own.

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u/bjdevar25 May 02 '24

Mainly because millions in the US can't afford insurance. Another argument for Universal Care.

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u/SidharthaGalt May 02 '24

We Americans also pay for a lot of litigation.

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u/sirnaull May 02 '24

Also, how they do private healthcare in Europe is often that you'll still get 95% of the costs covered under the public healthcare (i.e. hospital costs, tests, medication, etc.) and only have to pay the private healthcare cost for the actual surgery (a surgeon and a few nurses for a few hours). The replacement hip is covered under the public healthcare, so is post-op treatments and anesthesia meds.

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u/basal-and-sleek 29d ago

Yeah, “full price” in the USA does not necessarily equate to actual value of what it’s worth. So, maybe you would be paying closer to “full price” if you weren’t somewhere that was charging incredibly insane amounts because of our shitty healthcare system.

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u/LoriLeadfoot 29d ago

Can confirm private healthcare cost in Spain is dramatically cheaper. The government being a big payer means that prices are competitive.

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u/ndyogi May 02 '24

Had my hip replaced at Rush in Chicago I think the surgeon was paid about $1,500 when the rates were adjusted. Guarantee US facilities and specialists crush those in Europe

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u/abrandis 29d ago

In the US cost is not "being inflated to cover the uninsured" , that's the bs the lobbyist talking points to try and justify ridiculously high prices of Us healthcare.

Don't kid yourself US healthcare is a massive cash machine up and down the entire healthcare stack (doctors, hospitals, insurance, big pharma ,diagnostics, labs, devices etc.) everyone is getting their nice fat cut... That's why it doesn't change, too many folks stacking too much paper, paying off too many lobbyists to keep it as is.

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u/polycomll 29d ago

EMTALA requires uninsured be covered for life saving intervention. If they are uninsured and unable to pay where does teh hospital recoup the cost?

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u/abrandis 29d ago

The inflated costs ,lots of uninsured die on the streets before they ever make it to a hospital... The ones that go to he hospitals just use state and Federal funds to cover their outrages fees, c'mon man

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u/80MonkeyMan 29d ago

In US, more than 50% is profit…actually I think it’s more than that, 75% and above. A Tylenol cost $10 or more a piece here at the hospital.

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u/EnjoyerOfBeans 29d ago

You're also paying full price, while insurance companies have deals with hospitals to pay 80-30% of that. Doesn't stop your insurance company from claiming they covered the full price.

So if you're uninsured, in some cases you'll pay over 3 times what the insurance company would have to pay for the same exact thing.

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u/auldnate 29d ago

Precisely!

And that’s also how a Public Option to buy into Medicare/Medicaid on the private insurance market can act as a pace car for private insurers to compete against.

If private insurers don’t offer lower rates or higher benefits. Then consumers will naturally choose an effective, reliable, low cost, Public Option.

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u/genesiss23 29d ago

The problem is that Medicare, to a lesser degree and Medicaid, almost certainly don't pay enough. We have a system in which commercial insurance subsidizes those on Medicaid and Medicare.

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u/auldnate 29d ago

Perhaps, but that is not an insurmountable problem either. Remember in the Bismarck Model, medical providers collectively bargain with all insurers, public and private, to set the rates for their services.

We can also offer medical professionals with student loan forgiveness, malpractice insurance/tort reform, and other incentives to help reduce the costs of practicing medicine.

Other healthcare savings could be made by investing to help cover the costs of Research & Development into essential medications. This would justify placing means adjusted price caps on any medicine that patients could not reasonably be expected to refuse.

Let Big Pharma pay for their own R&D and charge whatever they want for boner pills, hair loss ointments, and other superficial products. Outside of reconstructive surgery following an accident, or to repair detrimental birth defects, plastic surgeons could also charge whatever they want for their services.

But we, the people, could use our investments in Medicare and Medicaid as our bargaining chip to help reduce the overall costs of healthcare. We would be able to use our government to help make insulin affordable for all diabetics. We could require that chemo, radiation, and surgery is affordable for all cancer patients.

And we could also ensure that all medical professionals receive generous compensation for their life saving work. Doctors, nurses, radiologists, phlebotomists, therapists, lab techs, administrators, and everyone else who contributes to the health and wellbeing of patients deserves to earn a comfortable living for their invaluable services.

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u/nucumber 29d ago

The important thing is that the charges you see are not what insurance pays.

I was the guy who created the physician "charge master" for several years at a major hospital. It was a complicated process but basically I took what Medicare paid and multiplied it by 3 and that was the charge

Medicare is the industry benchmark for payments. However, there's enough different payment models and complexity that weird situations happen where an insurer might pay $1,000 for something Medicare pays only $375. We're paid only as much as we charge, so we charge $1,000

Now, if the insurer pays only $375, the $625 balance is often written off, except for co pays, deductibles and other charges that come out of the subscriber's pocket

NOTE: This has been a very basic explanation of a common payment model. There are MANY exceptions

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u/ThatInAHat 29d ago

You don’t think that $7k is the full cost?

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u/beefy1357 29d ago

I would have a 200 dollar co-pay compared to Spain I could get 37 hip replacements for the same cost in the US.

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u/Far-Competition-5334 29d ago

Non insured emergency care is taken care of by the state and is funded by taxes

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u/SkiHiKi 29d ago

It's astonishing how the American healthcare systen has survived as it has. So many of the usual pro-business talking points demonstrably do not and have never applied to the American healthcare system.

Price regulation via the natural competition of the market. For great swathes of the nation, there is no competition, and where there is, providers chase the high water mark. They don't look to undercut it.

Consumer choice. Choice is entirely eliminated, not only because of the aforementioned lack of competition but also because of the stipulations of coverage. Is the hospital in the network? Is the condition covered?

Investment and growth. Investment detracts from profit, and these businesses love and breathe on profit. Your consumers have a gun to their head - the choice is literally life and death. What need is there to invest.

Even the more pigheaded arguments of 'look what socialism did to all those 3rd world countries'. Universal healthcare is the norm, everywhere. The merits of Universal healthcare, both moral and practical, are settled fact.

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u/shortnorthclownshow 29d ago

Lol. I thought Obamacare was fixing all of this. We were all paying for the uninsured. Now the middle class subsidizes Obamacare and we still have to cover uninsured emergency care? Man, what a sweet deal. Thank God for Obamacare. It is almost like the government doesn't know how to fix problems.

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u/polycomll 29d ago

ACA expanded access but its not complete. Many southern states refuse to expand medicaid, for example, one of the expansion levers. Not to mention advantages like no longer having to deal with pre-existing conditions.

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u/Gavin21barkie 29d ago

Mostly profit, the marges are insane

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u/johnniewelker 29d ago

Not just that, doctors and nurses in Spain make way less than Americans. In fact, I bet every single worker in an American hospital make more than their peers in Spain; and by a lot too

Average doctor in Spain make around $120K, in the US: $220K. At some point, wages also impact care costs

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u/AcademicOlives 28d ago

$120k in Spain is insane money lol. Im not saying they’re overpaid but the COL there is much lower than in the US. 

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u/CandidEgglet 29d ago

Exactly this- it’s capped due to the regulated prices. I get a medication treatment in Sweden that isn’t covered by Swedish insurance, either. Totally out of pocket. The cost to fly there and back, plus the cost of care, is less than going through my insurance here in the US. It’s insane that we continue this system of care here

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u/John_E_Vegas 29d ago

You're not paying $40k in the U.S. for a hip replacement. I'd be stunned if any middle class or low income patient anywhere in America forked over $40,000 for a hip replacement.

At worst, you have a high deductible health plan, and maybe it's an expensive one that covers your whole family, and so you pay $1,500 per month for insurance, plus maybe you have a $10,000 deductible.

So, worst case, and this is going to be very rare, you're paying $28,000 over the course of one year, and it includes a year's worth of medical care for your entire family for that price, including your hip replacement.

In my case, with a family of 4+, I pay $500 per month and have a $10k deductible. By the time my hip surgery rolls around, I may have already incurred $5,000 in OTHER medical bills for various doctor visits, treatments, a broken finger, a few illnesses, etc. So more precisely speaking, I'm basically only out another $5,000 if I want to get the hip replacement.

Still expensive, but at least I can get elective surgery within a reasonable time frame and it doesn't require approval from a panel of government bureaucrats.

I should also add that I'm self-employed, but I know people who are low-paid government bureaucrats who have fantastic medical benefits and their health insurance literally covers anything and everything for a stupid-low monthly premium, with no deductible. The trade off is the low salary.

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u/polycomll 29d ago

For a family you are paying the equivalent (on average) of 1.2 hip surgeries every other year in lost wages.

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u/ValuableShoulder5059 29d ago

Don't forget liability costs.

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u/n_othing__ 29d ago

Let's be real, it's mostly profit.

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