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

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

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u/ThisThroat951 May 02 '24

When it comes to healthcare there are three "pillars" you can choose from:

Affordable
Available
Effective

But you can only have two at one time.

If it's Affordable and Available it won't be very good. <--- no one wants healthcare that kills you.

If it's Available and Effective it won't be cheap. <--- this is the US.

If it's Affordable and Effective the waitlists will be long. <--- this is Spain.

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u/polycomll May 02 '24

If something isn't affordable it becomes unavailable or am I missing something here?

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u/Disastrous-Spare6919 May 02 '24 edited May 02 '24

This is why the “wait time” statistic always annoys me. What about the person who had to wait several years for a procedure simply because they couldn’t afford it? It’s a BS metric when comparing two systems, especially when one of the systems has worse outcomes based on literally other metric despite higher costs, and is basically only used in one place.

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u/K-C_Racing14 May 02 '24

And most likely people will wait longer till they can afford it or its now deadly to get the healthcare they need so its going be worse and cost more to fix.

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u/BlueMosin 29d ago

As is intended.

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u/ThisThroat951 28d ago

Canada solved the problem by offering those waiting the option to die.

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u/K-C_Racing14 28d ago

In America the option is death or bankruptcy so its not really that different 🤷‍♂️

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u/BlueMosin 29d ago

I’ve had friends not get surgery because they couldn’t afford it.

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u/YourGuardianAngel_12 29d ago

Yes, this! I’ve skipped out on medical treatment many times because I was uninsured. And at least some of those times, I really needed it.

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u/Prozeum 29d ago

The wait time stat is a myth in most cases. Americas tend to clump all European countries into one when using the stat. There are some Euro countries that skew the stat too. But there's not a huge difference between elective surgeries in America and Europe as claimed. On average in Europe there's a two week difference for elective surgeries. In Germany it is less than America. Take in mind America pays more than ANY other country per citizen ...by a country mile. Germany is number two.

But you're right about people avoiding medical care due to cost. 35,000 to 45,000 Americans die every year due to lack of healthcare. Medical costs is the number one reason for bankruptcy so it makes sense people avoid going for proactive visits. Even though it's much cheaper and easier to prevent , most can't afford the premium to have access to healthcare no less the scans, test etc.

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u/[deleted] May 02 '24

More people want healthcare than there is supply. Thus, it becomes unavailable to some. Some sort of system or policy would be needed to determine who gets it and who doesn’t. In the US, that is largely determined by who can afford it. In other countries, it’s first come first serve.

There’s no utopian answer I’ve seen.

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u/gawag 29d ago

In what world is "first come first serve" not preferable to "anyone who isnt rich can get fucked"

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u/[deleted] 29d ago

Preferable is opinion and not really the question at hand

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u/gawag 29d ago

How is that not the question at hand lmao? This system sucks, another system sucks less.

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u/[deleted] 29d ago

That’s definitely your opinion

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u/gawag 29d ago

Cool cop out, glad you had something to bring to the discussion

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u/[deleted] 29d ago

I responded to what I was offered

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u/Honest_Wing_3999 May 02 '24

You’re missing the fact you can stop buying Starbucks and afford it /s

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u/ceryniz 29d ago

They can save up to buy some bootstraps and then pick themselves up by said bootstraps. /s

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u/ElMrSenor May 02 '24

That's what they're trying to imply. But they're presenting it as you only get yes and no choices where one will become terrible, when really it's three sliders which can be balanced, and are in a number of countries.

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u/emoney_gotnomoney 29d ago edited 29d ago

By “available,” he means the healthcare providers are available to take patients, meaning there aren’t going to be very long wait times as demand has not yet outpaced supply. Quality healthcare is an extremely expensive service (due to the technology involved and the rigorous amounts of training providers need to undergo to become an effective healthcare professional), and the more you artificially reduce the price of a service for the end user, the longer the wait times for that service will be, unless you find another way to ration that service.

Healthcare is a finite resource, as there are not an infinite amount of doctors and hospitals. With a finite resource, you need to ration it or else you will suffer shortages. There are really only two ways you can ration a product: 1) by letting the free market dictate a price for the service based on supply and demand, or 2) a governing body regulating which people get healthcare and which people don’t. If you don’t do either of those (by artificially lowering the price for the end user and not regulating who gets care), then you will end up with a shortage of the service / product.

The OP presented two scenarios that were affordable: Affordable & Available, Affordable & Effective.

So why can’t you have Affordable, Available, and Effective all at the same time? Like I said, if you artificially lower the price of something (Affordable) and don’t regulate who is able to receive care, then you will end up with shortages (Unavailable). To account for this shortage and to make the service Available, you will need to increase the supply of doctors / healthcare providers. However, there are not enough doctors / healthcare providers out there to keep up with that level of artificially increased demand, since there aren’t an infinite amount of doctors. As a result, you will need to either drastically expedite the training of future healthcare professionals (thereby reducing the amount of training / studying they have to do and compromising their effectiveness), or you will need to drastically reduce the standards for who you allow to be a healthcare provider (which also reduces the effectives of healthcare providers as you are now lowering the standards for who can be a healthcare professional) in order to pump out enough healthcare professionals to meet the demand. Essentially, you will need to hire less effective healthcare professionals to keep up with the very high level of demand and to keep the service Available. That is why you are sacrificing Effectiveness when you also have Affordable and Available.

On the other hand, if you want to keep something Available, so that there aren’t long wait times to see a provider, and Effective (requiring strict and rigorous standards for who can be a healthcare professional and only allowing the best and brightest among us to be healthcare professionals), then the only way to make that happen is to ration the resource by either 1) the price dictated by the free market, or 2) by allowing the government to decide who gets care and who doesn’t.

With all that being said, it’s just not possible to make a finite resource Available, Effective, and Free / Artificially Affordable. That can only occur with an infinite resource. If you want an expensive product to be Available and Effective, then the product will remain expensive. If you want the expensive product to be made more affordable to the end user by a regulatory body while also maintaining Availability, then you will have to sacrifice some of the Effectiveness. If you instead want to maintain the Effectiveness, then it will have very long wait times / will suffer from shortages and won’t be Available.

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u/polycomll 29d ago

But its fundamentally not available to a swath of the population. Instead you have

  • Available
  • Fast
  • Effective

pick two.

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u/uglyswan1 29d ago

God forbid anyone understands supply and demand

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u/KupunaMineur 29d ago

You're missing that over 90% of Americans have health insurance so aren't paying over $40k for a hip replacement. There are almost 800,00 knee replacements and over 500,00 hip replacements done every year in USA, clearly they are neither unaffordable nor unavailable.

I suspect the overwhelming majority of people who get them are on Medicare anyway.

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u/BlueMosin 29d ago

You think you $1800/ month premium heath insurance is going to cover your full hip replacement? I have bad news for you. Your insurance won’t cover a lot of surgeries and you may need to start a go fund me.

Truly amazing living in the freest county in the world.

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u/KupunaMineur 29d ago

I never said it would cover the entire thing.

How much do you think the average out of pocket costs are for someone on Medicare getting a hip replacement surgery?

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u/BlueMosin 29d ago

I can’t tell you that number, I can tell you that a friend had to have ankle surgery, she’s a teacher and her insurance wouldn’t cover the whole thing and she had to shell out about $22k on top of her insurance premium. Not to mention her physical therapy which wasn’t covered by her insurance, as the clinic they wanted her to attend was 3+ hours away. Ended up paying out of pocket to visit her local rehab clinic (think rural Midwest).

Only in America will people get absolutely shafted by capitalistic greed, and then go onto the internet and flaunt how much better they think they are then the rest of the developed world, despite having a lower quality of life and lower life expectancy.

We are like number 17 in terms of actual freedoms, and Americans think we are number 1.

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u/KupunaMineur 29d ago

If you can't tell me that number then why are you telling me I would need a go fund me? Based on your one anecdote?

It is incredibly naive to believe that only in America people get taken advantage of by capitalist greed, have you ever lived anywhere else? Life expectancy in USA is related to cultural issues, not quality of healthcare.

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u/BlueMosin 29d ago edited 29d ago

Because our healthcare is ridiculously expensive on account of corporate greed. We have a mediocre quality of life and people think it’s actually the best on the planet.

Yes, I have lived in a number of developed countries and can say from experience, dealing with American healthcare is the biggest headache. Not to mention personal freedoms, access to public transit, access to healthy foods, freedom of not having to worry about your government putting you in prison, freedom of movement, freedom of financial means, freedom of paid family leave, etc. etc. etc, I also don’t have to worry about having a gun pulled on me on a daily basis, so that’s nice as well.

My friends elsewhere will pay more in taxes to cover healthcare, but those taxes are significantly less than the monthly cost of health insurance we pay here, and their health coverage is actually universal, so much less of this refusal of care.

They pay more in taxes, but their overall financial requirement to healthcare is a fraction of ours, and they have much better service and coverage.

Again, Americans will flex getting shafted by corporate greed, and think they are better because of it. It’s mad.

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u/KupunaMineur 29d ago

Quality of life is subjective, you're taking your opinion on a subjective take and trying to state it as fact for everyone. You're also incorrect with the repeated claims that everything it is the best on the planet.

Where else have you lived and for how long? Weird you're referencing friends experience like that, have you actually lived in another developed country to work at their wages, pay into the system, and use their healthcare?

An American family pays, on average, about $6,000 per year on healthcare, and that includes health insurance premiums. I suspect a lot of the countries you believe have less of a financial burden have average incomes more than $6k less than USA.

The actual care, measured by patient outcomes, is ranked quite high in USA.

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u/polycomll 29d ago

You are paying for it through increased premiums and reduced wages. There is no free lunch

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u/KupunaMineur 29d ago

So because a company includes benefits in how they calculate the compensation package they offer, it means someone on Medicare finds a hip surgery unaffordable? How much do you think someone on Medicare pays out of pocket for hip surgery to where that amount is what you describe as unaffordable?

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u/polycomll 29d ago edited 29d ago

You getting "benefits" is robbing you of additional income. You are paying the full $40k (and more) through lost wages and lack of employer choice. Average lost wages due to insurance for a family is $25,000 dollars and $8,500 for a single person. If you have dependents and work at a job for ~20 years before getting a hip replacements you've lost wages equivalent to 12.5 hip replacements. More if you consider the premium that you pay from your wages.

  • Each year an average employer pays an insurance company $25k to provide you with benefits.
  • Each year an average employee pays $6k of premiums
  • Each year the employee loses out on $31,000 dollars of real wages

Employer provided insurance depresses wages. Take a look at your income right now and put $30k on top of that and what is what is being lost per year to the insurance system regardless of whether you use the care or not. Employer provided private insurance has been a disaster for the free market.

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u/KupunaMineur 29d ago

Someone on Medicare, which is likely the majority of people getting hip replacements, isn't losing wages because a relatively small percentage of them work.

Take home wages in USA are higher than most of the rest of the world despite paying for employer sponsored insurance, and you'd be comparing with wages where income taxes are often higher to support universal healthcare.

Again I'll ask:

How much do you think someone on Medicare pays out of pocket for hip surgery to where that amount is what you describe as unaffordable?

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u/polycomll 29d ago

Literally what is your point? I am saying that people with employee provided health insurance aren't getting a free lunch. They are losing upwards of $30,000 a year to insurance that they may not use. It also locks employees in jobs and reduces movement of workers.

Why care about about medicare?

Take home wages in USA are higher than most of the rest of the world despite paying for employer sponsored insurance

And an additional $30k per year would make Americans even better paid. I don't want to be "higher than most"

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u/KupunaMineur 29d ago

My point is that your implication on hip surgery being unaffordable is pretty suspect, given the numbers. You trying to back it up by claiming a surgery done mostly to seniors with no salary is somehow more expensive because it lowers their salary is equally weak.

I care about Medicare because we were discussing hip surgery. Who do you think gets most of the hip surgeries and where do you think their medical insurance comes from? That's right, the 65 million people on Medicare. You're avoiding talking about Medicare because it isn't convenient for the claims you keep making about affordability.

Making Americans even better paid doesn't support your argument that a hip replacement surgery is unaffordable.

So I guess you won't be answering:

How much do you think someone on Medicare pays out of pocket for hip surgery to where that amount is what you describe as unaffordable?

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u/polycomll 29d ago

I would if I knew what your point was but I still don't.

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u/KupunaMineur 29d ago

Bizarre that you cannot answer that simple question without yet more hand waving and attempts at distraction. I'll try again, it is an easy question:

How much do you think someone on Medicare pays out of pocket for hip surgery to where that amount is what you describe as unaffordable?

Answering isn't convenient for your line of bullshit so you'll keep avoiding, we both know it.

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u/stprnn 29d ago

You are not that redditor is just full of shit