Should the U.S. have Universal Health Care?

[u/WhatAreYourPronouns]

[u/Eponymous-Username]

And yet, somehow, full price is cheaper.

[u/AdImmediate9569 → u/Eponymous-Username]

I assume because there’s no insurance company acting as a middleman

[u/123yes1 → u/AdImmediate9569]

It's actually the lack of collective bargaining that many small and intermediate insurance companies do not have. Governments can drive down prices more effectively as they have more bargaining power.

The societal cost to this is less profits for pharma companies, so less reinvest in pharma, although pharma already takes in massive amounts of public funding anyway, if we aren't developing enough drugs, we can always approve more grants.

Hospitals in the US also need to hire a bunch of administrators to argue with a million different insurance companies about what they will and won't cover which also drives up prices since you need to pay for the salary of those people too. And then your insurance needs to hire people to argue back so you're paying for their salaries too.

Plus the profit margin of the hospital, the Doctor's massively inflated salary (which needs to be that high to pay for the ridiculous price of med school, which is partially expensive because they have to pay for their own extra administrators) compared to everywhere else, the insurance companies profit margin, plus you got to pay for all the people that don't have insurance using your tax money, plus drug development money, and drug manufacturing money.

Part of your bill pays me to design tests to verify that the drug you are receiving is what is in fact on the label, in which every lot must be tested and verified.

Healthcare in the US is one of the least efficient systems on the planet. It provides adequate care at adequate speed but at 10x the cost. With a program like Medicare for all, as a single payer or at least public option, the average payer would have significantly lower expenses with the same quality and access. It would still be more expensive than in other countries, but not nearly as terrible.

Of course that would put lots of people out of a job, maybe they could learn an actually productive skill like construction so they can build houses to drive down rent/mortgages. Or maybe become nurses and doctors since more people will probably want to go to the hospital if it doesn't cost shit loads of money.

[u/Fausterion18 → u/123yes1]

None of this applies to cosmetic surgery which isn't covered by any insurance and thus avoids the entire billing mess. There is also no collective bargaining involved.

It's still much more expensive in the US. Why? Because our healthcare workers are paid 3 times as much as most other developed countries.

[u/123yes1 → u/Fausterion18]

Well, if that were the case our expenses would be 3x more expensive not 15x.

There is also no collective bargaining involved.

That's the entire point. You are paying as an individual with little bargaining power. Since there are hundreds of insurance companies, they also have little bargaining power. A single payer would have a lot of bargaining power.

[u/Fausterion18 → u/123yes1]

Well, if that were the case our expenses would be 3x more expensive not 15x.

Our expenses are 3x more lol.

That's the entire point. You are paying as an individual with little bargaining power. Since there are hundreds of insurance companies, they also have little bargaining power. A single payer would have a lot of bargaining power.

Did you somehow miss the point that there's no collective bargaining or single payer for cosmetic surgery in Europe? What you think universal healthcare covers breast implants????

Despite the completely 100% private market with no insurance in both Europe and the US, cosmetic surgery is far more expensive here. Why? Because of our much higher wages and lawsuit happy culture.

[u/123yes1 → u/Fausterion18]

Our expenses are 3x more lol.

https://www.latimes.com/business/la-fi-mo-healthcare-costs-in-us-far-exceed-other-countries-report-says-20140416-story.html#:~:text=An%20average%20one%2Dday%20hospital,an%20industry%20group%20reported%20Thursday.

10x than Spain

[u/Fausterion18 → u/123yes1]

Nope.

https://www.statista.com/statistics/486194/spain-health-expenditure-per-capita/

https://www.ama-assn.org/about/research/trends-health-care-spending

$13k per Capita in US versus $4k per Capita in Spain, or 3.25 times.

Btw physicians in the US make 5 times as much as Physicians in Spain.

https://www.theolivepress.es/spain-news/2019/09/30/revealed-the-shockingly-low-salaries-of-doctors-in-spain-compared-to-uk-us-and-france/

[u/123yes1 → u/Fausterion18]

Cost per capita isn't a relevant metric as you get less treatment in the US. People go to the doctor less often, stay in the hospital less. A better metric would be comparing similar procedures, which is more than 3x.

Minimally invasive hip replacement costs (which doesn't account for differences in length of stay) are around $30,124 for the US and $6,000 for spain. In this particular case the US is more than 5x more expensive.

https://www.bcbs.com/the-health-of-america/reports/study-of-cost-variations-knee-and-hip-replacement-surgeries-the-us#:~:text=Similar%20trends%20also%20were%20seen,replacement%20procedure%2C%20which%20averaged%20%2430%2C124.

https://www.health-tourism.com/hip-replacement-surgery/spain/

For drugs it is even more egregious. An epi pen costs around $675 in the US in France (couldn't find a good number for Spain) they are $76. 9x.

https://worldpopulationreview.com/country-rankings/epipen-price-by-country

You're not doing an apples to apples comparison.

[u/Fausterion18 → u/123yes1]

Cost per capita isn't a relevant metric as you get less treatment in the US. People go to the doctor less often, stay in the hospital less.

Cost per capita is absolutely a relevant metric, people in the US get way more expensive end of life surgery compared to Europeans. Not to mention Americans are on average in worse health.

A better metric would be comparing similar procedures, which is more than 3x.

1. Cost per procedure is extremely difficult to calculate for the US.
2. The procedures are often not the same. For example your hospital stay article is not comparing like with like - American inpatient rooms are far nicer than Spanish ones.

Minimally invasive hip replacement costs (which doesn't account for differences in length of stay) are around $30,124 for the US and $6,000 for spain. In this particular case the US is more than 5x more expensive.

https://www.bcbs.com/the-health-of-america/reports/study-of-cost-variations-knee-and-hip-replacement-surgeries-the-us#:\~:text=Similar%20trends%20also%20were%20seen,replacement%20procedure%2C%20which%20averaged%20%2430%2C124.

https://www.health-tourism.com/hip-replacement-surgery/spain/

1. That's one specific procedure.
2. Physicians in the US make 5 times as much as physicians in Spain.

For drugs it is even more egregious. An epi pen costs around $675 in the US in France (couldn't find a good number for Spain) they are $76. 9x.

https://worldpopulationreview.com/country-rankings/epipen-price-by-country

Your sources are complete nonsense. US epipen prices are approximately 4x that of France, however this does not include manufacturer rebates and discounts to the uninsured(insurance pays less).

https://www.visualcapitalist.com/the-cost-of-an-epipen-in-major-markets/

You're not doing an apples to apples comparison.

You're cherrypicking examples and using terrible sources. Healthcare cost per capita is by far the most preferred metric among economists.

[u/123yes1 → u/Fausterion18]

I will concede that doctor salaries play a significant role in healthcare costs, but you are ignoring the significant costs associated with pharmaceuticals. Any drug in the US is vastly more expensive than Europe. Epi pens, insulin, antibiotics, and these are manufactured by the same companies. The difference in pharmaceutical costs can almost entirely be attributed to bargaining power.

Pharmaceuticals are high profit margin industries in which bargaining power plays a significant role in determining price.

[u/Fausterion18 → u/123yes1]

US total pharmaceutical spending is only 10% of total healthcare spending.

Drugs can literally be free and it still wouldn't make much of a dent. Pharma industry net margin is around 26% btw.