Why does US health care has such a bad reputation? Is it heavily regulated?
Posted by MitchimNum@reddit | Libertarian | View on Reddit | 67 comments
I'm Brazilian, and we have an universal public health care and the quality of its services is a shame but the average leftist thinks is the best thing out there because if costs "nothing" and often points out how capitalism is bad look at the US health care system and how people are dying because they can't pay it.
My main question here is:
Is US heath care really bad ? Like, is it expensive?
And if it's indeed bad, why ? Is there many state regulations?
Thank u guys.
SEAWISEGEOWISE@reddit
Because there is almost zero regulation especially when it comes to pricing, insurance is private companies that exist only to make a profit, and most insurance is borderline useless leaving you with massive medical bills that you could never afford to pay off in a lifetime. Add extremely long wait times for scans etc and extremely low quality of care. Healthcare in the United States is a bit ethical at all. It is a privilege for the rich who can afford it. Healthcare is NOT considered a human right here
discourse_friendly@reddit
Our actual services are amazing. Paying for them is horrible.
our ER times are incredibly low, wait to see a primary doctor low and tons of specialty care is available.
If you have really good insurance you only pay a little bit out of pocket. most people have high deductible plans so they pay a lot out of pocket and tend to try to avoid being seen.
and about 7% of the total population has no insurance at all.
But the wealthy travel to the US for all sorts of treatment, including the Vice PM of Canada not too far back.
GeekShallInherit@reddit
The US ranks 6th of 11 out of Commonwealth Fund countries on ER wait times on percentage served under 4 hours. 10th of 11 on getting weekend and evening care without going to the ER. 5th of 11 for countries able to make a same or next day doctors/nurse appointment when they're sick.
https://www.cihi.ca/en/commonwealth-fund-survey-2016
Americans do better on wait times for specialists (ranking 3rd for wait times under four weeks), and surgeries (ranking 3rd for wait times under four months), but that ignores three important factors:
Wait times in universal healthcare are based on urgency, so while you might wait for an elective hip replacement surgery you're going to get surgery for that life threatening illness quickly.
Nearly every universal healthcare country has strong private options and supplemental private insurance. That means that if there is a wait you're not happy about you have options that still work out significantly cheaper than US care, which is a win/win.
One third of US families had to put off healthcare due to the cost last year. That means more Americans are waiting for care than any other wealthy country on earth.
Wait Times by Country (Rank)
Source: Commonwealth Fund Survey 2016
That's just not true.
https://www.commonwealthfund.org/publications/surveys/2023/oct/paying-for-it-costs-debt-americans-sicker-poorer-2023-affordability-survey
Hell, my girlfriend has $300,000 in medical debt from her son having leukemia, after what her "good" insurance covered.
discourse_friendly@reddit
It is true if you have good insurance you only pay a little bit out of pocket.
you deceptively pivoted to insured (93% of America) when responding to "good insurance" IE people with low deductible plans
your GF did not have "good insurance" ..
Duh Obviously. 300K in care would cost me ... 6K . she didn't have good insurance.
Orval11@reddit
It's bad unless you're very wealthy and then it's probably best in the world.
US healthcare is kind of the worst of a number of different systems. We basically have socialized tax payer funded expenses, with privatized profit for corporations. None of this is optimized or designed to provide high quality, efficient, cost effective healthcare for the population. It's instead optimized around high profits for what's basically a series of state sponsored private monopolies, where regulations are design to enrich private corporations rather than actually provide healthcare.
Middle class pays twice. Once in their taxes for the uninsured and to subsidize high cost care and a 2nd time for their own healthcare. Corporations profit off both and with full political and regulatory capture we don't seem to be able to unwind any of this catastrophe.
I seemingly get monthly GoFundMe type donation requests from friends and family of someone that needs money for catastrophic level care or injuries that's either not covered or they lack the out of pocket money to keep paying for. And I personally know a handful of people that were bankrupted and financially devastated from medical costs and debt after a serious illness or injury. There are absolutely people dying from lack of access to healthcare, because you won't get access to more than basic procedures without decent insurance and if you don't happen to have a big social circle you're unlikely to be able raise enough in donations to save you.
Inefficiency is built-in to the system at a deep level. Insurance is designed to maximize profit, so they have a team lawyers, and admin staff that create rules and loopholes designed specifically to deny paying for coverage of even necessary procedures. It's so bad that medical practices, need ongoing patients, so they have to hire their own army of administrators to combat the insurance policies and navigate the loopholes, so the medical practices can have paying patients.
Another built-in efficiency: We similarly are rarely ever able to get procedures or medicines that are more efficient and cost effective, but lack profit potential into our healthcare system.
Basically, it's a shitshow here too and if given other viable options the only rational people who would intentionally choose this system would be wealthy who also happen to lack empathy for others.
mmmhiitsme@reddit
I work in a hospital and this is exactly my thoughts. Just worded much better.
OkBorder387@reddit
The US usually gets killed with any metrics that present as cost versus outcome. That’s because a huge amount of the US cost of medical care gets wasted on the bureaucracies of health insurance and the administrations of hospitals and regulatory institutions, and none of that has any positive influence on healthcare delivery. The US has excellent physicians, robust availability, awesome technology, and incredible medication innovation. But when the system wastes so much money, and the regulations and hoop-jumping get in the way of patient care, no one prospers, except for the over-compensated milking it from the top.
GeekShallInherit@reddit
There's nothing terribly innovative about US healthcare.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866602/
To the extent the US leads, it's only because our overall spending is wildly out of control, and that's not something to be proud of. Five percent of US healthcare spending goes towards biomedical R&D, the same percentage as the rest of the world.
https://leadership-studies.williams.edu/files/NEJM-R_D-spend.pdf
Even if research is a priority, there are dramatically more efficient ways of funding it than spending $1.25 trillion more per year on healthcare (vs. the rate of the second most expensive country on earth) to fund an extra $62 billion in R&D. We could replace or expand upon any lost funding with a fraction of our savings.
KoalaGrunt0311@reddit
The entire billing and coding staff of a hospital system provides zero benefit to the patient, but is required for the hospital to navigate intricacies of various insurances to get payments approved.
Beginning-Town-7609@reddit
Not only to get paid, but coding itself can be used to get paid more.
codifier@reddit
It's a giant shit sandwich, and a lot of it comes from over-regulation and coziness of corporations help write those regulations but I will state a lot of people have no fucking idea how private insurance works. I can rack up 300k in medical bills in a year, and most I pay is $10k total, it's called max out of pocket, I can have a massive health problem and I am not going to walk out with a giant bill. There's a lot of gotchas, such as staying in network but most big networks like CHI are everywhere and on about every network, you just have to pay attention to how your plan works and every place I have hung my shingle has been prolific in helping people understand it. Many plans allow you to put money away tax free into an account to pay your Healthcare costs; not enough in my opinion but usually enough to cover at least your deductible and a chunk of your max out of pocket.
The poor have healthcare too, kinda. It's generally called Medicare/Medicaid (medicaid is a weird per state/federal program) and applies to retired/disabled in the former case and the indigent in the latter. The government essentially pays for their healthcare costs at whatever rate the government decides and is quasi-socialized Healthcare. The problem is that there is no limit or penalties if you're on Medicaid. Your kid has an earache? Go to the Emergency Room, which is expensive as it's designed to deal with... emergencies, but what do you care you're not paying for it. Want to go to the emergency room every day? No one can stop you. Want special, expensive tests? Just badger doctors and shop around until you find one that will do it. And when the bill to the government comes? The government pays hardly shit, so all those expenses get passed on to private pay because medical staff need paid too.
Wife worked at a major hospital. Most people who were staying there were on medicaid. Homeless would come into the ER, say they have chest pains knowing they would be admitted, and they could treat med/surg floors like a hotel and try to wheeled narcotics. Many others would show up as OD, get the full ER treatment with one or more expensive narcotics shots, then be released or admitted to do it again. Wife worked at small clinics, similar problems, someone with medicaid can make an appointment every week if they want and the clinic gets paid maybe 10%, which means they have to pass the cost on to people on private pay, who by the way are already funding medicaid. This is why socialized healthcare sucks, it treats a valuable commodity as unlimited, and someone eventually has to pay.
This is only scratching the surface, but we do have some socialized medicine, and it's part of why medicine is so expensive, there's tons of other reasons, but the fact we have a growing segment of the population that has a virtually unlimited tab that somehow must be paid is a good part of it. Don't get me started on how insurance companies are effectively cartels and write the laws for the government, someone else can run that.
Cynical_Toast_Crunch@reddit
I will not argue that some take advantage of Medicaid. I would like to say that I am an example of when it can do some good. Years ago I had late onset epilepsy (at the age of 27). I worked still for awhile while I could, but the seizures eventually were bad enough that I couldn't hold a job anymore.
I had to apply for Medicaid to have a chance at normalcy. I was surprised, honestly, at how easy it was to get it. What wasn't easy was finding a medication that controlled my seizures. I eventually found it, and started working and driving again as soon as I could. As soon as I could stay employed and pay for my own insurance I did. I would never have had that chance without government help.
VargevMeNot@reddit
Whether they're insured or not homeless people would go to the hospital and not pay their bills. The ethics of not serving people who can't afford care for emergent medical issues gets hairy pretty quickly. I am not saying the system as it is is right, I'm mostly mentioning this because this problem goes beyond the way medical care is handled in our country.
Our rate of homelessness is less than half the rate of countries that have universal healthcare such as New Zealand, Canada, Germany, and the UK, yet we pay a much larger margin on our medical care in the US, so it appears the problem is more complicated.
KoalaGrunt0311@reddit
Awesome explanation! Somehow, we've lost our way as a society and our youngest generations have failed to learn that there's no such thing as a free lunch.
I'm also going to add that the ones griping the most about the cost of Healthcare are the ones too proud to seek out assistance, or avoid checkups until problems get more severe-- like not wanting to pay for an oil change so you bring the car to the mechanic after the engine starts knocking.
We have the best care in the country so long as you're rich or destitute. I had a friend with a severe multiple bypass done, ending up in an induced coma for months because his organs were drowning in the oxygen- rich blood they had gotten used to not having. He recovered fine, with a bill shy of a million dollars that was handled by a variety of programs sought by the hospital's social worker with the final one being the hospital's charity care requirement. I still disagree with them being nonprofit, though.
iJayZen@reddit
I agree a shit sandwich that has been tweaked so many times it is a Franken-Shit monster. If you have nothing in your name then hospitals will not bother collecting so it is socialized medicine at no cost. Then it goes from there...
gumby_dammit@reddit
Very well explained.
NoAstronaut11720@reddit
I can explain it really really easily.
Imagine me and you are playing poker. I have to play by normal rules, but every time you get dealt a card you don’t like you can get a new card from the dealer with some negotiation on which card it is.
In this scenario I would be a private doctor, you would be the massive medical monopolies that are in bed with the government ever since the Nixon HMO bullshit.
Basically a handful of really rich, powerful, and pretty innovative companies get to pick prices with 0 worry of failing because if they go under because nobody wants their overpriced shit the government just gives them taxpayer dollars as a bailout.
MitchimNum@reddit (OP)
so it's's some sort of cartel that the government has its part in it. What does the government get in exchange for maintaining these monopolies alive ?
NoAstronaut11720@reddit
There’s not one thing. A big one is insider stock information. Keeps the money “legal”. Instead of big cash exchanges they get to know when and how much to bet on stocks for these companies.
The thing in the US is insurance. You get a plan and each paycheck a little is taken out. I’m 29, pay for my insurance, it’s about $36 a week. But everything is covered.
Gabbz737@reddit
You're right except one thing. For $36 a week your insurance might cover everything but not everyone. My bf pays for insurance through his job about the same as you. However to see a doctor it's always a $50 co-pay just to see any doctor. Treatment... well they cover about ⅔ the costs depending on what it is. My bf makes too much to be on Medicaid but not enough to actually see a doctor as much as he should. That $50 co-pay could determine if we can afford gas to get to work/the store. So unless a bone is broken or he's dying he doesn't go to the doctor.
NoAstronaut11720@reddit
The fact you make too much for Medicaid but $50 can have that much of an impact makes me question if there isn’t other spending problems.
Have you looked into subsidiary insurance? Or a medical account? There’s some insurances like mine where every time I pay that weekly amount a small bit of it is placed in an account where those copayments are taken from instead of me paying it.
Also you may want to see if tax laws where you live allow you to write off medical expenses. I found out that because my job is marginally physical, I can write off medical costs as a business expense.
Gabbz737@reddit
Maryland is one of the heaviest taxed states. No spending problems. We live in a small house, share a bedroom with our son. We only go out to eat on birthdays if that... usually just bake our own cake. We have one old vehicle paid in full so no payments. No drug or alcohol problems, no debts(thank God!). We're only his income until my son is in school full time and i can get back to working.
Beginning-Town-7609@reddit
You ask valid questions, and I’m going to answer you both as a medical doctor and a cancer patient. In short, the US healthcare system is excellent to all who can ACCESS it. Yes, it’s incredibly expensive. Many of my Canadian patients would wait until they came to the USA to get care, including surgery because of long wait lists in the provinces. I just finished a course of immunotherapy for kidney cancer of a year’s duration at a total cost of $525k. I won’t know until more follow up if it had any benefit. As a doctor, more than one half of my income went to overhead, maintenance, staff salaries, etc. Insurance costs for healthcare have risen faster than inflation for more than a generation. Costs (some of them) for people who are uninsured or underinsured are passed on to people who can pay. And yes, medicine is heavily regulated. And I haven’t even started to cover the cost of defensive medicine to avoid litigation. Hopefully this gives you some perspective from a physician’s experience who is also a patient.
that_matt_kaplan@reddit
My girlfriend and many of my friends are also MDs. I hear stories of secretaries taking days/weeks to send urgent paperwork. People lose disability/insurance/don't get what they need for court/etc.
One of my coworkers during covid wanted to get tested for cancer. Ny was in a state of emergency and that wasnt considered an emergency by the state. 12 months later and he was correct, stage 3.
Away_Note@reddit
This is an excellent response. I think one of the problems online is that people mistake expensive for lack of quality. US healthcare is overall excellent, it just costs a lot sadly.
KoalaGrunt0311@reddit
Don't forgot that the insurance industry has forced the creation of an entirely new department of hospital administration staff dedicated to insurance billing and coding, including an entire specialty education requirement of Billing and Coding for medical trade schools.
Some doctrepreneurs have found themselves being able to operate on a cash basis without insurance and provide more reasonably priced general practitioner services.
Beginning-Town-7609@reddit
You’re right; the bureaucracy that has accompanied all the insurance stuff has been staggering.
GME_alt_Center@reddit
The health care is fine. The health INSURANCE which shouldn't even exist is the problem.
WanderingPulsar@reddit
I disagree, in a free market people should be free to offer services as they like as long as it's not a criminal service.
I guess the issue is that, there is no progressive pricing in insurance. One fit dude, that's vegetarian, exercising, not smoking nor using alcohole shouldnt be paying anything close to what a 300lbs obese dude that chunks fast foods over his face with multiple bad habits.
First dude's insurance must be close to nothing, and he shouldnt carry other dude above his bank account.
GME_alt_Center@reddit
If it was a free market bereft of lobbyists, I would agree
benmarvin@reddit
That's one of the biggest problems.
Hospital: Ok, that will be $100
Insurance: We'll pay 10%
Hospital: In that case the bill is now $1,000
And the new cost is the same for someone without insurance.
bb0110@reddit
That isn’t true. There is a max that can be charged and those rates for the most part are set from medicare. They are adjusted off. They could say it now costs $1000000 but that win’t change what you pay in regards to your out of pocket cost adter insurance.
seanthenry@reddit
That's not true. Medicare sets the max they will pay some insurances will pay more than that amount, but if the hospital asks for the Medicare allowable that is what will be paid not the full amount they would pay. Most providers bill 2-3x the Medicare allowable and that is why there if a wright off amount because the contract says the provider can only collect up to that amount.
bb0110@reddit
That is correct that some insurances will pay more than what medicare pays, but it is typically indexed to the medicare rate. Each code is slightly different but a lot of the time an insurance will pay 220% (just an example) of the medicare rate. It is a bad system, but it is how it currently is. Either way there is an allowable amount, so if a hospital were to spike the price to $1000000 it wouldn't matter and what you pat out of pocket or what your insurance pays out of pocket would be the same (assuming their billable amounts are over the allowable, which it pretty much always is).
ACdirtybird@reddit
People come from all over the world to get treatment. Like most things in life you get what you pay for. Look at Canada
luminarium@reddit
People put up with healthcare providers not telling them up front how much something will cost. Then they are of course surprised when the bill's a lot higher than it should be.
If we had a system where we lynched healthcare providers for charging unreasonable prices after refusing to give price quotes, we'd solve this problem in a jiffy.
Gabbz737@reddit
Anytime a healthcare provider asks if i want any service, i ask if my insurance covers it. I won't get anything not covered. Even then i still get random pop up fees and bs....
Nguyen_Kai_Shek1911@reddit
As someone who has lived in other countries besides and has returned to Seattle a pair of years ago I can say that America's healthcare is good regarding quality but horrible regarding pricing given high prices that are nearly impossible to pay for the uninsured or underinsured and even the insured given the ridiculous amount of fees a treatment can produce. Its mostly the result of weird regulation schemes promoted by health corporations through their lobbies at government. Its basically what happens when a country's political system ends up turning into a weird hybrid between democracy and corporatocracy.
Gabbz737@reddit
My bf has "good" insurance. It's a $50 co-pay to see any doctor. He makes too much for Medicaid but not enough to see a doctor unless he's dying. That $50 is our gas money to work/ the store.
philackey@reddit
The U.S. has, hands down the most sophisticated, finest health care system in the world. All of the brain drain of everywhere in the world of the finest doctors…. Where do you think they all go… They go to where they get paid. You want the best, you come here. Why would a skilled Canadian Physician settle for $60,000 a year when he comes South and makes $2,000,000 a year. You think these people are dummies. Here in the US you get instant, and the highest quality care. But guess what? It costs. My family are of course homeless sleeping in a tent because of medical debt. Murica!
Gabbz737@reddit
Murica!
mikefut@reddit
The US has the best healthcare in the world. The problem is that not everybody can afford it because employers typically subsidize it heavily. So when the average redditor talks about how terrible US healthcare is they’re talking about the healthcare system and the fact that it’s not universal and 100% taxpayer funded.
Gabbz737@reddit
Still debatable. It's a racket. Insurance BS aside, you have to see your primary care for a referral before you can see any specialist other than an eye doctor/dentist. Sure some things you don't know which doctor you need, but if I have obviously broken a bone why can't I just go to the orthopedic doctor? Why do I have to wait 2 weeks for an appointment with my primary care to get a paper that allows me to make an appointment with the doctor that will actually help me ... That I will probably have to wait a month for an appointment.....? Sure you could go to the ER to get a shortcut referral, but the ER doctors act like "why did you come here to bother me with this? I got ppl dying I need to tend to. You should have just gone to your primary care!"
And if you're middle class or lower they only patch you up enough to survive/keep working. Nothing to improve quality of life. I'm in my 30's have bad knees, they creek louder than the steps for god sakes. Doc is like that's normal... you're just like that. I've had this issue a long time. However if I was a major league sports player, they would have replaced my knees by now. I was like 25 when i asked for a knee replacement. He told me no because insurance wouldn't cover it and that I'd need my knees replaced again in my 70's....ya know what? I don't care! I need my knees now while I'm still young. By the time I'm in my 70's I'll probably be in a wheelchair anyways.....why can't I walk without agonizing pain now?! I can't even run with my 5yr old son, hell i can barely walk without a cane most days....but apparently it's not debilitating enough to go on disability...
nowonderimstillawake@reddit
The US has the most advanced healthcare in the world, but there are a lot of problems with our system that date back 80 years. The federal government stepped in where they shouldn't have and are basically the reason health insurance is tied to employers instead of existing in a free market. Health insurance as it exists here isn't really insurance by definition, it is a cost insulator. True insurance should only ever be used in an emergency. For example people have car insurance to cover them in the event of a crash or accident. You don't go to the mechanic and pull out your car insurance car and put down a $10 copay for an oil change while your car insurance covers the cost, but health insurance is used for routine doctor's visits and routine healthcare. In an ideal situation everyone would have catastrophic health insurance for emergencies, and an HSA that they can put money into tax free from their paycheck to cover routine healthcare expenses. That would drive down the price of a lot of health services as providers could deal directly with patients instead of having to go through third party insurance which makes everything more expensive. This would also result in a lot more price transparency for healthcare. You can actually see what things cost and shop around (for non emergency care) when prices are known, and competition drives prices down. Look at the essentially the only 2 aspects of healthcare that aren't covered by insurance: lasik eye surgery and cosmetic surgery. Both have improved drastically while prices have dropped. That's what happens to goods and services that operate within a free market.
mrm0nster@reddit
Two reasons:
Congress passed a law that gives preferential tax treatment to health insurance compensation. Meaning: we don’t pay income tax on compensation we receive in the form of health insurance coverage. This makes it completely irrational to instead receive that compensation as after-tax dollars and go buy health insurance with it. As a result, everyone gets their health insurance through their employer, allowing health insurers to sell to groups instead of individuals. So, instead of your insurance following you, you lose it when you change jobs or lose your job.
Insurance companies and healthcare providers renegotiate contracts every 3-5 years. Each time, the insurance companies go line by line for each procedure, and if they agree to pay the hospital 3% more, the hospital must increase their cash or out of network patient price by 7% (or whatever it is). Insurance companies can then use this to sell their plans to employers, showing them how much they can save employers vs cash patient prices. It’s all about the discount. Over 70 years, this increases prices tremendously.
watchingbigbrother63@reddit
For the uninsured in the U.S. having health issues has traditionally meant bad credit. The prices offered to cash patients are so high I can't believe that hospitals actual expect people to pay them. $5k ambulance rides, $20k for an overnight stay in the hospital, it's a fucking joke if you aren't insured.
Now I understand that rather than fixing the absurd pricing schemes they are trying to stop medical debt from hurting your credit rating?
My opinion is that the healthcare is INTENTIONALLY impossible to understand so as to allow a bunch of bullshit games to enrich insurance companies and providers.
FearlessOriginal5170@reddit
Not just the uninsured tho, when I was 20, I had incredible insurance. I had surgery that was fully covered but had post-surgery complications, went to urgent care and they said I needed to go to the closest emergency room. I was taken to one that was out of network and was given a 20k bill at the end of it which ruined my credit and the insurance company didn’t care
Veritas707@reddit
I have felt this way too… the problem isn’t unsolvable but rather they don’t want to solve it as a means to an ultimate agenda
Bellicost@reddit
The regulation is heavy AND stupid. It's cronyism at its finest.
okaneeeee@reddit
Basically, the main reason for the high cost of healthcare in the US is the employer-provided insurance tax exemption, which creates a situation where instead of people buying their own individual health insurance plans, they ask for the companies to pay it for them in the form of health benefits (because the value of the health insurance is untaxed), stimulating overconsumption and thus skyrocketing prices.
I highly suggest reading the following article, the author explain this problem much better than me.
https://www.cato.org/study/original-sin-us-health-policy
MitchimNum@reddit (OP)
I'll read it, thank you
Adrestia@reddit
The USA healthcare system penalizes poor people for working. A patient had to be under poverty level with barely any income to qualify for aid in my area. They don't take size of family into account. A friend of mine is a mom of 4, her husband is self employed, but doesn't make enough to afford health insurance. He makes too much for them to qualify for state Medicaid. Their kids get Medicaid, but they don't. They don't care that they have 4 kids. It's terrible.
leftajar@reddit
The USA's Healthcare System is comparatively much more corrupt than those of europe. What the USA has is this Unholy Alliance of Corporations and government. The government places insane regulations on the medical industry, artificially limiting the supply of Medical Care in this driving prices up to insane levels. The USA also punishes people for not having Health insurance, which also drives a premiums. So, as it turns out, having a relatively non-corrupt socialized system can produce better results than a highly corrupt quasi not really capitalist system.
alexmadsen1@reddit
The way the US health insurance system is constructed has massively distorted things. Supply and demand or decoupled as businesses pay the bulk of premiums to insurance companies who then pay the doctors. This is grew out of the fact insurance benefits were not taxed and originally insurance was relatively inexpensive.
Companies could offer health insurance as a perk and could get More inexpensively than people because it was not taxed. But just like mortgages not being taxed it create a highly distortionary monster.
I think the data is in and very clear. Single payer is the way to go until someone comes up with a better system. Unfortunately single-payer is not very libertarian but It seems least bad option in arrogate for the time being.
okaneeeee@reddit
Precisely, that's why we need to eliminate this tax exemption, then the value of the insurance benefit people receive will be included when they pay their payroll taxes, creating an incentive for workers to ask their bosses to give them money directly instead of paying a healthcare provider (that the employer instead of the employee chose, I might add) for them, eventually making America's healthcare system individual once again instead of employer-owned. Btw, this elimination would bring a LOT of new revenue to the government, which we could use to cut the payroll tax rate, which would make this policy, in practice, neither raise nor decrease the tax burden.
You just said that the problem is that the tax exemption creates distortionary effects, what we need to do is to eliminate this tax exemption, replace Medicare subsides for healthcare vouchers and end the most harmful regulations in this sector (like the, in effect, prohibition of interstate insurance), these ideias I've described are nothing new, some politicians have already proposed this before, single-payer ISN'T the only option here.
And btw, even though the US healthcare system is a big mess, there are a couple really important upsides when compared to single-payer systems, thanks to our semi-private system, for example, we have considerably smaller waiting lists and we're in the lead when it comes to medical technology and innovation, a single-payer healthcare system could threaten those aspects while the proposals I've cited before would both mantain these upsides and drastically reduce the healthcare cost at the same time, besides the fact that they wouldn't need a massive tax increase to be implemented appropriately.
not_today_thank@reddit
The US system is what happens when you take the worst aspects of the free market and combine them with the worst aspects of a public system. It's way too expensive, procedures in the US often cost 5 times or more than the same procedure in other countries. The government pays more per capita than most countries universal systems and only covers some of the population. Government regulations protect the big players in the health care market.
There are good aspects of the US health care system, it has some of the best cancer treatment outcomes in the world. But overall between public and private spending, health care costs two to three times more per person than most wealthy countries and offers below average outcomes overall.
Nomad_Industries@reddit
Yes
Also yes.
Because it is multi-payer system. The cost of healthcare varies from person to person based on the deals brokered between insurance companies, doctors, pharmacies, employers, and employees. Oh, also the brokers. All of this gets renegotiated every year.
The regulations are generally written by the middlemen to protect the interests of the middlemen.
AndrewRemillard@reddit
You have asked a very good question which is well answered here. I think it is careful to distinguish between the three choices one has when it comes to anything, including health care. Your choices: low cost, high quality, fast service. Choose two, that is all you get. In the US we have chosen quality and speed. (I have had over 10 operations over the past 10 years. Some life saving, others much more minor. Each was scheduled very quickly, I had no wait times. However, let's just say, I love my insurance. I would guess my total costs are over $750,000 USD if not $1,000,000 for these operations and after care. Obviously, as many have commented, especially the docs, it is far more expensive than it needs to be, mostly because of the insurance and the ease of suing.
daboot013@reddit
It's basically a battle of pass the trash and liability off. And the consumer suffers for it.
cmeads1@reddit
There is no free market. And a lot of corruption.
lil_jakers@reddit
I like to compare it to the car market. In the US you can have a Rolls Royce or a Bentley. They are the best cars when they work, but when they break it is ridiculously expensive and absurd at times to repair. Most people can and would pay for a Toyota, but regulation has made that pretty much impossible.
over_kill71@reddit
in short. it is expensive, it is also very good depending on you you are asking. every foreigner I've spoken with loves it, every reddit person hates it. my humble opinion is that nothing is really free, instead it would be nice if our elected officials did something to keep costs down but unfortunately they have their hands in big pharmas pockets while the red and blue teams blame each other. I work in the plastics industry, you would be shocked how cheap medical supplies are to make.
Large_McHuge@reddit
The health care is generally excellent.
The cost of healthcare is insane.
Seventh_Stater@reddit
It is very heavily regulated.
UnitCell@reddit
I'ma come in here and give my 2c. I am a European/US dual citizen. No idea about Brazil, but I can comment from an EU healthcare comparison perspective.
The actual healthcare in the US is excellent. Competent professionals and modern equipment. I know some people in the US may disagree, but coming from Europe I would say that the US also has very short wait times.
Then you get to billing. In the US, your health insurance works like an actual insurance. In Europe, it is more like a holistic, flat rate care program. Big difference.
Many people in the US, some insured, some not insured, end up getting slapped with ridiculous amounts of medical fees, like it just would not happen in Europe. It is important to point out that, exactly how medical debt is treated, depends on the state you live in. But generally, it is not handled as "sharply" as consumer debt.
Hope this helps to clarify your question at all.
somerville99@reddit
Most people outside of the US think it is bad because it is different than what they are used to. It is a mix of both public and private insurances. It has some of the most advanced healthcare in the world. The difference is the government does not control all aspects of it. This is actually what most people want since Americans historically do not trust large centralized government or politicians. And for good reason.
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