Americans Want More Health Care Investment by Government

[Filuwaúrdjan]

This is true, according to the statistic I have seen.   The U.S. spends about 14 percent of its GDP on health care.  Canada spends about ten percent and the UK spends about nine percent.  Put another way, we spend about 4200 dollars per capita on health care (of which 1700 is public money), while Canada and UK spend about 2300 and 1500 dollars, respectively.  (The numbers vary depending on whom you ask and their spin and motivation)  I think OECD countries spend, on average, about 2000 dollars per capita on health care.  Despite our spending, we usually rank about tenth or so out of the 30 OECD countries on fairly objective aggregate standards comparisons.  I'm not sure why.  But I don't think the data suggests, a priori, the need for greater centralization or government involvement in the US.

No, but it indicates how monstrously inefficient the current U.S healthcare setup is. There's just no justification to spend that sort of money on a system that doesn't cover everyone.

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That's because they haven't actually got a clue how either system works, but like to pick up random scare stories to try to demonstrate quite how bad they are at making logical arguments.

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All national healthcare systems in industrialised countries "work". It's just that they "work" for different groups in society; a blatently Socialist system like the NHS is excellent for working class and lower middle class (by which I mean lower middle class in a U.K context) people as it enables us to get a level of healthcare that they would never otherwise be able to afford and they don't have to worry about the nasty side of any insurance based system.
On the other hand a paternalist setup like France (and most insurance based systems are like this to a certain degree) is excellent for what would be called upper middle class in the U.S, but it can be extremely demeaning and somewhat soul destroying to the sort of people who benefit most from the NHS. This is of course the idea.

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Perhaps, but that really isn't as big a factor as it's often made out to be.

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Customer satisfaction in healthcare is meaningless and extremely subjective. Some people will never be satisfied with anything, others will take a "mustn't grumble" approach.
As such it's a terrible way of measuring how good a given healthcare system actually is (o/c there's no good way of comparing healthcare systems unless they have the same basic setup as otherwise you aren't comparing like with like. And doing it by a survey is an especially big mistake as people start getting all nationalistic in their answers).

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If you take a broad definition of what rationing is, it occurs in just about everything you can think of though. Which I guess is sort of your point.

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Waiting lists were a major political issue from some large (and IMO stupid) cuts in the NHS in the '80's (I think half or a third or something like that, of all beds were got rid of on the orders of central Government to "save money"...) until a few years ago (which gives a rough indication of when a problem emerged and when it started to get better).
The main problem has always been minor/vanity operations (accident/emergency, serious operations, longterm conditions etc. have never been a problem as far as waiting time goes) things that used to be really quite rare when the NHS was founded, and there've been some interesting ways to get around the problem (and they're a problem as they are clearly the lowest priority thing that a hospital has to deal with, yet cost the same amount of money to conduct than a more serious operation) alongside the usual method of just recruiting more doctors and all that. One trick (which I mentioned above) has been to dump some of these operations on the private sector (this was one reason why it was never made illegal) and another has been to bring in independent contracters to do the operations within the NHS. I've no idea how effective this has been as I don't use that side of the NHS (although I'm in hospitals a lot for other reasons) but seeing as less people are complaining now (and being British we like to complain for the sake of complaining) then were a few years ago and seeing as the waiting lists have shrunk a hell of a lot recently, I'll assume that they've been reasonably successful.

Asking about customer satisfaction in the U.K is o/c a total waste of time as we are a nation of moaners

[??????????]

Yes, but the UK is a much smaller nation and more insular, overall, then the USA. Here illegals expect to automatically receive healthcare upon entry into the US which is really a true shame.

[© tweed]

one day

[David S]

It’s no secret that I’m a believer in the free market system. Let me illustrate why.

One of the best examples of a competitive free market in action is the personal computer business. The power, speed and available features keep getting better and better while the prices keep coming down. Why is this? Well when I’m in the market for a PC I browse through the tons of ads I get in the local paper. I look for models that have the features and quality I want and then I look for the best price. Price is definitely an important consideration. When I find the one I want I just go buy it. I suspect most people do much the same thing. That kind of shopping puts a competitive pressure on the manufacturers. They know they have to provide quality products with desirable features at low prices if they want to stay in business.

Now compare that with the health care industry. A few years ago I had hernia surgery. The process started when I noticed a bulge in the lower abdomen. I went to our family doctor who confirmed my suspicion that it was a hernia. He gave me the names of a couple of surgeons who could fix it. I made an appointment with the surgeon. He examined me and briefly explained the surgical procedure. Then he told me to schedule the surgery through his nurse. There was no waiting list. It was just a matter of finding a mutually agreeable time. I had the surgery a few weeks later. My insurance covered the whole cost. Now what’s missing from that picture? How about price? It was never discussed with any of the doctors. Shame on me, but knowing that my insurance would cover it I never gave it much thought. This is how our current health care system defeats the free market. Doctors don’t advertise their services or their prices. And people generally don’t have an incentive to shop because someone else is paying the bill, either Medicare, Medicaid, or the insurance company. Also, note that with the PC purchase there are no administrative costs. But with medical care the doctor has administrative costs of submitting bills, and insurers have administrative costs to process the bills and they also add their profit to the bill. All of that is added to the total bill.

If we could create the kind of competitive pressure on the health care industry that exists in the PC industry we would not have a health care “crisis”. An example of where this has actually occurred in the medical field is vision correction surgery. Twenty or so years ago the procedure cost about $3000 per eye. Today it is frequently advertised for less than $1000 per eye despite the fact that inflation has driven other costs up by 75% over the last 20 years. The reason is that the procedure is not usually covered by insurance or Medicare/Medicaid. People have to pay out of pocket so they tend to be careful shoppers. Providers of the surgery know this so they advertise their prices to attract customers. Under these circumstances the free market forces work fine. Quality goes up and prices come down. That’s exactly what we need.

[The Duke]

Someone said that Medicare has lower overhead costs than private health care.  This is not true.  Medicare passes large overhead costs onto private hospitals, and leaves private sector consumers to pick up the tab.  Medicare keeps its costs down by asking someone else to pay them.

Also worth taking into account is the fact that Americans are less healthy than anyone else in the world.  We are the country that pays the most of its GDP because we consume the most, and we consume the most because we aren't healthy.  If you want to drive down the cost of health care, then get people healthy.

[Nym90]

Good point, John. The best long term solution is to emphasize and promote prevention, rather than focusing solely on cure.

[TheresNoMoney]

Good point, John. The best long term solution is to emphasize and promote prevention, rather than focusing solely on cure.

The current system discourages prevention. A single-payer system would do just the opposite.

[John Dibble]

Good point, John. The best long term solution is to emphasize and promote prevention, rather than focusing solely on cure.

The current system discourages prevention. A single-payer system would do just the opposite.

How? Would single payer magically change people's eating and exercise habits, even though it's already common knowledge that overeating/eating fatty foods and not exercising often are bad for you? Or would it make people stop smoking, even though it's common knowledge that smoking is bad for you?

And how does the current system prevent people from taking the same steps?

[angus]

No, but it indicates how monstrously inefficient the current U.S healthcare setup is. There's just no justification to spend that sort of money on a system that doesn't cover everyone.

indeed.  And that's probably the motivation for the poll that started this thread.  And many others.

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hadn't thought of it.  Yes, such subjective polling in any country is meaningless as specific quantifiers of efficiency.  I concede that point.  Still, if as a measure of the moral comfort of a society the polls indicate satisfaction, then one can argue that we spend twice as much per capita as Canadians, for nearly the same level of customer satisfaction.  That's an interesting fact, and supports the point you make above.  Still, we don't have a nationwide consensus on the best solution to the problem.  Unfortunate, since the status quo (or status quid, to be exact) really bites.

I won't argue with the other points, many of which seem valid but all of which are subjective.  Your input is interesting and invaluable, but you and I argued about this subject in the early days of my existence and I trust you are as convinced in the need for Nationalized Healthcare as I am of getting the government to leave the business of health care to the private sector, in toto.  Of course I consider intellectual property rights outside the specific scope of this arguement, and do not mean to imply that companies who pay good money to chemists should not expect a reasonable return on their investment and therefore also expect international manufacturers to generally abide by international patent laws.  But then I note that India and China and others are moving in this direction, according to various articles in trade publications I receive regularly, so I have no reason to believe that continued investment in US and German pharmaceutical companies is a bad idea.

Oh, and for a guy who comes from a "mustn't grumble" culture, you sure like to grumble.