Almost 100 Million People a Year 'Forced To Choose Between Food and Healthcare' (theguardian.com)

Almost 100 million people are pushed into extreme poverty each year because of debts accrued through healthcare expenses. From a report: A report, published by the World Health Organization and the World Bank this week, found the poorest and most vulnerable people are routinely forced to choose between healthcare and other necessities for their household, including food and education, subsisting on $1.90 a day. Researchers found that more than 122 million people around the world are forced to live on $3.10 a day, the benchmark for "moderate poverty," due to healthcare expenditure. Since 2000, this number has increased by 1.5% a year. A total of 800 million people spend more than 10% of their household budgets on "out-of-pocket" health expenses, defined as costs not covered by insurance. Almost 180 million people spend a quarter or more, a population increasing at a rate of almost 5% per year, with women among those worst affected.

Comments

Don't be mistaken

[damn_registrars]

The reason health care is so costly in the US can be found at the top of the insurance companies. Many of the top execs of these companies - including the ones that are listed as "non-profit" or "not-for-profit" take in guaranteed annual bonuses that exceed the lifetime earnings of most Americans. The "Affordable Care Act" just gave these greedy capitalists the keys to the kingdom as well, in guaranteeing them customers for the rest of time.

People dropping out of the insurance market and having no coverage won't solve this problem. The solution is to finally have our country behave like a modern industrialized nation and have a single-payer system. It's too bad nobody was willing to propose such a sensible thing.

Re:Don't be mistaken

[mridoni]

Single-payer would bankrupt the country. There will never be enough of anything to satisfy demand completely.

Well, I just can't understand how most of Europe and Canada do it without actually going bankrupt.

Re:Don't be mistaken

[dcw3]

Bullshit. Single payer removes a middleman that is of no value added, and in fact raises the total cost of healthcare.
And, for whatever it's worth, I'm saying this as a fiscal conservative.

Re:Don't be mistaken

[damn_registrars]

Single-payer would bankrupt the country.

Just because the GOP says that, doesn't make it true. The rest of the industrialized world uses some form of single-payer and their nations aren't going broke. We use a market-based system with essentially no floor and we are going broke. We are the only industrialized nation where it is even possible to go bankrupt due to medical debt.

The solution is to relax regulations, not increase them

Single payer does relax regulations. The biggest barriers to health care right now come from the insurance industry, not the government.

Remove the artificial limits placed on the number of doctors by the AMA

You really need to look in to what you're saying. Several problems exist with that statement.

First of all, we have alternative paths to practicing medicine. Ever hear of a Nurse Practitioner? They are able to practice medicine on their own now in several states. Ever hear of a Physician's Assistant? They are taking patients independently for routine cases in many states as well. Ever hear of a Doctor of Osteopathic medicine? They can also see patients on their own. We also have pharmacists who can do more patient care than before in many situations - they are doing a lot more now than just handing out prescriptions and selling Sudafed.

Do you really want someone practicing medicine who has less qualifications than that?

Cap malpractice payouts through tort reform.

Malpractice payouts are a trivial expense compared to what goes to the top of the insurance industry. In fact most doctors pay vastly more in malpractice insurance than they will ever pay in malpractice settlements. The reason why so few doctors go in to Obstetrics (for example) isn't because they are actually concerned about the possibility of committing malpractice, but because the insurance industry requires them to carry absurd terms for their malpractice insurance. Sure, the lawyers are getting a big cut but it is dwarfed again by what the insurance company execs get - and the insurance execs get it regardless of their own performance while the lawyers have to prove a case in court to get the big paycheck.

In other words the bulk of your argument reads like an ad for the insurance industry.

Re:Don't be mistaken

[ranton]

It's not how much they draw compared to each person, it's how much they draw in total. It is, in fact, obscene.

Considering this thread was started with the statement: "The reason health care is so costly in the US can be found at the top of the insurance companies.", the only thing that matters is how much they draw compared to each person. For the purposes of this discussion that is. Whether or not their pay is obscene has no bearing on whether or not it is the reason health care is so costly in the US, which is the contention which was being refuted by the post you replied to.

Based on the figures I found here the top 10 highest paid insurance CEO's made $159 million in 2014. That is about $1.30 per household. I don't think health care costs are so high just because of an extra ten cents per month we all pay extra to pay these CEO's.

If I use Amtrust Financial Services (home of the highest paid CEO above) as a model, the entire C-level suite including the CEO made 261% of the CEO's pay. So I'll estimate that the C-level suite at the 10 companies above were paid $415 million in 2014, which is about a quarter per household per month.

If you factor in every C-level executive in every insurance company in the US, I doubt you would come to more than a couple dollars per household per month. That is not why insurance is so expensive. I would still agree that private insurance companies are the number one reason why health care is so expensive in the US but it has far more to do with the stockholders who demand return on investment (gasp, the horror) than it does with obscene CEO pay.

Re:Don't be mistaken

[Anonymous Coward]

This is so very wrong. As much as we would like to think we have that much effect on the world economy, the reality is that the reason why drugs are so expensive in the USA is because the pharma companies can charge as much as they want. And it is coming to light that most of them are doing just that. Most of the rest of the civilized world took one look at the potential for rent-seeking that could happen in health care and quickly put in fee schedules to keep their citizenry from being robbed blind. Did this slow down progress? Not really, since a majority of the pure research that feeds these drug companies is actually funded by public monies. By the time pharma companies actually start picking up the bill on research of a promising drug, most of the basic research is done. The majority of the private money spent by pharma companies from that point on is in the marketing of that drug. The clinical trials are actually little more than a speed bump in comparison to this. This is true whether the drug is being developed in the US, Germany, France or the UK. And a lot more research is happening in Europe and Asia than in the US right now. And that's in markets where the governments regulate the profits that pharma companies make on their products.

Re:Don't be mistaken

[PopeRatzo]

Sure with death panels and less than stellar services.

Countries with single-payer health care have better medical outcomes and longer life expectancy.

https://www.oecd.org/els/healt...

Re:Don't be mistaken

[Kjella]

Well, I just can't understand how most of Europe and Canada do it without actually going bankrupt.

It's because US people put up a straw man and cut it down. A single payer system means it's funded almost entirely by taxes (here in Norway co-pay is ~$30/visit and capped at ~$250/year), it doesn't mean they got infinite money or resources and it doesn't mean they deliver everything the patients want or need. There's only so many hospitals, doctors and nurses as the budget permits. Treatments are granted based on medical need and ranked based on quality-adjusted years of life. Waiting lists are prioritized on urgency and impact. It's not the best care money can buy, it's trying to be the most fairly distributed level of care possible at that funding level.

Single payer doesn't mean exclusively public employees, there are many private doctors and institutions delivering services into the public system. But apart from that there's also truly private insurance and private healthcare, if you can afford it. It's not subsidized, you don't get a tax refund and it caters to a market that won't wait and won't take anything less than excellence. LIke if a pro sports player is injured and need surgery, they often use that because in the public system they're not special and you can't pay to get to the head of the line. Same way some people bankroll certain medications we've rejected to give because of cost, typically >$100k/year. Even though they're medically proven to work and the patient will die sooner.

So if it's not a happy wonderland, why is it working better? Because we don't have insurance people trying to save costs by denying coverage. We don't have doctors that earn more by billing more or get kickbacks from selling brand drugs. While there's an ever ongoing pressure to reduce costs, we're not looking to cherry pick profitable patients and hospitals don't get stuck with unprofitable ones. For the most part we simply have medical personnel and administrators trying to balance out the limited resources based on who needs it most. And they're actually pretty good at it, as long as they don't get other personal incentives.

Just to take one example, there's a national standard for average ambulance response time which says it should be <12 minutes in >90% of the cases in urban areas and <25 minutes in >90% of the cases in rural areas. Poor or rich area? Easy or hard geography? Doesn't really matter. The money is distributed so it's mostly uniform no matter where you live, we're not quite hitting that metric but then we'd rather fall a little short most places rather than fail spectacularly in a few. Those are the stretch goals, on the low end you have a standard of adequate healthcare which is like a legal minimum. It's a pretty low bar though where violations are usually human error, flaws or failures in the system like say no ambulance is actually dispatched. It's not your typical triage.

Re:In the USA you just show up at ER and don't pay

[damn_registrars]

In the USA you just show up at ER and don't pay if you don't have a med plan and they can't turn you away.

That is not entirely true. If you are having a medical emergency the ER cannot turn you away for lack of insurance but that doesn't mean they can't bill you for coming in - and they will. They're just limited in how far they can go with their attempts to collect on fees before they hand them over to the government.

Furthermore as already pointed out the hospital only needs to stabilize you. If you need an organ transplant and you have no insurance, that simply won't happen. If you went in because you were suicidal you'll be kept for a couple days and then sent right back out.

This nonsense again

[fyngyrz]

In the USA you just show up at ER and don't pay if you don't have a med plan and they can't turn you away.

The ER has to try to stabilize you. They don't have to provide needed treatment beyond that, or drugs — and they won't. What they will do is determine what will stabilize you, do that, give you perhaps one dose of whatever prescription(s) is(are) needed which you can then go get from a pharmacy if you can pay for it, and refer you to a doctor, who you can also go to if you can pay for it, and that's the end of it.

You have cancer? Diabetes? A hernia? You're not going to get the treatment you need for that at the ER. Period. The ER does things that are specific to the moment, like set a broken arm. Still, you get to pay for the meds, and any follow-up care.

ER visits are not even remotely comparable to appropriate medical care for anything serious. People who claim it is have no idea what they are talking about.