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Hospital Prices Are About To Go Public in the US (ajc.com)
Prices hospitals charge for their services will all go online Jan. 1 under a new federal requirement, but patient advocates say the realities of medical-industry pricing will make it difficult for consumers to get much out of the new data. From a report: A federal rule requires all hospitals to post online a master list of prices for the services they provide so consumers can review them starting Jan. 1. The health care industry nationally has a reputation for having little price transparency, which can make it difficult for consumers to price compare. But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look, consumer advocates say. That's because the final bill a patient receives is almost never the same as the sticker price for the services they received. Insurance companies negotiate discounts on the sticker prices. Co-pays, co-insurance, deductibles also add other layers of complexity that bring discounts or increased costs before a final charge is determined.
Doc: Do you smoke?
Me: No.
$130 smoking consultation charge.
As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system. Most other 1:st world countries (in Europe, Japan, South Korea ...) have some variation on a single-payer system, where hospital visits and drugs are in most part paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance.
In Sweden, a visit to a doctor, district nurse, psychologist or physiotherapist always cost $10-$20 (free for children below 18 years old and the elderly). A hospital visit is $20-$40, regardless of what procedures are administrated. (hospitals also seems to base the procedures applied based on medical need, rather than what can be billed). On top of that, there is a yearly cap so no citizen need paying more than $150 each year in hospital fees, and no more than $150 each year for prescription drugs.
And, to the point, the average EU citizen pay much less (including paid via taxes) for equal 1:st world class health care than the US citizen.
For example, the British spend around half the US amount on health care per capita, despite having by several measures higher quality:
https://www.bbc.com/news/uk-42...
All this "oh we can't tell you the real price" bullshit needs to come to a screeching halt. This is just cartelism, or guildism, or whatever you can call it. It's an industry screwing us over because it can, and claiming technical difficulties prevent it from changing. It was bullshit when Microsoft did it with Internet Explorer and it's bullshit with hospitals.
Shutting down free speech with violence isn't fighting fascism. It IS fascism!
Now all we need is a Nondiscrimination law --- that is, to say,
a federal rule against price discrimination or blanket pricing deals in that: A healthcare provider may not charge individuals a higher price than a partner insurance company would pay for the same service.
If you want to compare what things cost elsewhere here's price list from greater Helsinki area(24 counties).
I couldn't find the master price list in english but those terms should google-translate just fine.
Like the summary above says, it's not that straightforward to calculate the actual costs but on that list the prices are as is, before any deductibles from the government etc.
The description how to calculate the costs is actually available in english.
There are no atheists when recovering from tape backup.
Privatized medicine can work. There are clinics in the US that offer a menu of fixed-price services, and take direct payment (no insurance). No bureaucracy leads to reasonable prices - everybody wins.
The problem comes when the government intervenes too much. In the health insurance market, insisting that everyone must be covered, regardless of health problems or pre-existing conditions - that's no longer insurance, and has led to the problems the US is facing. Let the private insurance market work - it worked just fine for most people, most of the time, over many decades.
For people who cannot qualify for private insurance, the government can become the health care provider of last resort. That's basically where Medicare/Medicaid would come into play. Essential services only, no cosmetic or optional treatments. This is also where people would land, who get ill or injured, but couldn't be bothered to pay for insurance.
The situation in countries like the UK is actually not too dissimilar. The NHS provides health care for everyone, as long as you don't mind waiting months or years for anything that's not immediately life threatening. Meanwhile, there is a perfectly functional private insurance market for people who don't want to wait - the prices are reasonable, and coverage is good. As far as I can tell, the government basically ignores the private market - which is probably why it works.
Enjoy life! This is not a dress rehearsal.
But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look
Correct. Because nowhere on the chargemaster is a service that says "colonoscopy". Good luck getting the average American to interpret ICD-10-PCS code descriptions. According to this website, a screening colonoscopy should receive the following three codes:
Z12.11: Encounter for screening for malignant neoplasm of the colon
Z80.0: Family history of malignant neoplasm of digestive organs
Z86.010: Personal history of colonic polyps
No word for "colonoscopy" that I can see. Furthermore, this doesn't include the anesthetist charge, recovery, the room charge (which is always charged for with surgery, inpatient or outpatient), or the food charge. Other hospitals even throw in itemized charges for IVs, needles, hoses, gowns, laundry, and tissues.
It'd be like shopping for a car, and before you go, you have to look up online the costs for all the individual parts that make up a car. Except most Americans don't know every single nut and bolt, camshaft and wiring assembly, window and panel, that goes into one. And you get to the car lot, ask how much the cost is, and the salesman says, "We have all our costs online." You get your car, you drive it home, and then you get a bill in the mail three months later for five times what it really should cost.
What health care really needs is the sticker price posted right in the window.
One reason, probably not the biggest, is illegal immigration. The people telling you about fixed wages after WW2 are more correct than this answer, but this is why it can't politically be done now.
We have between 12 and 25 million illegals in the country. Asking the middle class to pay for health coverage for them, while calling those same tax payers bigots/racists doesn't go over well. Had the DNC instead thanked them and said they were great people for helping others, things might be different.
Even Clare McCaskil (Hillary's #1 supporter) is giving interviews saying the DNC has screwed up with their attacking the middle class. With their new Congresspeople, who are even more antagonistic to the middle class, its not likely to happen any time soon.
I broke my clavicle skiing several years back, a non-unionizing break, and had to have a plate installed. After the surgery I got a "This is not a bill" statement from the plate manufacturer, telling me the cost of the plate is $7800. I then later got a "this is not a bill" statement from the hospital, telling me the cost of the plate to them is $3400. I then got a "this is not a bill" statement from the insurance company telling me their non-negotiated cost for the plate is $1100. I then later got a "this is not a bill" statement from the insurance company telling me their negotiated cost for the plate is $391, and they're covering all of it, so I don't owe anything. I guess my question is, is anyone anywhere actually paying $7800 for this plate, or is that all bullshit?
I have lived under the British (UK) health care system and it Sucks! The reports of wait times for surgery, scans, procedures & treatment are much longer than in the USA. The overall Quality is much poorer than the USA. The overall "out-of-pocket" price may be lower but the human costs are definitely lower. USA Federal Government intervention/take-over of the America health care system is the ruin of both health insurance (a la, Obamacare) and health care (restricted treatments, proscribed treatments, etc.). My Carpal Tunnel Syndrome surgery was performed in Memphis, TN. At the time of my surgery, Memphis had more MRI machines than the entire country of Canada (a 1st World Country with single payer health insurance/care). While I can't speak about Sweden's health insurance/care system, I can address the British and Canadian systems with some sort of personal experience. The reports from the MSM in the USA all seem to note that 1-payer systems are "cheaper" for the consumer but the quality is still inferior to the USA.
Balance billing isn't the only reason that this is a good thing to be publicly available. Hospitals have been playing a game with insurance companies for years. The how much is too much game. Lets say service X actually costs the hospital $100 dollars to perform. Even though many hospitals are supposed non-profits (funny how 7 of the top 10 most "profitable" hospitals in the US are non-profits) they determine, hey we're going to charge insurance $300 dollars for service X. Insurance company doesn't argue.... so next year, hospital decides to raise cost of service X to $500 dollars, and the insurance company doesn't argue. So the hospital goes, "Hey, wonder if they'll pay $1000!" and raises the cost of service X to $1000. Insurance company goes, no that's too much for that service, we'll pay you only $800. So the hospital decides, "fine, so they'll pay us $800, so lets keep it on the chargemaster as $1000 so we can continue to justify receiving 800 from the insurance companies and maybe some poor sucker with no insurance will be stuck paying us $1000 sometimes.
Hopefully being able to see the chargemaster and the ludicrous pricing that hospitals charge will open the eyes of the public to say enough is enough.
I've done the US system, and I've run into a few issues.
The US system can be horrible, or it can be great. It depends on how much you are willing to pay. For example, the doctor prescribed the textbook prescription for an ailment. My insurance company denied it. I had to go back and forth with them, the doctor, and the doctor had to call them before it was covered.
If I could pay out of pocket, I would have gotten the prescription right away. As it was, it took about two weeks for the insurance company to okay the treatment.
As if you're in any condition to negotiate prices when you're having a heart attack.
Or when you have a child dying from cancer.
Those are not the times when you negotiate for medical care. A market in medicine would be a market in prearrangements. That was the whole point of the ACA, and is why people liked it better than "You have a choice of the one insurance company that goes with your job. You do have a job, don't you?"
The downside of ACA is that it did nothing to control costs. That is what we could use capitalism for.
Quote from the parent comment: "... start with letting American purchasers buy FDA-approved compounds on the world market, ..."
Why pharmaceuticals are cheaper outside the United States. (Sept. 28, 2015)
Quoting:
"According to the International Federation of Health Plans, Americans pay anywhere from two to six times more than the rest of the world for brand name prescription drugs."
Compare drug prices among reputable online pharmacies. ("Prices collected March 2018")
Discount Drugs from Canada
This does not match in any form my experience of living in the UK and the USA. Under the UK NHS I have had GP visits arranged on the same day, often within a couple of hours, saw the doctor, got a prescription, left all very smoothly and got charged a prescription fee of around 8 pounds (11 ish dollars).
In fact, just about anyone I've talked to who's used both has stated that they prefer the NHS, though it does suffer from underfunding due to years of conservative government. See https://www.businessinsider.co... for example.
It is cheaper, faster and better than the USA healthcare. It treats more people for less money. The human costs of the US system are people dying of preventable diseases, minor issues ending up at the emergency room and bankrupcy from simple medical problems. A single payer system leads to longer life expectancy and a better standard of living. Funded at even 50% of the amount americans currently spend on healthcare, a US NHS would be heaven on earth compared to what exists now.
So, I work in the medical device field and have recently undergone some major procedures. The doctor was a associate of mine and I went over some of the pricing with him. The Procedure itself ended up costing somewhere around $20,000 (after negotiations) The doctor received around $500 for the time (billed to me at about $4,000), the device used was around $600. I believe the anesthesiologist had the same. The Pharmacy billed $9,000 for drugs, I hope they were made from gold. Where did the rest of the money go?? I have never been able to figure out what the hospital did for the additional amount or for the markup on the doctor. This did not include any of the hospital stay, just the procedure itself.
So rather than thousands of pages of new regulations we could have just enacted the following:
1) All compensation for employment shall be taxed as regular income
2) A medical insurer may only set prices based on individual underwriting, covered services, and size of deductible; they are forbidden to offer rate variances or discounted based on the insured association with any third party such as employment by a business, membership in religious organization, etc.
3) Non-cosmetic medical expenses including medical insurance my be deducted from individual income on individual returns. Keep your receipts if your costs exceed the standard deduction itemize!
That could have been the entirety of the ACA and it would (in time) have done more to straiten out the idiocy of the current market place than the ACA has.
Repeal the 17th Amendment TODAY! Also Please Read http://www.gnu.org/philosophy/right-to-read.html
Our healthcare system still remains fucked
I hope it's more useful than I'm imagining. When someone is unconscious and someone else calls 911, they're not going to be able to browse a list of ambulance providers and hospitals and review prices. Also, most people that don't have insurance, don't have a lot of money in general, so I'm not sure how helpful this would be, unless there are places that provide reasonably competent care for pennies in comparison to what I've seen.
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I have lived under the British (UK) health care system and it Sucks! The reports of wait times for surgery, scans, procedures & treatment are much longer than in the USA. The overall Quality is much poorer than the USA. The overall "out-of-pocket" price may be lower but the human costs are definitely lower.
How much of that is from certain political parties in the UK spending the last 30 years sabotaging the NHS for the sole purpose of "proving" that single-payer can't work?
The quality may be inferior to that of any country. That does not mean a lot.
Car comparison: The Rolls Royce and the Bentley are far superior in quality than that of a Toyota Yaris, But if I am unable to buy one, that is meaningless.
The fact that average age is declining in the US is a telling tale how people are litteraly dying because they can't pay for their health. If people do not have the money, they will not go the the anual checkup at their doctor. They will not go to their docter when they are ill, because they need the money for food and rent.
People walk around with papers that say they do not want to be saved in case of an emergency, so they are not a financial burden on their family.
So when you look at the total population, the quality of the UK is better, because people are actually able to get help.
(following numbers are made up)
If there are 100 people and 90 can't get help, it does not matter that the 10 others get 10 times as great help.
It is better to give 100 people average help. Yes, that will result in the occasional death if that person would be one of the 10. The oposite of people NOT dying is also true for the people whou would have died if they where in that 90 bracket.
And just out of curiosity, how much did you pay for that surgery?
Don't fight for your country, if your country does not fight for you.
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""In the long run, Medicare will probably be gradually extended to cover everyone, which will give us Single-Payer by default"" Hope not - the managed care we have today is starting to break already. Try getting insurance for your family without working for an employer (self-employed). Why? Well actually - before "managed care" set into the marketplace in early 80's from academics setting policy in 70's - and indemnity insurance was still the main way of getting health insurance for employers and private policyholders - mostly Medicare had rising costs within 10 years of implementation - i.e. starting in 1966. Cost containment measures (i.e. putting in limits) stabilized this eventually but efforts backfired due to horror stories about "heartless" insurance companies rationing, etc. At some point a "semi happy" medium was reached between quality, patient satisfaction and cost containment. Managed care kind of followed the same suit with a increase in the 80's and 90's. In the managed care environment - rising costs have a few key root causes -- increasing demand, lower supply (of clinics/doctors/facilities willing to take Medicare/Medicaid) and shifting costs from care dollars to administrative dollars. The largest disincentive to "manage demand" is lack of transparency to overall price and consequence which has a boomerang effect to premiums and member share of cost depending on utilization patterns in prior periods. Additionally, the increase in regulatory requirements are not to be discounted. Regulators have some major latitude under very broadly written laws (currently PPACA/HIPAA, etc) to make many changes - even on a quarterly basis - that the "private corporate" insurance and hospital and even small medical group industry must comply with. Instead of hiring the extra nurse, physician assistant or taking on the extra junior MD partner - a "healthcare institution" are hiring an analyst, compliance officer, administrator (i.e. non-medical or middle manager) who can navigate the complex regulations and oversee policy and billing. Extend that constantly shifting regulatory landscape onto the harsh reality of shifting "software requirements" - and you can see how these costs get amplified in terms of software vendors, IT, etc - i.e. more administrative costs. Payors, Providers and their outsourcing suppliers (i.e. software vendors, pharma, PBM's, TPA's, medical supply, etc) have always responded to increased regulation via consolidation. This means "less competition", not more of it. With PPACA (aka Obamacare) - we have increased participation (which is true) - but also increased risk and demand without truly changing the supply side of the equation. The other reality is that regulation increased by magnitudes under "government defined" healthcare and so less dollars go into competitive models and more consolidation has occurred. What we are left with is fewer and larger players that tweak regulation via "crony capitalism". Before people point to Kaiser as a model - please look up "Stark Law" and Kaiser - the current modern managed care based system has it's origins in crony capitalism. Basically it is not easy to "startup" a Kaiser competitor using Kaiser's model in the current day. There is no free market healthcare in the US. It hasn't been even close to free market since the advent of managed care. Regulations have created a barrier to new experiments in healthcare delivery. Regarding Single Payer - by illustration, Medicare is not really run by the government, rather government policies by regulators are "interpreted and implemented" via fiscal intermediaries - which are large insurance companies - i.e. crony capitalism. Single payer won't be any different. The government doesn't ever reduce the cost of anything except to deny it and limit the "private marketplace". Single payer has a huge potential to a massive failed social experiment that will be a slow moving disaster spanning 50 years. It is not small business/entrepreneur or even consumer friendly (lack of choice/options to me is anti-consumer). Any
Hospitals won't tell you they're gonna bill your insurance company $1000 for 4 stitches. 20/20 Sick in America: Whose Body is it Anyway? (6/6) - Dr. Robert Berry PATMOS EmergiClinic http://bit.ly/25Au4TG
"Tempers are wearing thin. Let's just hope some robot doesn't kill everybody." --Bender
A Congress critter was once asked why the tax code was so complicated, and why didn't they just simplify it. The critter responded, "Why would we voluntarily give up so much power?"
I ask you here, why would the Congress critters give up so much power?
Aah, change is good. -- Rafiki
Yeah, but it ain't easy. -- Simba
Yeah, canadian here, I can see a doctor just fine. I've had *multiple* serious health issues in my family and I can attest to the fact that i was always seen right when I needed to be.
Laws are rules for the court, but merely a bottom bar to hit for life. Think beyond laws in your actions always.
Yeah, canadian here, I can see a doctor just fine. I've had *multiple* serious health issues in my family and I can attest to the fact that i was always seen right when I needed to be.
Laws are rules for the court, but merely a bottom bar to hit for life. Think beyond laws in your actions always.
I have lived in both the USA and the UK and I can report from personal experience that you are wrong.
When my sister was diagnosed with cancer, she got quick, effective treatment under the NHS. No waiting.
That's because the MRIs are largely used for pointless diagnostics that only drive up the cost of medical insurance.
Whenever my wife and I have moved or travelled from the USA to the UK with a medical issue, the UK doctors have remarked on how inappropriate or outdated the treatment we have received in the USA was.
I'll allow that non-urgent care may require more waiting in the UK than the USA, but when you actually get the care, it's likely it will be better than you get in a typical medical facility in the USA.
There is only one way that medical treatment in the USA excels: the cost.
The real "Libtards" are the Libertarians!
Insurance is for unusual events you can't budget to pay cash for. Home insurance covers if your house gets destroyed by a tornado, not replacing the $5 flapper valve in the toilet. Car insurance is for when your car gets totalled, not for oil changes.
Can you imagine if you had to deal with insurance companies and their forms every time you replaced a toilet flapper or painted a wall? It would easily triple the cost. (Insurance company employees have to get paid to deal with this stuff.)
Taking a kid to the doctor every now and and again for something like an ear infection is normal, expected, and affordable. A bilteral cleft palate is neither normal nor affordable. We used to have "major medical insurance" for unexpected medical costs you couldn't slap in your monthly budget. It was affordable. For an ear infection, you handed to the doctor a 20 dollar bill and that was it - no insurance company bureaucracy adding expense.
We've confused routine healthcare with catastrophic illness, and in the process we've greatly increased the cost of the routine stuff by adding ridiculous amounts of bureaucracy.
You post lies (Germany and Japan require citizens to buy insurance), then cite a blog?
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
In Canada it is now legal to pay for your own healthcare out of system.
Because it is a human right to pay, rather than just die.
You need to argue with the Canadian courts, they say you are full of shit.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
So, admittedly, this won't address every issue, as noted by the OP. But there is one issue which I've personally encountered, which this could possibly help to mitigate -- depending upon the scope of impact, of course: that of insurance companies recommending charges for services/products which are above what the hospital or pharmacy might have otherwise charged.
I was once having a friendly conversation with my pharmacist about my family -- and he was a bit floored when I told him how many mouths I have to feed. Moments later, he hesitantly informed me (in one of those "I'm not supposed to say this, but..." type of comments) that my insurance was recommending that he up-charge me for one of the prescriptions that I needed to pick up; apparently my co-pay for that medication was actually higher than his usual prices. He told me very frankly that he just didn't feel right charging me that much, and that I could save money by not using my insurance for that particular prescription. I never would have even suspected that such a practice might exist, if not for his commentary, so I gratefully accepted his advice.
The medical industry is pretty badly messed up in a lot of ways, and for a lot of reasons. This legislation will hopefully lead to there being at least one or two fewer ways for unscrupulous people to screw me over. I'm going to call that a win.
Off topic. The Toyota is a much better car.
Better at what? Pulling mercenary birds? Buy the Bentley. Getting from point A to B. Buy the Toyota.
Argument by analogy doesn't really work. What is analogous medicine to English cars? Expensive, unreliable but looks good sitting there leaking oil? Where's Locas Electrics?
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
My boss went in for his annual check up, and when the doctor asked if there was anything bothering him or he felt the doc should know about, my boss just said "I've been feeling tired".
That answer adjusted his 15 minute visit from a routine health check-up that's more or less covered under his insurance to a consultation that cost him $160 out of pocket
I had a similar experience. Annual check-up was supposed to be covered in full by my insurance plan, and when I went in, there was even a sheet I had to sign stating that any other concerns raised would be billed. I made doubly sure I did not ask a single question, and did not bring up any health issues (not that I had any).
Yet, I ended up with bills on top for several hundred dollars that were not covered by what the insurance company paid for the annual.
The doctor noticed a mild anaemia and ordered extra tests to be done on the blood I had already given (without consulting me), and I of course was billed for that. And billed for an "office visit" so she could tell me that I had a mild anaemia (something I already knew, and which is perfectly normal for someone who runs a 10k every day).
Then they tried to bill me for a follow-up that I said I didn't want.
The biggest problem is that I have no way to not pay for this. They get to decide what to bill for, whether true or not. I can contest until I'm blue in the face, but that does not stop them from sending the bills to collection. And the insurance company doesn't give a fuck either - they follow scripts and won't ever go "wait a minute... you didn't order this?" If the doctor's office submitted the paperwork correctly, that's all they care about. They have no script for "the doctor is billing for something the patient never agreed to".
The end result: I no longer will have an annual physical.
The only thing I will use non-ER doctors for now is writing prescriptions for things like antibiotics. Otherwise, they're worse than useless.
Regardless of whether it's intentional or incidental, that's what all health care, functionally-speaking, engages in, and it's bullshit.
Worse: you can't even call a health insurance company and ask them "Is such-and-such covered by my plan?". I tried this once (I take allergy shots); I was told (I kid you not) "You're not authorized to know that". Really? I'm paying you bastards and you won't even tell me if something specific is covered? Seriously?
If you take your car to a shop to get some major work done on it, by law they have to provide you with a written estimate, which gives you the opportunity to approve it before the work is done; any additional charges of substance that might come up have to be further approved by the customer. Now, I'm not saying that when you're unconscious and hauled into the Emergency Room in an ambulance and are dying that you have much choice, or that when you're under anasthesia on an operating table and literally are splayed open that they're going to bring you around to explain how fucked-up you are and how much more it's going to cost you so you can sign off on it, but those are extreme examples. I'm talking about the day-to-day, more garden-variety stuff, even if it's still about you continuing to live. I also acknowledge that the typical doctors' office is a very busy place, but I still say we need a system by which they can give you something concrete you can approve of or not, be able to discuss, and make modifications to. As an example there's a doctors' office I go to where annually they need to do some testing on me to monitor a chronic condition; some of the testing is really more for 'supplemental data' for them and not necessary unless there's something more extreme going on with me than what's typical. Knowing this I can tell them I don't want those things done because I know I'll end up paying for them out of pocket. They don't argue with me. The point here is that there are many things that a doctors' office will want to do during a visit that aren't necessary but that they want the data from anyway. You should have the opportunity to know what those cost and be able to say 'yes' or 'no' to them. Similar with hospital stays; you should know what everything costs and be able to say 'no' to non-essentials, especially if they're expensive, and especially if you're going to have to pay for them out-of-pocket because your shitty insurance company decides they're not going to pay for them -- and for that matter, you should be able to know specifically what your insurance company is and is not going to pay for, before it's a done deal and you have no choice. No more of this 'bait and switch' from insurance companies.
I'm not sure what this has to do with my comment. I'd be crazy to do anything outside of the Canadian health care system.
Laws are rules for the court, but merely a bottom bar to hit for life. Think beyond laws in your actions always.
The fact that average age is declining in the US is a telling tale how people are litteraly dying because they can't pay for their health.
If the average age of a population is changing, it is because over time the birth and death rates are not consistent. Do you have data that shows an average US age decline is due to lack of health care *affordability*? (as opposed to other factors that could change the average US age such as change in birth rates, change of ethnic mix, new diseases, etc.)
People walk around with papers that say they do not want to be saved in case of an emergency, so they are not a financial burden on their family.
Many people have DNR papers (Do Not Resuscitate) not due to financial reasons but because they don't want to live their life hooked up to machines or in a diminished functionality after a serious medical event.
The Surgery Center of Oklahoma has posted their final prices online for years. They don't take insurance, but you can still file a claim with your insurance afterwards. In some cases, the net cost is zero since their prices beat traditional hospitals and insurance companies are used to paying more. This is the model I'd prefer: knowing the final and complete cost BEFORE.
I too have lived in Europe with universal healthcare.
And my experience is that the European system was way better. No arguing with insurance companies over treatments, and having to accept substandard treatments because they're cheaper.
No avoiding going to the doctor because the co-pays alone can be a fortune.
No three-month wait for an appointment to see a cardiologist.
But most of all, the quality of treatment is superior outside the US, because the US system is tailored to increase profits while reducing the liability for doctors and hospitals, meaning it's test-heavy and risk-averse.
As an example, I have bilateral total hip replacments, done in Europe. The doctors consulted with me before the procedure and gave me alternatives. I opted for uncemented threaded implants, which allows me to run as much as I want, do yoga, and pretty much function better than with the original hips. They will never have to be replaced, although the ball caps can be replaced with minor surgery. The risk is slightly higher during the initial surgery, but the quality of life afterwards is immensely better. This is not even an option for insurance-paid surgery here in the US. The slightly higher risk and higher cost of a longer surgery prohibits it. US hip replacement patients are always given cemented screwed hips, and told that they must not run or do anything hard, for the rest of their life. And that the hips will last for around 20 years.
Another example is laser vision correction surgery, which was available in the Soviet Union and then in Europe long before it became available in the US. Yet the average American thinks it's an American invention not available elsewhere...
And non-NSAID, non-opioid pain medications? There are several whole groups of medicines that have been successfully used in Europe for decades now that aren't available in the US, mostly due to lobbying from the existing drug producers.
And people here in the US accept that crap? And think they have the best healthcare in the world?
It sucks. It really does. For anything serious, I book a plane and go back to the country for which I still hold a passport. Because the service is so incredibly much better, focused on quality of life for the patients, and not maximizing profits and minimizing liability for hospitals and their marionettes.
It's truly a world of difference, and not in favour of my new country.
If that were true, the case wouldn't have been decided as it was.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
One of the dirty little secrets is that America had at least 3 separate occasions when we got ready to implement a single payer healthcare system. All three times it was shot down because northern states insisted all citizens be covered while southern states, still in the age of "Separate by Equal" didn't want blacks covered (we're talking pre WWII here folks).
Once again the "Southern Strategy" of using race to divide the working class cost us Americans something valuable. I wish we could kill it once and for all.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
discrimination? That's what the current system is, after all. You're getting "Group Rates" negotiated by a company (your insurance company) on your behalf.
The real problem here is that you're trying to fit the square peg of healthcare into the round hole that is capitalism. Capitalism works great for things that you buy periodically, can obtain and understand all or nearly all relevant information on, lend themselves to competition and are relatively low risk for the individual. Think twinkies, soda pop, video games and even cars.
Capitalism breaks down when paying for healthcare because you can't do any of that. You can't comparison shop for a heart transplant, you'll pay anything for it since without it you die and you can't understand what makes one hospital better than another for a transplant (and no, looking at a few statistics isn't enough, how much do you know about the doctor doing the transplant? The heart being transplanted? The staff who will care for you before and after?).
Oh, and this is before we discuss how your insurance company has every incentive to try and avoid paying for your care. RE: Pre-existing conditions.
This is why folks in the know (like the doctors and nurses themselves) want single payer. But you're taught from childhood that the only answer to any problem is capitalism. When I took econ 101 in high school socialism wasn't even discussed. Capitalism was at fait accompli. A given. No other competing solutions or systems were brought into play. They didn't even try and bad mouth it, it was just capitalism rah-rah-rah for 6 months. It's tough to get out of that mindset. And I assure you, that's by design. Go look up why pubic schools were formed sometime. They're not there to teach you to be a good citizen, they're there to teach you to be a good worker. I'm not saying that's the only thing they do (don't get me wrong, I support public schools), but we need to think about where we came from and where we're going.
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...And it shows. My wife and I have similar difficulties with our providers. The doctor (a well respected professor of Internal Medicine at our university) will prescribe reasonable tests to verify our health at our annual physical exam (we're both > 60 years old). We are fortunate and have no major issues, so we wait to comment about being a bit fatigued or whatever at the next exam (we assume it's a minor vitamin deficiency, but we make sure she knows just in case there's something real there...) The insurance company does not cover those tests for the annual exam.
So the Corporate "Healthcare Provider" charges us 23+ times the insurance-paid rate for the tests. (For insurance: $44 total, for us: $1020.00).
Providers these days have a powerful financial incentive to charge for services specifically to NOT be covered by insurance.
Steven Brill's report in Time a few years ago mentioned a different but related scam: For a procedure, we sign a contract promising to pay for all services rendered. It's an open-ended "contract": We cannot know up front what those services will be. The provider brings in all sorts of additional "expert consultants" that we the patient/customer have no idea are involved until it's too late and we're on the hook for big bucks worth of all those facility and consulting charges.
Back when we had medical insurance, you'd pay the doctor $20 to cover the cost of keeping the lights on for the 20 you were there, and that was it.
Now, you first pay the health plan $1,000 / month, then you pay the doctor $20 copay, which they use to pay the full-time employee they need to handle insurance paperwork.
So basically, you would claim that people not going to the doctor for an ear ache before was because they couldn't afford $20 for the doctor, but now that it's $1,000/month plus $20 for the visit they can more easily afford it?
Not saying I agree or disagree with that arithmetic just want to make sure I fully understand what you are saying.
Two weeks and multiple phone calls by myself and my doctor. To get what is literally the textbook prescription for my ailment.
Now this isn't some major thing. But from a healthcare perspective, it is broken. Why should the standard treatment be denied?
From a capitalistic perspective, it makes perfect sense to deny a few people - for a big company, just the delay in payment may be worth it. More importantly, maybe some people will pay for it out of pocket or will drop off the insurance for other reasons.
The insurance company's job is to be profitable, and that is a goal that doesn't always align with getting the best treatment. The insurance company seeks to deny coverage, and if they do have to cover treatment, it's best to pay as little as possible. They'd prefer I'd never use medical services at all, and if I did, I should use as little as possible, be it that I recover quickly or die quickly. (Recover quickly is the best for them, since I'll keep paying my premiums, but dying quickly is cheaper than a slow, medically intensive death.)
Btw, you'll find that gross ineffeciencies tend to end up badly. That's the case pretty reliably.
It's a frequent pattern that someone will propose something to make things more fair* (fair meaning having the same results from vastly different actions), and someone else will point out that the proposal is grossly inefficient - it wastes a lot. The person making the original proposal may concede that it's inefficient, or it may just be plainly obvious that it's wasteful, but proponents will say that the increase in fairness* is worth the waste.
In such cases, if you actually work through all the costs you'll almost always find that gross inefficiency, being wasteful, has a stronger effect that the balancing "fairness" aspect, such that the people whom the proposal was supposed to help are actually harmed.
--
* Distinguishing two different views of fairness.
Consider yesterday my daughter ate some Christmas stocking candy which she had saved. She chose not to eat it all on Christmas because she wanted to have some for later. Her cousin are all of hers immediately. Some people would forcibly take her candy my daughter and give it to her cousin, because it's "not fair" that my daughter still has hers, while the cousin no longer has any. Others would say taking it is very unfair. My daughter should be able to enjoy the benefits of her earlier sacrifice, they say.
Having the chargemaster is still nearly worthless because you can't predict which of the redundant codes your hospital will use to calculate the bill or even which procedures they will charge you for. One hospital will bill your for every glove they use and another will bill you some flat rate for supplies. Even if you hold insurance negotiations constant you can't do an apples to apples comparison between two hospital billings just based on how their chargemasters compare. It's such a fucked industry for the consumer.
when your car gets totaled they pay you in dealer invoice. If you can afford it you buy gap coverage and other misc insurance but you're always wondering what's gonna happen if something does happen because they'll fight you. And that's over a $25,000 car. Take that and do it for a $1,000,000+ dollar illness.
You're right about getting rid of insurance but you haven't gone far enough. We know the solution: single payer. In the States this means expanding Medicare for All.
Healthcare is too important and too complex to leave paying for it to corporations. The care itself can be handled privately (as has been demonstrated in numerous other countries) but the paying for part needs to be done by the Fed.
It wouldn't even be a change. The money that leaves your check now would just go somewhere else. And most estimates are it would save us $5 Trillion every 10 years. Wanna pay off the national debt? Because that's how tyou do it.
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intervening. The government runs Medicare with 99% efficiency. And I've never met anyone who'd trade VA healthcare for the mess that is private care.
The problem is that healthcare and insurance are fundamentally incompatible. Insurance works for clean up after random disasters. But healthcare stopped being about that decades ago. Today we can and do perform maintenance and actual repair work. A family member of mine had childhood cancer. 20 years ago they'd be dead. Today they're in their 2nd year of college.
There's also the complexity of healthcare and the fact that when you need it you _need_ it. Also it's not something you can just swap other goods out for. If I'm hungry and steak's too expensive I can settle for pizza. I can't do the same with insulin.
This is a classic square peg in a round hole. Insurance needs to go away. The individual hospitals and doctors can be private, that's been shown to work just fine. But when it comes to paying for it that needs to be done by the Fed. Take the money I give mega corp insurance companies ($1200/mo if you include what my company pays) and give it to the Fed and let them run it through that 99% efficient Medicare program. Problem solved.
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I think the real problem is that healthcare is too complex for laymen to price out. You say "colonoscopy" but there's a lot that goes into that. And there might be follow up tests after it, like having the results referred to a specialist. And then let's say I get my colonoscopy at hospital A and then want the follow up at B. I've just added a bunch of complexity to move the documents around and deal with potentially different processes and formats. More stuff a layman doesn't know/think about.
When I buy a car it's a finished thing. I know exactly what I'm getting. In terms of complexity there's no comparison between the human machine and a car. There's just too many variables for you to go shopping around.
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My dad had to go to the ER recently to get an ultrasound because for some stupid reason the local medical imaging center takes three days to read the ultrasound. In the four hours we were there, we interacted with twelve different paid employees. TWELVE!
Beyond that, my brother-in-law is the chief endocrinologist at the hospital where he lives and I asked him how many people the hospital system employs. He said, "About 5000." So I then asked him how many of those are actual doctors or nurses. He said, "Fewer than 1000." He went on to say, "I'm head of the department and I have no idea what these people do all day long." The fact is that they all get paid and a lot of them get paid way more than he does.
Forget the cost of prescription drugs. THIS is where the high cost of healthcare lies.
An interesting way to look at health insurance across countries is to do so via a medium of travel insurance. I was shocked when I found that one month of travel insurance in the U.S.A. was going to cost me almost two times what a month would cost in France.
So, from a New Zealand perspective (Using Southern Cross Travel Insurance, Age - 44, single trip, one month, $NZ) the costs are.....
USA - $230.75
France - $142.42
Australia - $72.17
Also interesting is that if you look at Australia vs the U.S.A. in an international comparison on Wikipedia then Australia beats the U.S.A. in almost every metric (7/9) for half the price per person. There is something seriously wrong with the American health system and it is bad enough that if you adopted the Australian model you might save roughly one and a half trillion dollars each year.
I reserve the write to mangle english.
Firstly most people which go for a private practice Doctor, a generalist which has his cabinet not in a hospital, don't have to wait that long be it in Danemark, Sweden or Germany or France, this is a daily stuff with hours long wait time. Now doctor in a hospital or specialist , like getting a MRI, this is a different story But even there , they have a sort of triage, if you get something they estimate as emergency , you get a much quicker. E.g. when I complained I had head aches for weeks and was taking aspirin daily, they scheduled me for MRI and a echography (for the artery of my neck) the next day in spite of the normal weeks time you normally have. I am not doubting what you got TOLD by your friend, but I am doubting that this is the story as a whole or that it was what really happened as you tell us (story told through 3rd party after all changes - regardless if any party want to really give it back 100% as it happened). Furthermore I have no doubt that over the million of medical stuff a country does in a year, there are some failure. The question is not : are there anecdotal story of failure, there will be in ALL countries even with the best HC, the question is how often and likely are such story to happen. I get the feeling you will agree with me that your anecdot would be quite rare for Danemark, but quite not for the US HC system.
C. Sagan : A demon haunted world:
http://www.amazon.com/gp/product/0345409469/
visit randi.org
Healthcare is not a universal certainty. When my kid was brought into this world it popped out, cried a bit and we had it home no fuss...
Well, of course. Instead of saying "healthcare is a certainty," it would have been more accurate to say "routine low-cost procedures, such as having an annual physical, are a certainty." Don't throw out the entirety of a good post, just because one part had a less-than-ideal choice of words.
I live in a first world country which has socialised healthcare so the concept of using insurance to fix this problem just seems so dumb.
If socializing is a great solution, why not apply it to other things covered by insurance, such as auto collisions and structure fires? Answer: because insurance companies compete with each other on the basis of better coverage and/or lower premiums. (Surely you have noticed that gasoline prices are significantly lower in locations where there is more than one gas station competing for your business.) If I don't like the fact that Insurer A is slow to add newer, more effective cancer drugs to its formulary, I can switch to Insurer B.
But where insurers are replaced with a single government entity run by government bureaucrats, there is no longer any competition, no way to seek a better alternative if you're dissatisfied, and no economic mechanism to pressure the entity to apply innovations.
Canadians cross the border in large numbers to pay out-of-pocket for medical treatments that they either can't get in a timely manner, or can't get at all:
In the United States, suffering for a year or more before receiving a joint replacement is unheard of. In Canada, it's normal.
Back when MRI was a relatively new technology, there were more MRI machines in the city of Philadelphia (population 1.5 million) than in the entire nation of Canada (population 37 million). Not because Philadelphia is a particularly wealthy city (it is not); and not because of government largess, but in spite of it. Free markets really are more innovative and more responsive to customer needs.
If the U.S. system becomes as dismally socialized as Canada's, it won't be long until both Americans and Canadians start booking trips like these in large numbers. And if those countries become dismally socialized, we're all just screwed. Progress in medical technology will slow to a crawl, because all the customers for new technologies will be gone.
That that is is that that that that is not is not.
You're absolutely correct that routine, low-cost medical procedures -- analogous to refueling a car -- shouldn't be covered by insurance.
But don't stop halfway with the analogies.
Imagine someone walking up to an insurance agent and saying "I wrapped my Mercedes around a telephone pole last night. I wasn't covered at the time, but now I want you to sell me a policy that will replace it. Oh, and you must charge me the same low premium paid by people who had the foresight to buy insurance before they needed it."
Would any sane insurance company sell such a policy? No.
Or the customer who says, "My house burned to the ground this morning. I wasn't covered at the time, but now I want you to sell me a policy that will replace it."
Would it be fair to spread this guy's loss to the homeowners who faithfully paid their premiums for years without filing a claim? Of course not. Covering such pre-existing conditions is not insurance, it's charity.*
But somehow, reason and fairness go out the window if the thing that's insured is health, not cars or buildings.
* There's nothing wrong with charity, as long as we document it honestly and transparently, and not try to disguise and obfuscate it as something else. Like insurance.
That that is is that that that that is not is not.
Let me translate:
"derpa, derpa, derpa, derpa... When I was young... derpa, derpa, derpa..."
Does that clear it up?
Cheap storage VM.
discrimination? That's what the current system is, after all.
No... the insurance company is NOT a big customer.
The insurance company is not the customer at all.
The insurance company is a cartel that represents customers of the insurance company.
The cartels are currently allowed to negotiate discounts which are available ONLY to people who
pay that insurance company for full insurance coverage.
Discount Membership Programs AND Insurance (protection against loss) are two different kind of products that all the insurers are co-mingle:
you can't as an individual get the discount rates to members of their network, unless you also have insurance from the insurance company.
If access to a Discount Membership Program is available separately to all individuals at a nominal fixed monthly or annual price as a separate product without buying insurance, then that could be fine ---- what should be prohibited is restricting access to the health provider discounts to Only people who also purchase an insurance policy from that insurer.
a significant percentage of people are not going to save for a $1.5 million cancer procedure. an $80,000 stent to stop a heart attack and follow=up care. like, say, everybody.
what we need is a single-payer health system, which has been proven in every other industrialized country to save money and deliver more services to all who need them.
if this is supposed to be a new economy, how come they still want my old fashioned money?
I keep hearing from you and other that there are such people with bad experience in germany and other europe country. I simply can only state that from all the peopke i know of some with public some with private insurance none woukd change the system in any shape which would make it more private. Sometimes i would like to meet one of those. Because their experience must gave been a thorough failure and a rare one. There is a reason most people want to keep the public HC system in EU. So the experience you describe seem very very rare and the opinion accompanyng the same.
C. Sagan : A demon haunted world:
http://www.amazon.com/gp/product/0345409469/
visit randi.org
The price of health care in markets where insurance is involved will always be higher than those without, because the money to pay for for a profit insurance industry has to come from somewhere. Go look up the annual revenue generated by insurance, that is coming out of your pocket as someone who consumes healthcare.
Republicans politicians don't hate national healthcare because it is socialism, big government, or even because it is named after our first black president. They are against it because if everything is paid for by taxpayers, the billion dollar insurance industry will not survive. They get a lot money from the health insurance lobby. Call them corrupt, evil, whatever you like, but they aren't dumb.
HA! I just wasted some of your bandwidth with a frivolous sig!
Ah, yes... free markets are wasteful. That's why a crazy number of ghost cities get built in countries with free markets, while that never happens under the thoughtful guidance of China's Central Planning Commissions.
That that is is that that that that is not is not.
America the king of Insurance companies can't even get insurance companies right without over complicating the system.
If you're against overcomplicating the system, you must by definition be against the Obamacare law which included 1800 pages of new regulations (which is why Nancy Pelosi said we would have to pass the law to find out what is in it).
Obama's campaign promise was that his plan would make healthcare costs decrease by $2500 per year for the average family. At the time, I warned people that history has never provided an example where imposing more regulations on an industry -- let alone 1800 pages of additional regulations -- caused costs to go down.
Of course I was right. In 2013, California jurisdictions experienced unprecedented premium increases of between 64-146% -- and that was merely in anticipation of Obamacare's main provisions going into effect on January 1, 2014. Since then, there have been annual double-digit increases that compounded the 2013 increases.
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First, your $3 trillion figure is wrong.
Second, according to Politifact, the Mercatus report contained a less-likely scenario -- in which "Medicare for all" reduced expenses by $2 trillion -- and a more-likely scenario in which it increased expenses by $3.25 trillion. Politifact criticized Bernie Sanders for cherry-picking the less-likely scenario.
By falling for Sanders' cherry-picking, you have shot your own credibility.
Also, the cherry-picked scenario assumes that health providers would be paid at Medicare's payment rates (~40% percent lower than those paid by private insurance). Of course lower national health spending would follow from such an assumption. But could that actually happen without other negative consequences, such as mass retirements of doctors unwilling to accept lower fees? Public health experts say no.
And finally, neither scenario took into account the effect of transitioning from a competitive environment to a government monopoly. Currently, insurance companies are forced to compete for your business on the basis of lower premiums and/or better coverage. (Surely you have noticed that in locations where more than one gas station is competing for your business, the price of gas is significantly lower than in locations that have only one gas station.)
The benefits of competition are certain, but difficult to quantify, and the folks behind the Mercatus report didn't even attempt to quantify them.
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The only reason to hold the current state of the NHS up as an example of anything is as an example of deliberate mismanagement by the government.
Take for example waiting times - waiting times are an issue, so what does the government do about it? Decree that GP surgeries have to open in the evening and weekends to allow patients better access to their GPs. Does it matter that GP surgeries struggle to provide their current level of care? Not one bit.
You've just made an excellent case for getting government out of healthcare. Free markets, by definition, are immune from arbitrary government decrees, and from any type of government mismanagement (deliberate or otherwise).
Furthermore, free markets tend to be self-correcting. If there's a surplus of healthcare (or any other service), prices decrease and people leave the field; conversely, if there's a shortage of healthcare, prices go up and create a powerful incentive for more people to enter the field.
This is all self-evidently true, despite it being fashionable to bash Adam Smith these days.
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In Sweden, a visit to a doctor, district nurse, psychologist or physiotherapist always cost $10-$20 (free for children below 18 years old and the elderly).
You are confusing "cost" with the much more specific phrase, "cost to the patient."
I guarantee that in first-world countries where the cost to the patient is $20, taxpayer subsidies cover the rest of the overall cost, which is much much higher. And "free" is misdirection for "wholly paid for by someone else."
There's a reason insightful people use the acronym TANSTAAFL (from Robert Heinlein's astute phrase, "There ain't no such thing as a free lunch").
Yes, having an accurate understanding of the amount of resources actually required to effect a desired outcome -- as opposed to a fantasy attitude of "it's free!" -- matters a great deal.
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by the time the notion of Single-Payer got some momentum, Medical Insurance as a benefit of your job was so embedded in the economy that getting rid of it was next to impossible.
Single payer, and your insurance being tied to your employer, are both terrible ideas.
You seem to think that we must have one or the other. Not so; with a little education about why they are both terrible ideas, we could be rid of both of them.
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laser vision correction surgery, which was available in the Soviet Union and then in Europe long before it became available in the US. Yet the average American thinks it's an American invention
Um... that's because it is an American invention. You can't get away with this kind of propaganda in the age of easy-to-use search engines, arth1.
I really searched hard for a non-American who had a significant role in developing this technology, but came up with nothing.
The keratotomy procedure developed in the Soviet Union used knives, not lasers.
- Dr. Theodore Maiman (U.S. citizen) invented the first laser in California.
- Dr. Samuel Blum (U.S. citizen) invented the ultraviolet excimer laser, necessary for LASIK, in New York.
- Drs. Rangaswamy Srinivasan and Stephen Trokel (U.S. citizens) developed the photorefractive (laser) keratectomy procedure in New York.
- Dr. Gholam A. Peyman (U.S. citizen) invented LASIK and Mesik. (And fortunately, he tested and refined the procedure extensively on animals -- rabbit and monkey eyes -- before it was used on humans.) He did the relevant work in Illinois and Arizona.
While it's true that routine LASIK treatments were first administered outside the U.S. due to overly-conservative FDA regulations, that is an argument for reducing government involvement in healthcare.
This brings us to another fact that should be pointed out: ever since European countries went to single-payer systems, the vast majority of new treatments and new drugs have been invented in the U.S. This is not because Americans are smarter; it's just that medical R&D is inherently an expensive activity, so only a system that allows for healthy profits has the means to do lots of medical R&D.
If the rest of the world shakes their heads disdainfully because a larger percentage of U.S. GDP goes into healthcare, I can live with that, knowing that our system is a powerhouse of innovation, thanklessly churning out new technologies that benefit the rest of the world.
The real solution would be to make healthcare a profitable endeavor in the rest of the world, so the U.S. doesn't carry the vast majority of the R&D burden, and so smart scientists -- most of whom do not reside in the U.S. -- can get some meaningful private-sector funding.
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Nice anecdote, but the plural of anecdote is not data. Here's some data from Canada's Fraser Institute.
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unequally accessible
Wrong; everyone has equal access. Since 1986, federal law explicitly forbids the denial of care to indigent or uninsured patients based on a lack of ability to pay.
Now, to many politicians, "accessible healthcare" is an inaccurate euphemism for "healthcare coercively paid for by someone else." That's probably what you mean.
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Capitalism breaks down when paying for healthcare because you can't do any of that.
Wrong; there are insurance companies competing for my business on the basis of better coverage and/or lower premiums (i.e., how efficient their internal operations are, and how effectively they negotiate lower prices with healthcare providers). I periodically reevaluate whether I want to stay with my current insurance company, or switch to a different one. I do so well before I actually need treatment for some condition.
(Surely you've noticed how competition benefits consumers. E.g., in locations where more than one gas station is competing for your business, the price of gas is significantly lower than in locations that have only one gas station.)
Now, if we go from this competitive environment to a single-payer monopoly run by government bureaucrats, free markets will truly break down.
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The country is run by a bunch of old rich people who see their own health as being fine and therefore don't understand the problem.
Everyone, with the exception of the rare misanthrope, wants to make the social safety net more robust and reduce the number of people who are exposed to potentially bankrupting medical bills. But there is a whole spectrum of ways to attempt to do that, and some of those ways do more harm than good. Government is not the only way to make the social safety net more robust. Arguably, it is not a way at all, because absolute poverty would have been eliminated decades ago if unnecessarily burdensome governments hadn't made economic growth much less exponential than it otherwise would have been.
In 1900, approximately 0% of Americans had health insurance. By the time Obama was elected, the figure had grown to about 83%. Going from 0% to 83% is a huge improvement in the robustness of the social safety net, and it did not happen because of any freedom-sapping mandates. It happened organically: economic growth gave most people the means to buy health insurance (or, it made their labor valuable enough that their employer willingly provided health insurance to the employee's entire family).
That progressive upward trend, borne by economic growth alone, would have continued if it hadn't been tampered with. For those who are unable to obtain insurance, there is private charity (which already funds a surprisingly large fraction of the U.S. social safety net, and always grows faster than GDP, for reasons I won't get into now), and Medicaid. That is why there are exactly zero headlines in the U.S. that read, "Joe Smith died of cancer because he couldn't afford chemo."
Any honest person who doesn't have a totalitarianism fetish, and gives thought to the matter, would agree that if you can make the social safety net more robust, and at the same time increase the fraction that is funded by voluntary charitable contributions, and decrease the fraction that is funded by the coercive takings of the Internal Revenue Service, that's a good thing.
But the unthinking nanny-state types (funded by old rich people like George Soros, and led by an objectively uber-arrogant technocrat) didn't see the steady progress (going from 0 to 83% insured); they only saw 17% uninsured, and wrung their hands in anguish until they came up with what they thought would be a quick fix: Obamacare. It's neither sustainable nor organic -- which is ironic because the left repeats those two buzzwords ad nauseam when it comes to environmental practices.
Also -- unless the "clever" Judge O'Conner gets overruled by a higher court -- it is unconstitutional.
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healthcare is a Provincial thing.
That would explain why wait times are unthinkably long in New Brunswick, but merely atrocious in Ontario -- as documented by Canada's Fraser Institute.
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