patrick.net

bob2356 says

Read Affordable Excellence by William A. Haseltine of the Brookings Institute. It documents the system very well, but is a very dense 170 or so pages that I found to be a bit of a slog.

Interesting!!

xyliang says

It's a fascinating government design. Very corporate: efficient and profit focused.

Republicans will love it here.

Republicans would love a 37% tax rate for a medical system totally controlled by the government? Really? As in the koch brothers republicans? I don't think so.

xyliang says

Back on track:

For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...

Cost of GP visit - 40 dollars

Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust.

There are very successful public health care systems out there. There are also some continually underfunded disasters like NIH in Britain.

Of the 5 health systems I've had experience with I like NZ best. You get good care for the money with the least hassle. All are far from perfect. In NZ the top income tax rate is 33% and I paid about 24-26% nominal. That was total income tax for all government services. Health care, low cost college, roads, police, military, legal system, retirement, etc.,etc.. That's vs 23-24% nominal income tax I pay in the US plus 7.65% fica, plus 5-6% state (which through the miracle of AMT I can't write off) with no health care at all.

NZ cost of gp 25-30 USD.
Everything else cost is 0.
No there aren't endless waits or death panels. Drugs are evaluated for cost vs effectiveness then bought in bulk by the government at a low negotiated rate. Expensive procedures are done on a regional basis so there isn't tons of expensive equipment sitting around underutilized. You might have to travel for a complex procedure. When I had a heart mapping and ablation the health system paid for my airfare (sitting in the copilots seat of a cessna 172, I was in a very rural area), hotel, taxi's, and even airport parking.

What is missing is:
the cost insurance companies selling and billing for policies (since taxes are collected anyway there is no additional cost for collecting health care taxes)
the cost of and inherent conflict of interest in pay by procedure (gp's get capitation, specialists are employees of the health system)
the huge cost of doctors negotiating with, billing, and getting paid by the insurance companies (doctors offices don't have any billing staff at all, just a receptionist and nurse(s))
the cascading profit markup on every single procedure or item
profits to insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.,
lawsuits (there are no lawsuits in NZ, lawyers have to actually practice law)
the amount of money spent lobbying politicians by insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.
the list goes on and on.

All of this adds directly to the cost of health care. The vast majority of Americans have no idea were the money is going because they don't know the difference between the cost of health care and the cost of health care insurance. They only know the political talking points of whatever party they follow.

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage. Parliamentary systems are messy, but it's difficult to have a large political influence financially since you don't know what the majority coalition will be.

bob2356 says

Republicans would love a 37% tax rate for a medical system totally controlled by the government?

Did you actually read what xyliang wrote? The part that goes into the medical fund is only 7.7% (of the first 50K salary).

As Patrick has said, full price transparency by every provider would do miracles in bringing down the price of healthcare. Focusing on the payer side is stupid...that will naturally follow as provider prices plummet. I believe Rand Paul's plan comes closest to accomplishing this.

bob2356 says

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage.

So true.

Your entire post - one of the best/most informative I've read on PatNet.

FP says

bob2356 says

Republicans would love a 37% tax rate for a medical system totally controlled by the government?

Did you actually read what xyliang wrote? The part that goes into the medical fund is only 7.7% (of the first 50K salary).

True, I meant to type system not medical system. However It is all intertwined. I still don't think the republicans would go for 7.7% and total government control. He also didn't discuss what happens if someone doesn't have enough in the account to cover a major medical event. Read Affordable Excellence if you want to know how the whole system works in detail.

just any guy says

As Patrick has said, full price transparency by every provider would do miracles in bringing down the price of healthcare.

Feel free explain how this miracle will happen in detail since the vast majority of people have their medical bills paid by a third party. The information is out there on the internet already and I don't see any miraculous bringing down of the price of healthcare.

bob2356 says

The information is out there on the internet

Actually price agreements between insurers and providers are highly confidential.

You can sort-of find out some prices that insurers pay and some prices that the uninsured public pay, but it's a very long way from transparency.

The miracle will happen if people can shop around.

rando says

Actually price agreements between insurers and providers are highly confidential.

You can sort-of find out some prices that insurers pay and some prices that the uninsured public pay, but it's a very long way from transparency.

The miracle will happen,if people shop around

if people shop around

So what is going to inspire huge numbers of people to shop around when the insurance company is paying anyway? A question that never is addressed by the price transparency cult. Just the chanted mantra of price transparency, price transparency.

Most people choose a doctor by recommendation of someone they know or the closest doctor to them off the insurance company list of doctors. If people did somehow miraculously find the inspiration to shop around the odds are very high are the cheaper doctor won't be on the same insurance plan. What then?

I;m not against price transparency, but it's not going to save much if it happens. Unless human nature changes also.