Comments by "Xyz Same" (@xyzsame4081) on "Jake Tapper’s Lazy "Fact Check” Of Medicare-For-All" video.
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6) World Bank data 2014 - per capita healthcare expenditures
U.S. USD 9,200 then (now 10k), Germany 5,600, most wealthy European countries between 5,000 and 5,500, Canada is in that range too, Australia has 6,000.
There are outliers like the U.K. (only 3,900 but they are definitely underfunded - but with only HALF the U.S. expenditures their non-profit NHS which delivers most of the services would run like a charm).
On the other hand Norway had 8,400. (High wages, likely very high standard incl. dental).
Or Switzerland 9,600 they were even higher than the U.S. - but then they pay staff very well, and everybody is insured.
Switzerland is one of the very few developed countries that do not have a non-profit public insurance agency but let the for profit private players have that niche . Well, it shows.
I do not know of any larger country (except the U.S.) which lets for profit actors handle (most) of the healthcare insurance market. Switzerland has less than 10 million people, I think Singapore might lean strongly towards a private system.
Let me add that most developed countries beat the U.S. when it comes to life expectancy and infant mortality.
Most (or all) wealthy European countries have a population that is on average older than the people in the U.S. (so that should result in LOWER expenditures for the U.S.)
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1) Single payer non-profit system COST much LESS than the U.S. system. They are very streamlined, little administrative overhead (it is a lot of work to DENY care and chase down the patients for medical bills), medical necessity not the quality of the policy decides the treatment, no profits paid out to shareholders, the non profit insurance agency negotiates well with Big Pharma, doctors are well paid but do not earn as much as in the U.S.
The next question is WHO pays for it: a First world medical system STILL is expensive (even if it delivers in a cost efficient manner).
There needs to be additionally public funding if the individual contributions (all paid in advance not bad surprises) should be affordable (so that everyone is covered.
The insured contributes as much as they can without burdening them unduly, and that system can include people with low or no income.
The Koch financed study assumes 10k per year and person (for 326 million people). that is very high, the per capita expenditures in Europe, Canada, Australia are in the range of 5,000 to 6,000 USD per year per person (seems like a wealthy country can have a modern system for that kind of money - for everyone).
So there is plenty of room for the U.S. to include people who could not afford to have insurance coverage until now AND still save some money.
Of course the U.S. must figure out as well WHERE the budgets will come from. (And it might be that affluent people will be asked to pay more AND it is a "socialist" approach so many oppose it for ideological reasons even if it would be better for almost everyone.
If that works well, it very obviously disproves that private for profit is always, always better. We already know that - not for natural monoplies and not when the "free market" does not work because the patients are by far the weakest player in the system. The other countries have proven that for decades - but it seems the U.S. citizens and even more the "special interests" including the colluding media * are unwilling to look beyond the U.S. borders.
* The Big Donors, for instance Big Pharma or the healtcare industry and the insurance agencies that bribe both parties also provide the advertisements for mainstream media.
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8) The non-profit agency has a budget and has to stay within - that said, if they can prove the benefit of an effective new treatment method for society in general (often medication, new surgery methods are often immediate cost savers) - which would however overwhelm their budgets - there would be a political and lively discussion about how to increase and shift around their funding.
These costs may well pay off for society ! even if one cannot put a price tag on the indirect benefits (elderly people can live longer unassisted, people can take care of their family, avoid the trauma of losing a family member to cancer, restore (quicker) the ability to work, how will that person fare in 20 or 30 years in their old age, ….)
None of these considerable benefits _manifest for the insurance agency._, Since they serve the public and not the shareholders (with the incentive to maximize profits and to think only short term) - they can include these considerations.
The agency must have a reasonable budget - healthcare costs are always on the rise and the population is getting older - so that alone forces them to be economic and to weed out inefficiencies.
Most doctors and hospitals have a contract with the non-profit agency - they bill according to the negotiated contract / price list.
(Private doctors w/o a contract do exist - maybe 20 - 30 % of the practices. Private hospitals w/o a contract are rare, they would have a hard time finding patients).
There are quotas - in an area with a certain population there will be only a limited number of doctors and specialists and hospitals that get a contract. (Consideration for touristic regions, saisonal demand in winter - skiing - and for very rural areas can be made to make sure they are served well).
The patients often have a choice where to go - but that the number of contract for doctors/hospitals in limited, ensures that they have enough patients and revenue while working for very competitive rates.
The Pharma industry has a negotiation partner that represents 300,000 or 85 million people (Iceland / Germany -). Now, Big Pharma cannot rip off little Iceland, the Vikings can have a friendly chat with the other Nordic countries (or the UK or Germany, or Netherlands). Or they could pool their purchasing with another country or threaten to allow imports from other countries.
They will have a general idea what other countries pay for pharmaceuticals, machines, devices - these are the costs that a country / non profit system cannot control and where they could be taken advantage off.
They control the wages for staff, the costs for training doctors and nurses, or the costs of construction and ongoing operation of a hospital - all these expenditures also contribute to the local economy and the country can provide the resources and also effectively negotiate the prices for them. Even in a small country.
If they train doctors and nurses for free in the public education system (which is almost always the case) - they will not lose those potential employees in large numbers to other countries.
That is one of the reason why Vermont did not succeed to have their own Medicare for All system - while Iceland beats Germany when it comes to per capita expenditures.
They have about the same number of people - 300,000 - but Iceland CAN import drugs if the pharma industry would like to play games. And their doctors make a nice living but they will not leave for the next state because they can earn double. The income situation for doctors in the wealthy European nations is not that different and most do not care to move (even if though they can within the EU).
Vermont would have lost many doctors to other states. The medical profession in the U.S. has very effectively made sure they do not have competition in the job market. Doctors cannot migrate to the U.S. - their training will not be recognized and it is expensive and time consuming to do it again - so not many are coming.
And there are mechanisms to make sure not too many doctors are trained in the U.S. (like high costs for medical school). - That is why doctors earn almost double of their European counterparts (which have more competition so most of them are willing to accept the rates of the public contract - if they can get one). They are doing well btw, no need to pity them.
But of course unless the availability of enough staff is tackled the U.S. will have a problem.
The insurance agency is of course a powerful buyer on behalf of the patients.
But: if most doctors CAN refuse to work for a a lower income than other (not exceptional doctors) are getting then there will be a shortage and problem for hospitals and general practicioners that have most revenue from Medicare for All contracts:
Then the quality and/or waiting times will suffer and the doctors can promote a 2 tier system. Where people are effectively forced to accept the high rates of private doctors IF they want good treatment. with all the games of the private insurance companies
2 tier systems are invariably more expensive - and that is even in the European environment where the private patients profit from the fact that the competition from the non-profit sector somewhat prevented the worst excesses (like they are common in the U.S.)
The government could of course invest in a public training system (with some forgiveness of student debt if they work for a certain time in the U.S.) Or losen the rules regarding immigration.
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