Thread: Universal care cheaper and better than private insurance.

Originally Posted by JAD_333

The big question to me is, what would be the overall effect of lowering the percentage of GDP spent on medical care in the US from 15% to 6%? (10% GDP is what? $1.1 trillion; nice piece of change. Think of that as money people could spend on beer and fancy cars... )

John, I came across a few numbers concerning the percentage of GDP spent by other countries on health care.

According to WHO:

• Belgium: 9.4%
• Denmark: 9.2%
• Finland: 7.5%
• France: 11%
• Germany: 10.2%
• Iceland: 9.8%
• Italy: 9%
• Netherlands: 8.9%
• Norway: 9%
• Sweden: 9%
• Switzerland: 10.6%
• United Kingdom: 8.2%
• United States: 15.2%

So, of the selected countries, Finland is at rock-bottom with half the per capita spending. Others range from mostly around 60-75%.

WHO | WHOSIS | Search

But...

A comparison of the payment-based spending estimates in 1987 and 1996 (columns 7 and 8) reveals a remarkable stability in the concentration of expenditures over the past decade. In 1996 we find that the top 1 percent of the population accounted for 27 percent of aggregate expenditures, while our adjusted 1987 estimate is 28 percent. We also find that the top 5 percent of spenders accounted for more than half of health spending in both years, while the top 10 percent accounted for more than two-thirds.

The Concentration Of Health Care Expenditures, Revisited -- Berk and Monheit 20 (2): 9 -- Health Affairs

I don't know quite what to make of that information yet.

Originally Posted by Ironduke

John, I came across a few numbers concerning the percentage of GDP spent by other countries on health care.

According to WHO:

• Belgium: 9.4%
• Denmark: 9.2%
• Finland: 7.5%
• France: 11%
• Germany: 10.2%
• Iceland: 9.8%
• Italy: 9%
• Netherlands: 8.9%
• Norway: 9%
• Sweden: 9%
• United Kingdom: 8.2%
• United States: 15.2%

So, of the selected countries, Finland is at rock-bottom with half the per capita spending. Others range from mostly around 60-75%.

WHO | WHOSIS | Search

But...

The Concentration Of Health Care Expenditures, Revisited -- Berk and Monheit 20 (2): 9 -- Health Affairs

I don't know quite what to make of that information yet.

Universal Healthcare is by it's nature extremely progressive, so the tax system reflects that.

It's a trade off, that either you want or you don't - It gives the rich higher taxes (though naturally it's worth noting they can easily afford it) and it gives security and comfort to those on lower economic rungs.

In relation to you guys current system it also takes a large weight off the company's shoulders, and because of the simpler system and chain of command it's despite all stereotypes less buerocratic than a more private one.

Naturally you wouldn't have to go entirely public - you could for example use the Dutch HC model which is extremely successful and which Ireland wants to adopt where the state is a regulator, compulses everyone to have health insurance, pays the bills for those under 16 and allows private companies and hospitals to compete for the rest in a free market enviroment.

It's transparent as everyone can see the costs, and you can switch to different plans at any time - it's personally my favourite system, good article (including downsides) on it here: Healthcare Economist WSJ on the Dutch Health Care System

It's not NHS or nothing ya know!

Originally Posted by crooks

Universal Healthcare is by it's nature extremely progressive, so the tax system reflects that.

It's a trade off, that either you want or you don't - It gives the rich higher taxes (though naturally it's worth noting they can easily afford it) and it gives security and comfort to those on lower economic rungs.

In relation to you guys current system it also takes a large weight off the company's shoulders, and because of the simpler system and chain of command it's despite all stereotypes less buerocratic than a more private one.

Naturally you wouldn't have to go entirely public - you could for example use the Dutch HC model which is extremely successful and which Ireland wants to adopt where the state is a regulator, compulses everyone to have health insurance, pays the bills for those under 16 and allows private companies and hospitals to compete for the rest in a free market enviroment.

It's transparent as everyone can see the costs, and you can switch to different plans at any time - it's personally my favourite system, good article on it here: Healthcare Economist WSJ on the Dutch Health Care System

It's not NHS or nothing ya know!

That's something we might want to look at. We also might want to look at not allowing public advertising of prescription products (only to health professions) and requiring insurance companies to work with all care providers, not just ones they have deals with and let the doctor have the final word on care, not the insurance company.

Originally Posted by Ironduke

John, I came across a few numbers concerning the percentage of GDP spent by other countries on health care.

According to WHO:

• Belgium: 9.4%
• Denmark: 9.2%
• Finland: 7.5%
• France: 11%
• Germany: 10.2%
• Iceland: 9.8%
• Italy: 9%
• Netherlands: 8.9%
• Norway: 9%
• Sweden: 9%
• Switzerland: 10.6%
• United Kingdom: 8.2%
• United States: 15.2%

So, of the selected countries, Finland is at rock-bottom with half the per capita spending. Others range from mostly around 60-75%.

WHO | WHOSIS | Search

But...

The Concentration Of Health Care Expenditures, Revisited -- Berk and Monheit 20 (2): 9 -- Health Affairs

I don't know quite what to make of that information yet.

Thanks, Matt.

In reading the survey results, this paragraph stood out. (I added color)

Use of resources. While most of our discussion focuses at the high-expenditure tail of the distribution, it is worth noting the extreme stability over time in the amount of resources used by the bottom half of the population. The 1977, 1987, and 1996 surveys all show that the lower 50 percent of the population collectively used about 3 percent of total health care resources. Ideally, one should expect a somewhat skewed distribution; it is certainly not efficient policy for healthy people to be using equivalent services as those who are seriously ill. However, the degree of concentration raises interesting issues: It is clear that the majority of Americans collectively are responsible for only a very small proportion of what is spent (or paid for) on health care.

That's an amazing stat, but it's not perfectly clear what the top or bottom half of the population means; I presume it has to do with income.

Another interesting observation is that the...

Diffusion of new technologies in the health care sector continued over the past decade. For example, in 1990 alone nearly 5,000 new medical devices were introduced in the United States.3

Some argue that tech is what is driving up the cost of health care.

It's an interesting subject, and I suppose we'll never know whether national health care would be good or bad in this country until we try it. Ah...there's the rub...

Originally Posted by JAD_333

That's an amazing stat, but it's not perfectly clear what the top or bottom half of the population means; I presume it has to do with income.

No, with usage, sicker people use more services, the sicker they get the more they use and less likely they are to be able to pay for it. The elderly, the very young, pregnant women, diabetics, fybromyalgia sufferers, cancer patients etc even combined they are no where near a majority of the population but they soak up services like a sponge.

Originally Posted by zraver

No, with usage, sicker people use more services, the sicker they get the more they use and less likely they are to be able to pay for it. The elderly, the very young, pregnant women, diabetics, fybromyalgia sufferers, cancer patients etc even combined they are no where near a majority of the population but they soak up services like a sponge.

Thanks, Z; makes sense. I suppose it has always been that way and always will be.

I'm a bit too lazy to read all 17 pages, but was it mentioned anywhere that the German government does not subsidize universal healthcare (unlike unemployment insurance and pension insurance) at all?

Healthcare is considered a privatized business in Germany; there used to be over 200 individual healthcare insurance companies, by now through mergers down to less than 100. The government simply makes it mandatory to have health insurance with any of these companies, and prescribes the insurance companies a certain minimum set of procedures they have to cover in their policies.

Total expenditure for healthcare in Germany was €240 billion in 2003 (plus €65 billion in sick pay, 75% covered by employers and pension insurance).
Of these €240 billion, €18 billion was covered by the government, and 60% of those €18 billion went into research, education and investions in that field (covering 95% of all expenditure in Germany in those three).
Healthcare insurance companies covered €182 billion, employers covered €10 billion (25% for preemptive education), and privately paid expenditure was €30 billion (i.e. non-covered procedures and drugs).

Average health insurance premium in Germany was €260 per month per member the same year btw. And the insurance companies are profit-oriented.