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Why Medical Bills Are Killing Us (2013) [pdf]

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Re: Why Medical Bills Are Killing Us (2013) [pdf]

#61
post #59

Earlier quoted context omitted.

What's the country?

Most of Europe

Monthly rates vary though. In the Netherlands you pay €90 or so a month for (mandatory) health insurance, with a €350 a year deductible. Low income households do get partly subsidized by the government of course.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#62
post #43

If anyone is interested, you can look up what single payer costs[1] are for various procedures in Australia, you can pay more than what is listed if you go private, but it still isn't anywhere near the cost of what procedures cost in the USA. [1] http://www.mbsonline.gov.au/internet/mbsonline/publishing.ns...

Can you get a private MRI without a doctor's requisition in Australia? I know in Canada they try to burn you at the stake if you do that.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#63

Earlier quoted context omitted.

Most of Europe

Monthly rates vary though. In the Netherlands you pay €90 or so a month for (mandatory) health insurance, with a €350 a year deductible. Low income households do get partly subsidized by the government of course.

The Netherlands spends ~$5200/pp on healthcare[1]. Where does the rest of the money come from?

[1]: http://www.who.int/countries/nld/en/

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#64
post #59

It is good to live in a country where I only spend 50 euro per month in taxes for all the care I could need! Its great to be in the first world!

What's the country?

Spain. https://en.wikipedia.org/wiki/World_Health_Organization_rank...

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#65

It is good to live in a country where I only spend 50 euro per month in taxes for all the care I could need! Its great to be in the first world!

The thing is, most people dont need to spend 50 euro per month so millions of people pay in order to not be left out the system if they need it. I need it when I was a kid, so now I pay gratefully.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#66
post #63

Earlier quoted context omitted.

Monthly rates vary though. In the Netherlands you pay €90 or so a month for (mandatory) health insurance, with a €350 a year deductible. Low income households do get partly subsidized by the government of course.

The Netherlands spends ~$5200/pp on healthcare[1]. Where does the rest of the money come from? [1]: http://www.who.int/countries/nld/en/

Taxes withheld from salary, just like ainiriand mentioned. In The Netherlands (and most other European countries) you pay for insurance directly (which here includes a mandatory basic plan that can be expanded to include things like full dental) and via taxation of income.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#67

I came across this last night and stayed up too late reading it. It's a fascinating exposé of where at least a good part of the money is going -- the extra money that we Americans spend on health care that doesn't bring us any better outcomes. I think it's relevant to HN because a lot of us with families and/or in middle age can't risk quitting our jobs to start startups without assurance that we'll be able to buy ad…

Relevant quote from the article re: what an effective solution needs to achieve: >The real issue isn’t whether we have a single payer or multiple payers. It’s whether whoever pays has a fair chance in a fair market. Congress has given Medicare that power when it comes to dealing with hospitals and doctors, and we have seen how that works to drive down the prices Medicare pays, just as we’ve seen what happens when Con…

How about capping the salaries of doctors at, say, 100,000 and nurses at 60,000? US salaries in health care are incredibly high. Administration and the like could be capped at the nurse level. Only a very small minority could realistically get higher paying jobs outside the US anyway. If your main motivation is to make a lot of money, choose a different career.

Also, cap profits to almost zero while moving to a completely not-for-profit system.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#68

I came across this last night and stayed up too late reading it. It's a fascinating exposé of where at least a good part of the money is going -- the extra money that we Americans spend on health care that doesn't bring us any better outcomes. I think it's relevant to HN because a lot of us with families and/or in middle age can't risk quitting our jobs to start startups without assurance that we'll be able to buy ad…

A great book on this is Healing America by T.R. Reid, who saw doctors in eight countries about his bum shoulder and wrote about their healthcare systems. Interestingly, single-payer isn't the only good option, or even necessarily the best.

Canada was the only country with single-payer like we talk about in the U.S. The U.K. is single-payer but also single-provider, the doctors work for the government-run healthcare system.

But the best results were in France, Germany, and Japan. They function a lot like Obamacare (multiple insurance companies, though all non-profit, and mandates to buy insurance). However, they add several critical features:

- Government controls on the price of services. Doctors make a lot less money than in the U.S.

- No claim denials allowed for anything on the national price list. If a doctor prescribes it, prompt payment is guaranteed.

- Good digital medical records.

According to Reid, a lot of German doctors don't bother hiring office staff. They swipe your medical card, get all your records, prescribe what they want, and get paid in a week. They can charge less because their costs are lower.

At least one of those countries also has subsidized tuition for medical school, I think Japan. Japan has the lowest costs (only 5% GDP on healthcare, with great outcomes despite an aging population of smokers), and the tightest cost controls; e.g. they make do with simple MRI machines without a lot of bells and whistles, but they do the job, and an MRI costs $100. Japan implements their mandate in an interesting way: you're free to not pay, but if you go to the doctor and you want it covered, you have to pay your back premiums.

Anyway, it's a fascinating book if you're interested in this stuff.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#69

It is good to live in a country where I only spend 50 euro per month in taxes for all the care I could need! Its great to be in the first world!

On average the Spanish pay $223/month on health care, not $50. Spain has a $GDP/capita of $30k and spends 9% of GDP on health care.

Re: Why Medical Bills Are Killing Us (2013) [pdf]

#70

Speaking as an extremely pro-Capitalist person, this is the kind of area where Government interventions are required. Capitalism and fair markets require a few basic things: - Informed consumers (most consumers of healthcare either don't know enough about it to make any solid judgement) - Competition (most hospitals in any given area are grouped together and rarely compete, if at all) - Choice (if you're in an ambula…

As a person who consumes capitalist medicine in India, I don't see how any of your issues are fundamental to capitalist medicine.

There is plenty of competition among hospitals. You can choose which one to go to (from an ambulance or any other time). Customers are strongly price sensitive and prone to comparison. There are plenty of choices as to where to go.

Assuming I'm well enough to travel, I'll always fly to capitalist India to have my medical work done.

And again as a Capitalist: You take a high value, required product, mix with a group of consumers who don't have a choice whether or not to buy, and a business minded person with no ethical compass whatsoever and you'll have record profits and screwed customers. Simple as that.

So do you believe that Indian doctors/other medical types are just vastly more ethical than the (very often Indian) doctors in the US?

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