U.S. HC Spending Compared to other countries

[Red Badger]

In Texas Whataburger will advertise 15 times a night that the Monterey Melt sandwich is gooooood for your belly. But they do not tell you it’s 1,000 calories. Require calorie/fat content on all food advertisements!

Better yet, implement a fat tax! Every year when you do your taxes, you go to a body mass index table and depending on your weight, you get a fat tax. That would fix the obesity problem in the U.S.A. in a few years.

And that tax dovetails nicely with a size wise check at the airport gate. Not for your bag, but for your ass. Don't fit through the cattle chute? Buy a second ticket.

 

[Alan]

We have now completed 2 tax years living in England. Being dual citizens we are taxed on our worldwide income by both HMRC and the IRS. The taxes paid to HMRC are used as foreign tax credits to reduce our US taxes to zero as the taxes to HMRC are higher. This does mean that I get to see each year how exactly much extra we pay. For 2016 we paid $5k more and in 2017 we paid $7k more.

Our premiums alone in the USA were close to $11k then we have copays, deductibles etc and our oop healthcare costs were over 12k in 2014 and $15k in 2015 because of health issues I had. We have been quite impressed at the treatment while back and have been hitting it quite hard this year. I’ve had a suspicious mole and 2 other suspicious lesions incised and tested, plus AF Ablation surgery and my wife has had cataract surgery. My regular ongoing prescription plus all the extra prescriptions associated with our surgeries are also free at point of service. I still get the retiree health insurance sign-up forms from my ex employer and for 2019 I would be paying $956/month for the PPO plan we need and had been using.

This is just one datapoint from our personal experience.

 

[ShokWaveRider]

We have now completed 2 tax years living in England. Being dual citizens we are taxed on our worldwide income by both HMRC and the IRS. The taxes paid to HMRC are used as foreign tax credits to reduce our US taxes to zero as the taxes to HMRC are higher. This does mean that I get to see each year how exactly much extra we pay. For 2016 we paid $5k more and in 2017 we paid $7k more.

Not to mention the "Service First" attitude vs "Money first" or "Insurance First". Also the lack of continuous follow up and EOB paperwork. No fighting with Insurance No Service when requiring a procedure. If it is required or recommended by the doctors you get it.

Shame the weather is so bad.

 

[Offgrid Organic Farmer]

.... but for your ass. Don't fit through the cattle chute? Buy a second ticket.

If you can not fit through a cattle chute, you have serious problems.

 

[Koogie]

As a Canadian, I'm not about to comment on the quality of US healthcare since it's not my country and I ain't one of those type of people,

I will say every time DW and I are in the US (say, about 4 weeks a year) we are always shocked by the sheer amount of adverts for drugs and pharmacare in general. It seems like every other advert on US television is for a drug. I'd be hardpressed to say if you'd see one or two a day in Canada. Does that lead to better healthcare outcomes or worse ? Don't know the answer but it's always a surprise.

I am getting little tired of saying this. IT IS NOT FREE. It is paid for by Taxes and Provincial monthly HC charges, at least in Canada.

Ontarians don't pay monthly HC charges. You might of had to since you were waiting to qualify for OHIP (we do charge "dang furriners")

Mind you, a lot of Canajuns think the gubmint gives them a free edshookaysun too.

 

[ShokWaveRider]

Ontarians don't pay monthly HC charges. You might of had to since you were waiting to qualify for OHIP (we do charge "dang furriners")

Sorry I meant BC. I have lived in Ontario, Alberta and BC. I am a Canadian as well as a UK and American Citizen...… My friends call me 00Ian (Double "O" Ian)

 

[Koogie]

Sorry I meant BC. I have lived in Ontario, Alberta and BC. I am a Canadian as well as a UK and American Citizen...… My friends call me 00Ian (Double "O" Ian)

Ohh, BC.. well, that doesn't surprise me. On the Wet Coast they're so far down the rabbithole they pay taxes on their taxes....

 

[Midpack]

Our waiting lines to see a specialist are much shorter than they are in other nations. I live in a border town, my nearest hospital gets a lot of medical tourists [foreigners who come here for medical treatment, that in their native countries would require very long waiting lists].

I see the ‘wait times’ argument trotted out over and over, like it’s common knowledge, without any supporting data. Do you, and others who’ve claimed the same, have anything to support your broad assertion?

From what I can tell, Canada had/has the longest wait times of any developed country that’s reporting. So drawing conclusions based on Canada is misleading at best.

Yes, some of these charts are older. That shows the widely held assumption among some Americans that universal health care inevitably leads to longer wait times, has long unfounded for many years. It’s only the myopic comparisons with Canada that support that (false) conclusion.

 

[youbet]

Insurance companies in the USA make record profits.

.

Do you have any backup data for that statement? What kind of records are the insurance companies breaking? Bottom line profit as a percent of revenue or? Are these "records" all-time records historically? I thought the insurance companies were regulated and monitored by the gov't in regard to the percentage of premium dollars they must pay out before being subject to "corrective action."

I'm not defending insurance companies. But I know you wouldn't make a statement like that without some backup data and I'm sure curious to see some of it.

Thanks.

 

[jimbee]

As a Canadian, I'm not about to comment on the quality of US healthcare since it's not my country and I ain't one of those type of people,

I will say every time DW and I are in the US (say, about 4 weeks a year) we are always shocked by the sheer amount of adverts for drugs and pharmacare in general. It seems like every other advert on US television is for a drug. I'd be hardpressed to say if you'd see one or two a day in Canada. Does that lead to better healthcare outcomes or worse ?

My guess is it leads to better pharmaceutical company income.

 

[youbet]

It's always great fun to bitch and moan about our circumstances while failing to do anything about them even though opportunities arise. For example, for the folks who've pointed out that many docs in the USA medical system order too many tests (for whatever reason - profit, litigation worries, hate to see the machine get dusty, etc.). Have any of you simply said "No Thanks?" Last time I checked with my long time family doc, he was more than willing to explain why he was suggesting a test, what the alternatives were, the risks of both doing and not doing the test, what kind of coverage to expect from my insurance (now Medicare) and much more. He's a DO, not an MD, and DW and I have been with him for over 30 years. If he was some other way, we'd go to another doc.

How about elective procedures that might be a very low priority in other countries? Has anyone opt'd out of an elective procedure here to save the resources for others with more urgent needs?

Have you learned to talk to your doc about the drugs he/she prescribed and challenge if an inexpensive generic isn't used? Do you shop for the best price rewarding the low cost providers with your business instead of expecting insurance to just "take care of things?"

I bet we all stumble across ways we could be better consumers of medical resources in terms of what we choose to consume, how we shop for the services to be sure to reward low cost providers and not over-using medical services just because "we're covered."

Anyone doing anything other than just bitchin' about it all?

 

[MRG]

I had a holter monitor for a week. Received an EOB; 12 pages in color, of why I was an idiot to go out of network! Yes, twelve color pages of details on the $6,500 worth of charges I owe for a routine test. I'm an idiot, of course!

The providers office checked the coverage before they gave it to me. Why would they give me such a thing? Surely they are idiots too?

My final EOB and bill matched at $84.00. Of course they provided 6 pages of color paper to tell me this.

How's the system working? When insanity becomes acceptable something is broken.

 

[Midpack]

It's always great fun to bitch and moan about our circumstances while failing to do anything about them even though opportunities arise.

Anyone doing anything other than just bitchin' about it all?

Yes, I’ve detailed examples on ER.org before so briefly - DW and I always do our homework in advance and politely ask (hopefully thoughtful) questions that have led to declining quite a few tests, many prescriptions, some therapy (DIY when possible), and even more serious procedures (a needle biopsy). Even though our health insurance would have paid for it all. Some doctors are put off or insulted, but some welcome our interest and accommodate our desire to hold costs down. They say patients often get angry if they aren’t given a prescription (there has to be a pill for everything) or other costly procedures, and could care less what anything costs.

You?

 

[NW-Bound]

... patients often get angry if they aren’t given a prescription (there has to be a pill for everything) or other costly procedures, and could care less what anything costs...

In the book "The Emperor of All Maladies: A Biography of Cancer", the author, Siddhartha Mukherjee, describes how the daughter of a terminal cancer patient said she could not understand how modern medicine could not do anything for her mother who was suffering.

The daughter was an MD.

 

[travelover]

Hmmm, this seems to be a "Groundhog Day" topic. Someone blames the threat of lawsuits, someone else blames the insurance companies, someone else claims other developed countries' healthcare really isn't any good, someone blames people for not following a healthy enough diet. Rinse and repeat.


Are we smart enough to realize that complex problems have complex causes? Given that we spend $8000+ per person per year for health care in the USA, why has there not been a comprehensive analysis done with recommendations on how to get costs under control and provide real affordable healthcare? IMHO, until we answer that question, we are kidding ourselves.

 

[Midpack]

Hmmm, this seems to be a "Groundhog Day" topic. Someone blames the threat of lawsuits, someone else blames the insurance companies, someone else claims other developed countries' healthcare really isn't any good, someone blames people for not following a healthy enough diet. Rinse and repeat.

Are we smart enough to realize that complex problems have complex causes? Given that we spend $8000+ per person per year for health care in the USA, why has there not been a comprehensive analysis done with recommendations on how to get costs under control and provide real affordable healthcare? IMHO, until we answer that question, we are kidding ourselves.

It’s complex to be sure but what to do isn’t the biggest problem. We have the luxury of looking at dozens of different universal healthcare approaches from all around the world, including some very mature systems, and picking the best parts of each that would work in the US, and working toward implementation. Incidentally that’s exactly what Taiwan did. Switzerland began with an expensive disjointed system not entirely unlike the US. There are living templates for us to study all over the world.

The biggest obstacle in the US is the political climate, campaign finances, entrenched special interests with all the $ they need and plain old resistance to change. Early drafts of ACA actually attempted to include “affordable” in the law, but special interests made sure all that was stripped out and institutionalized the status quo plus.

Add an electorate that mostly has no clue what health care actually costs them, with highly subsidized premiums and low out of pocket costs they don’t care. Many here blindly support the status quo based on little more than hunches, anecdotal examples, out of date assumptions, etc. - they appear in thread after thread, year after year.

What to do isn’t simple, but it’s not the biggest problem.

 

[travelover]

..........The biggest obstacle in the US is the political climate, campaign finances, entrenched special interests with all the $ they need and plain old resistance to change. Early drafts of ACA actually attempted to include “affordable” in the law, but special interests made sure all that was stripped out and institutionalized the status quo plus...........

Bingo.

 

[Silver]

It’s complex to be sure but what to do isn’t the biggest problem. We have the luxury of looking at dozens of different universal healthcare approaches from all around the world, including some very mature systems, and picking the best parts of each that would work in the US, and working toward implementation. Incidentally that’s exactly what Taiwan did. Switzerland began with an expensive disjointed system not entirely unlike the US. There are living templates for us to study all over the world.

The biggest obstacle in the US is the political climate, campaign finances, entrenched special interests with all the $ they need and plain old resistance to change. Early drafts of ACA actually attempted to include “affordable” in the law, but special interests made sure all that was stripped out and institutionalized the status quo plus.

Add an electorate that mostly has no clue what health care actually costs them, with highly subsidized premiums and low out of pocket costs they don’t care. Many here blindly support the status quo based on little more than hunches, anecdotal examples, out of date assumptions, etc. - they appear in thread after thread, year after year.

What to do isn’t simple, but it’s not the biggest problem.

IMO, most of our elected leadership in the house and senate are owned by the big businesses in our health care system because of their election contributions. They have been bought out through campaign finances, and so must act in their "master's" interest. Independent thinkers can't be elected any longer....they just don't have the money to run a campaign and win. Nothing will change until there is campaign finance reform.

 

[Rianne]

For example, for the folks who've pointed out that many docs in the USA medical system order too many tests (for whatever reason - profit, litigation worries, hate to see the machine get dusty, etc.). Have any of you simply said "No Thanks?"

Hell Yes! I said "No Thanks" to chemo, radiation and constructive surgery and I had great insurance with mega corp. I also said "No Thanks" to meds I did not want the side effects. Granted, I am lucky, I"m healthy today. I am skeptical of every procedure and med that is offered and weigh the consequences. Maybe I have good genes. My mom went to the Dr. to have children. I can't remember anytime (other than her last year of life at 93) that she went to a Dr. Dad the same, although he was a medic in WWII.

This is IMHO. I do not condone this attitude, it is simply my attitude.

 

[ivinsfan]

2017 data compares U.S. HC spending per capita to other countries. Are we a sicker nation?


https://www.healthsystemtracker.org...iDMrQvOvZmkpZ5-2O1w&_hsmi=68267802#item-start

Are we sicker is that really the question? We are an aggressive nation when it comes to saving and healing and that costs money. A sweet little baby of a neighbor just left the hospital after a birth weighing 1lb 9. Together she and Mom spent 117 days in a high care hospital setting. Two weeks trying to prevent labor and the rest in a NICU unit. A great many of those days were staffed at a level of 2 RN's per shift for her care. I'm guessing she's literally a million dollar baby. Her long term outlook is good, yet in four months she has used literally a whole lifetime of medical care for the average person.

 

[Midpack]

IMO, most of our elected leadership in the house and senate are owned by the big businesses in our health care system because of their election contributions. They have been bought out through campaign finances, and so must act in their "master's" interest. Independent thinkers can't be elected any longer....they just don't have the money to run a campaign and win. Nothing will change until there is campaign finance reform.

+100. It’s almost impossible to fund a winning campaign without special interest and PAC money, and fundraising continues for anyone who wants to be re-elected. Some reports suggest congressmen/women spend 40% of their time fundraising while in office. Special interest money comes with strings (I know first hand from my Megacorp days), it would be naive to expect otherwise.

We can talk about the dozens of issues with US healthcare, all for naught until campaign finance changes - and that would probably take an effort from the electorate on a scale like civil rights. Special interests protect the campaign finance status quo as well...

 

[MRG]

One thing I've personally seen was huge internal waste at insurance companies. At one time I was offered a development project that would be "very good for my career".

I turned it down as it was a joke. This was 25 years ago and the technology still isn't near what we were supposed to deliver back then.

A large number of insurance companies gave up millions in R&D money for something that was a technology boondoggle. Anyone who understood what was being sold said no way.

That was one of many.

 

[oscar1]

About the same for me which means your employer or the government is subsidizing insurance companies to the tune of billions of dollars so they can hire even more lawyer lobbyists to keep the gravy train going.

 

[oscar1]

+100. It’s almost impossible to fund a winning campaign without special interest and PAC money, and fundraising continues for anyone who wants to be re-elected. Some reports suggest congressmen/women spend 40% of their time fundraising while in office. Special interest money comes with strings (I know first hand from my Megacorp days), it would be naive to expect otherwise.

We can talk about the dozens of issues with US healthcare, all for naught until campaign finance changes - and that would probably take an effort from the electorate on a scale like civil rights. Special interests protect the campaign finance status quo as well...

+1000

Step 1 - Overturn Citizens United (get special interests out of politics)
Step 2 - Implement Term Linits (too many politicians beholden to profit monger lobbyists)
Step 3 - Pass Healthcare Transparency law requiring rate range disclosure based on country, state, zip. Insurance companies will HATE this one. Until we have transparency, consumers have no hope of market establishing rates.

In the mean time, get to know the GoodRX (www.goodrx.com) iPhone/Android app. I got a 6 month supply of Chloesterol meds for $20 at Wal-mart.

 

[Midpack]

About the same for me which means your employer or the government is subsidizing insurance companies to the tune of billions of dollars so they can hire even more lawyer lobbyists to keep the gravy train going.

To be more direct, WE the people are paying for it, not employers or governments. Those costs are included in the products, services, taxes and fees WE pay. Quite an “arrangement.”