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Thread: US healthcare expenditure to hit 20% of GDP

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    Senior Member RandBlade's Avatar
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    Default US healthcare expenditure to hit 20% of GDP

    Interesting. More than any other economy but with worse results. It always amuses me that tax expenditure is more on the US model than it is on the UK one even before you consider insurance, private, copayments etc

    Does the US model have anything going for it? Can or will anything ever be done?

    https://seekingalpha.com/news/337601...=1#/email_link
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  2. #2
    SEÑOR Member Aimless's Avatar
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    Stay tuned for dubious arguments about how this is only due to the rest of the world leeching off of the US's ingenuity and generosity by not paying the "true" cost of drugs.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

  3. #3
    Well, the Koch Brothers recently funded a study that backfired so spectacularly that it accidentally showed medicare for all would save the US trillions.
    https://www.mercatus.org/system/file...paper-v1_1.pdf

    So maybe there is hope still?
    "In a field where an overlooked bug could cost millions, you want people who will speak their minds, even if they’re sometimes obnoxious about it."

  4. #4
    ======== Timbuk2's Avatar
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    yes but much better to spend trillions extra than have teh socialisum
    Quote Originally Posted by Steely Glint View Post
    It's actually the original French billion, which is bi-million, which is a million to the power of 2. We adopted the word, and then they changed it, presumably as revenge for Crecy and Agincourt, and then the treasonous Americans adopted the new French usage and spread it all over the world. And now we have to use it.

    And that's Why I'm Voting Leave.

  5. #5
    Senior Member RandBlade's Avatar
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    Spending trillions extra in tax dollars as they do at the moment isn't socialism because ... ???
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  6. #6
    SEÑOR Member Aimless's Avatar
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    In all honesty, there is one major advantage (depending on your perspective) to the US system, and that is that it arguably generates more profits for those who develop and sell drugs and medical equipment. This provides a strong incentive to research and develop new and better tools for identifying, treating and monitoring illnesses, which arguably increases overall welfare. It's possible that the profits are higher than what is strictly necessary to generate the optimum or maximum amount of R&D, but it's also possible that the converse is true. It's possible that the costs also have negative consequences elsewhere that reduce overall welfare. Regardless, incentivizing research and development is the one unique reasonably objective advantage of the US system. In a similar vein, many laymen who are quite taken with the notion of American exceptionalism believe the high profits are also responsible for generating the highest number of the most exceptional scientists and clinicians.

    A questionable advantage relatively unique to the US system is that it is emotionally (and, from some perspectives, morally) satisfying. In an idealized view of the US system, you have maximum liberty, you get to make decisions about your health together with your physician without any interference, you don't have to take responsibility for anyone's healthcare but your own or burden anyone else, and other people's poor choices have no impact on your life. Many also believe the US system reduces moral hazard. These beliefs about the US healthcare system are at the very least questionable (see across-the-board overuse for example, contradicting misconceptions about moral hazard, or practical restraints on liberty), but if you believe the system confers these philosophical and emotional advantages, the high cost might be worth paying.

    A debatable advantage to the US healthcare system is that, compared to some implementations of universal healthcare in other western countries, the US system may be better at providing elective treatments intended to address issues that have a high long-term impact on quality of life without being fatal or causing extreme disability. Some examples are conditions that cause chronic pain, such as joint problems, where surgical intervention in some countries with universal healthcare might be delayed by months compared to what you see in the US. Is this truly a major advantage? I believe reality in the US is more complex and less cheerful than many would like to believe, when you factor in obstacles to access (such as lack of coverage, lack of money etc). I also believe there is an over-emphasis in the US on invasive quick-fix treatments of questionable utility compared to best medical treatment and lifestyle interventions. Regardless, if you have the money and the coverage, and are suffering from joint problems that may be alleviated by surgery, it's possible you'd prefer to just do that instead of trying out a months-long regimen of exercise and weight-loss or go back in time to change your lifestyle and profession before the problem arises. If you have less money, you can always travel to a European country and have the procedure done at a private clinic, with the same downsides as doing the procedure out-of-state. Similarly, many in the US appreciate the idea that they can easily access a specialist clinic, instead of having to first go through the equivalent of a GP. Frankly, I don't regard this as an advantage, as I recognize how much can be satisfactorily accomplished at the primary care level at a much, much lower cost--and with much less hassle for everyone involved.

    As for the arguments about market forces and efficiency etc. it's difficult to take those beliefs seriously, because the US healthcare system is one of the best examples of a borked market.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

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    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by RandBlade View Post
    Spending trillions extra in tax dollars as they do at the moment isn't socialism because ... ???
    Depends on who does the spending. If it's done by lefty European states, it's socialism. If it's done by the US, it's compassionate capitalism. Many Americans apparently have no idea how much the govt. actually has to spend on healthcare in order to help the electorate sustain the delusional belief that they don't have a (poorly implemented) socialized healthcare system.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

  8. #8
    Senior Member RandBlade's Avatar
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    That's my problem. I can understand saying we won't socialise this on a philosophical basis but they are. Taxpayers are still left with the burden that a socialised system carries they just do so without getting the benefits. That to me is still socialised it's just very inefficiently done so.

    Interesting thoughts on your other post thank you.
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  9. #9
    Local talking head LittleFuzzy's Avatar
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    Hey look, trying to get coverage for everyone before reducing costs didn't work. Just like I repeatedly told Choobs et al back when the ACA was being created and debated,
    Last night as I lay in bed, looking up at the stars, I thought, “Where the hell is my ceiling?"

  10. #10
    SEÑOR Member Aimless's Avatar
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    In much of the developed world, getting coverage for everyone and enabling better collective bargaining is one of the most effective ways to reduce costs or rein in cost growth. Afaict, ACA has been associated with a slowdown in growth of healthcare costs, despite the attempts to cripple it.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

  11. #11
    Senior Member GGT's Avatar
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    Quote Originally Posted by LittleFuzzy View Post
    Hey look, trying to get coverage for everyone before reducing costs didn't work. Just like I repeatedly told Choobs et al back when the ACA was being created and debated,
    Getting "coverage" meant using the private for-profit insurance industry, with some gov't subsidies based on income, so of course that didn't reduce the overall costs of medical care. There was no way single-payer or Medicare-for-all type system would get legislative approval (because of "teh socialisum" as Timbuk said), but also because the insurance industry is a powerful lobbying group (along with durable medical devices, plus the pharmaceutical giants, that all rely on insurance re-imbursement for their profits). There were some good efforts at regulating the insurance industry, especially the Patient Protection part that focused on pre-existing conditions and gender-related conditions, but the Individual Mandate was just too much. And without that, the whole scheme fell apart.

    Yes, it's a borked system. That was evident when ACA protesters were holding signs saying, "No Socialized Medicine" AND "Hands off my Medicare!"

    But Trump will give us the best, most beautiful and affordable healthcare system, and it will be so easy! He promised, so it must be true, huh.

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    Our system is uniquely shitty. As long as insurance mandates price and provides coverage there can be no real competition. Without competition there is no pressure on price to come down.

  13. #13
    Senior Member GGT's Avatar
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    Who is going to "compete" with the insurance industry?

  14. #14
    Administrator Dreadnaught's Avatar
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    Quote Originally Posted by Aimless View Post
    In all honesty...As for the arguments about market forces and efficiency etc. it's difficult to take those beliefs seriously, because the US healthcare system is one of the best examples of a borked market.
    I haven't agreed with one of your posts like this in a while

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    Quote Originally Posted by RandBlade View Post
    Interesting. More than any other economy but with worse results. It always amuses me that tax expenditure is more on the US model than it is on the UK one even before you consider insurance, private, copayments etc

    Does the US model have anything going for it? Can or will anything ever be done?

    https://seekingalpha.com/news/337601...=1#/email_link
    Thanks Obama!

  16. #16
    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by Lewkowski View Post
    Thanks Obama!
    This is stupid. This is a continuation of a trend that has existed for decades. It's likely the growth in costs slowed down slightly compared to what they would've been without the ACA even in its crippled form.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

  17. #17
    All Worship Ragnarök Loki's Avatar
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    Quote Originally Posted by Aimless View Post
    This is stupid. This is a continuation of a trend that has existed for decades. It's likely the growth in costs slowed down slightly compared to what they would've been without the ACA even in its crippled form.
    I doubt it. Any system that increases the number of people covered without doing anything to lower per patient cost is going to be more expensive.
    Hope is the denial of reality

  18. #18
    That depends wholely on the level of service being used.
    "In a field where an overlooked bug could cost millions, you want people who will speak their minds, even if they’re sometimes obnoxious about it."

  19. #19
    Senior Member RandBlade's Avatar
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    It also depends upon the efficiency of how they are treated.
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  20. #20
    https://www.athenahealth.com/insight...-administrator

    From 1975-2010 the number of doctors increased 150%, the number of administrators increased 3200%.
    Guess which one a single payer system would, by nature, control best?
    "In a field where an overlooked bug could cost millions, you want people who will speak their minds, even if they’re sometimes obnoxious about it."

  21. #21
    Senior Member RandBlade's Avatar
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    Gee that is a shocking number. I wonder what the doctor/capita and administrator/capita ratios are in the USA and UK. A lot of work in recent years here where the Tories have been controlling expenditure tightly has gone on reducing overheads.
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  22. #22
    SEÑOR Member Aimless's Avatar
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    *shrug* The Tories have fucked the NHS.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

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    Senior Member RandBlade's Avatar
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    No they haven't. They have expanded funding in a controlled manner to record levels despite the ludicrous £175bn deficit we inherited. What else could have realistically been done?
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  24. #24
    All Worship Ragnarök Loki's Avatar
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    Hope is the denial of reality

  25. #25
    Senior Member GGT's Avatar
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    Medical costs can bust any budget. 20% of national GDP sounds bad, but 30-40% of personal or household income is even worse. Subsidies from employers (or the government) may help pay for Insurance premiums....but that hasn't done much to reduce or contain escalating medical costs. Because human health isn't like any other "market".

    So many moving parts. New discoveries and treatments thru R & D, higher expectations for saving life, improving quality of life, extending longevity. All these things cost a lot of money, but few could pay the 'real' costs out-of-pocket. Insurance started out as a good idea to help people defray the 'real' costs of medical care, but when it got tied to employment it went off the rails. (Yes, union lobbyists were part of that, but they weren't tasked with reducing medical costs nationwide.)

    The for-profit Insurance Industry created the model, and everyone followed suit, including our governmental agencies and their lobbyists. Social Security is an Insurance product with federal subsidies. Ditto for Medicare, Medicaid, VA benefits, and CHIPs. We've been duped into thinking Insurance means the "freee market", and isn't SSSocialized at all. The middle men are making hefty bank deposits, they're an industry on their own, and haven't done a damn thing to reduce costs

  26. #26
    Senior Member RandBlade's Avatar
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    Wow look at that. Despite years of austerity from 2010 the UK is spending a higher percentage now than it was any Labour year until 2009. But that's nowhere close to 20%
    Quote Originally Posted by Ominous Gamer View Post
    Being upset is understandable, but be upset at yourself for poor planning, not at the world by acting like a spoiled bitch during an interview.

  27. #27
    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by RandBlade View Post
    No they haven't. They have expanded funding in a controlled manner to record levels despite the ludicrous £175bn deficit we inherited. What else could have realistically been done?
    Quote Originally Posted by RandBlade View Post
    Wow look at that. Despite years of austerity from 2010 the UK is spending a higher percentage now than it was any Labour year until 2009. But that's nowhere close to 20%
    This argument of yours is even more asinine in this thread than it was the last time you made it.

    What the graph shows is that the Tories presided over the longest stretches of sustained funding squeezes in the past several decades, from which the NHS has struggled to recover. It is stupid to point to "record levels" of funding as a defense because 1. the record levels were not reached primarily due to the Tories, and 2. because these "record levels" do not match the NHS's needs. The NHS's needs have not risen primarily due to avoidable costs such as administrative overhead etc (although more on that later) but due to largely unavoidable costs associated with an aging population and increases in cost of treatments, diagnostic procedures, etc. Many NHS trusts have been required to make completely unrealistic cuts under the Tories and the only "record levels" appropriate to talk about in this discussion are record levels of underfunding and understaffing.

    That said, some portion of the cost increases may indeed have been avoidable, and the Tories are largely to blame for this as well, because of the role they played in sabotaging cost-effective primary care, mental health services etc. In addition, they were responsible for the Health and Social Care Act of 2012, a reform that set the NHS on the path to assuming some of the less beneficial characteristics of the US healthcare system (mirroring similarly harmful but less incompetently implemented legislation in Sweden) such as increased overhead, poorer coordination, misallocated resources etc. This legislation--and its farcical implementation--has been criticized in the strongest terms by all major groups of British healthcare professionals, for good reason, and the Tories are wholly responsible for its failure.

    The Tories have also been responsible for greatly exacerbating the NHS's chronic and now catastrophic staffing shortages. They are responsible for this in several ways: through their general defunding; through their specific defunding of staff training (eg. through defunding bursaries absolutely vital to student/trainee nurses); through their policies that have caused burnout and dissatisfaction leading to fewer workers; through their foolish pledge to cut immigration to the tens of thousands; through their decision to leave the EU and their incompetent implementation of that decision. Again, pointing to "record levels" on various metrics is a stupid way to defend these clowns; the NHS's staffing needs increase with the growing needs of the population, and recruitment must also compensate for attrition due to retirement, changing jobs etc. Training and recruiting takes both more time, more money and a larger pool, and the Tories have ensured that the NHS has neither.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

  28. #28
    Senior Member GGT's Avatar
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    Aspirin is dirt cheap. Bayer made billions thru its branding schemes that made aspirin more expensive, without changing its basic molecular structure. They added caffeine and called it a headache/migraine medicine. They reduced recommended dosage and called it a cardiac preventative (aka baby aspirin). It's an OTC med that got full-reimbursement, if prescribed by a doctor, because insurance covered it. Now aspirin isn't so cheap, huh

  29. #29
    SEÑOR Member Aimless's Avatar
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    Your account is a little misleading but nevertheless I'm going to launch a new product that sells aspirin together with nice single origin espressos.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

  30. #30
    SEÑOR Member Aimless's Avatar
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    Quote Originally Posted by Loki View Post
    I doubt it. Any system that increases the number of people covered without doing anything to lower per patient cost is going to be more expensive.
    You're right, which is why the ACA didn't simply increase the number of people covered.
    “Humanity's greatest advances are not in its discoveries, but in how those discoveries are applied to reduce inequity.”
    — Bill Gates

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