As long as systems similar to the ones being actively proposed by credible 2020 candidates keep producing horror stories, I’ll keep posting them. I think people fail to appreciate the damage the government / socialist incentives do to the timeliness and quality of care available to everyone, not just the poor, under those healthcare systems.
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I was born into a poor family, and our access to health care was the same as middle class families.
Oh, and we paid for our health care / insurance out of our own pocket. How could we do this if we were poor? We lived well within our means and prioritized our spending. For example, a new car to us was about 5 years old when we got it. My parents didn’t get a color tv until the early 80s. The B&W one lasted so long because we watched it about an hour a night. About every other year, we took a staycation and painted the house or did some other major project.
Both of my parents worked, and the kids helped with house work, yard work, and garden work. We also had no problem going to sleep between 8 & 9.
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yeah, going to sleep at 8pm will totally help people not get bankrupted by a $100k+ hospital bill when one of their kids ends up in the hospital. superb advice.
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Last time I went to the doctor they didn’t ask for my tax return or my government issued “middle class member in good standing” card to see if they would take my payment. The fact is in the US right now anyone can pay for good and prompt healthcare, either via insurance or cash (in contrast to year long wait lists or other countries where private competing care is disallowed). Perhaps what you meant is whether poorer people should get quality healthcare without paying for it?
Who pays and how much and for what level of care are usually the main points of discussion. The doctor isn’t willing to work for free, the drug companies aren’t willing to make the drugs for free, etc, so someone has to pay or the work won’t get done and the healthcare services won’t be delivered.
So who do you propose to pay for it, and how much? Because people generally and poor people especially have a nasty habit of over- and mis-using free services and as you know many healthcare services can be very expensive. Right now we have Medicaid which provides a moderate level of basically free medical services to the poor.
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I don’t have a magic bullet to fix it. But when people argue ‘Oh, there would be long wait times if everyone had access to healthcare’, it directly translates to ‘I want someone else to be denied care so that I can have access.’ If you’re ok with that then the status quo is just fine. I’ve negotiated excellent coverage for myself and my family through my employer, so I’m in good shape. Guess now that I’m on top I should just repress everyone below me.
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In a capitalist system, nobody gets denied care so that you can have it. If me and you are both willing to pay, someone will take our money and provide the services we want (or the market price will rise, or more people will work overtime, more will become doctors, etc). Now people who can’t afford to pay may get denied care (or as good care, or as prompt care), depending on how generous the rest of society is feeling who are the ones actually paying for it.
In a socialist system, you’re right - giving me better access to a limit resource means giving someone, maybe you, worse access. That translates to my life being better and your life being worse. In a capitalist system, the resource isn’t limited since you pay for it and supply will rise to meet demand. In a socialist system, cost controls invariably necessitate limited service spending which is then rationed, both in terms of level of care offered and timely access to care. You pay with your money or you pay with your (quality of) life.
Some people like to talk about a “right to healthcare”. But fundamentally healthcare is not a right like free speech or freedom of belief which can be had by social contract/agreement and nothing more. Healthcare is no more of a “right” than the “right” to food or clean water. The universe doesn’t owe you food just because you want it, someone has to do a much of work to make that happen.
Since the demand for healthcare is already such that we spend nearly 20% of our GDP on it here in the US, you can imagine that if it were “free” and of unlimited/top tier quality, demand would be much much higher. At some point, society just can’t or won’t choose to afford spending like that, so you have to draw the line somewhere. To me it’s less important where to draw the line, ala food stamps/welfare, for the minimum level of care that will be subsidized, than it is the structure under which the care is delivered and that the incentives are still such that quality and timeliness and innovation are encouraged and rewarded.
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I don’t feel general economic principles can be fairly applied to something like healthcare. This is a financial decision that is essentially made under duress. Yes, you are ‘demanding’ a service from someone else (doctor, hospital, etc), who obviously won’t do it for ‘free’. How is this any different from ‘demanding’ the services of a police officer when a crime is being committed against me? Or ‘demanding’ the services of a road crew to fill a pot hole?
Sure, we could say that if someone wants a pot hole fixed they could just pay for it. If nobody is individually willing to pay for it, I guess it doesn’t need to be fixed? We could say that if you want a police force, you can go ahead and hire private security. It sounds ridiculous when we apply it to other ‘socialized’ services, but to me, it sounds ridiculous to say ‘just pay for your own care if you need it’, when the costs of even simple things (like a broken arm) run into the hundreds of thousands of dollars.
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Did I say pm? 
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What seems crazy to me is the fact that we spend as much or more per capita on healthcare as other industrialized countries, yet still have nontrivial amounts of uninsured citizens. Why do we pay so much for so little, as a society?
And if not single payer, why not single pricing? Why should five different patients, all getting the same drug, service, or procedure, all pay different amounts?
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A typical issue with those types of arrangements is that there is still a “haves” class: the politically well-connected, party-loyalists folks. Somehow they’ll be at the head of any list.
What I dislike most of that arrangement is that it negates real fairness. In my opinion, if you put more effort in what you do, your education, your career, your financial planning, then you should derive the benefits of being diligent and responsible.
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Lower taxes. Your tax bracket in Europe would likely be 10-15% higher. There is a trickle down effect. Education is grossly underfunded here partially due to lower taxes (and obviously political prioritizing of other expenditures like defense). Back home, my undergrad education was all free so I basically started with no college debt. If you become a doctor here or in most European countries, you’re either starting $300k in debt or virtually debt-free. How do you think doctors here pay down that debt? By charging the public (insured or not) higher prices. The medical tourism industry abroad is very grateful though.
Drug costs is another issue. The US is essentially subsidizing drug costs in other countries because we refuse to regulate drug prices like they do in other countries. So what drug manufacturers cannot get elsewhere, they make up here. The doctor-drug company relationship is also more ripe for abuse here. What essentially amounts to bribes for prescribing high cost medication in exchange for gifts happens openly here. Finally, the cost vs benefit analysis in the US vs in Europe is not the same for new drugs. Very marginal benefit drugs get approved by FDA all the time where as the drugs won’t be available in other countries based on dubious benefits vs 1000+% increase in cost. The upside is outcomes for a few difficult to treat conditions are better here than anywhere else. Whether that’s worth the cost is strongly hinging on whether I’m the patient who’d rather stack the odds in my favor or not. 
I don’t think Medicare for all would change a lot of this by itself. A lot of the costs (say education or research costs) are sunk at this point and would take even more profound changes to the system before they’ll decrease. By itself M4A would just be a basic immediate wealth redistribution without cost reduction.
Question though amidst all the debate over it, is what do you think the chances are for M4A to happen in your lifetime? IMO, whoever is in power next has no chance to get anything done. The annual budget deficits are at record highs thanks to BOTH administrations being utterly fiscally irresponsible. So it’s not like we have tax revenues to support costly additional entitlements. And that’s in a climate where existing entitlements already need to be reformed (cut) to keep them afloat. The tax increases needed to support both reforming current entitlement and adding extra ones is just political suicide for either party and you know none have the guts to do what’s needed if kicking the can is possible. So IMO M4A is just campaign fodder for Dems. A populist simple miracle solution to a very complex problem. It’ll sell well I’m sure but it’ll be swiftly forgotten past the election cycle.
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Many service oriented businesses are like this, not all for the same reasons. Flights and hotels have people in the same plane or same type of room paying a wide variety of rates. Not saying this is right, just saying it is not unique to healthcare.
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The best and brightest Canadian doctors, many of them anyway, have already migrated to the USA . . . where they can make decent money. If you want to be treated by the sharpest docs, don’t travel to Toronto . . or anywhere else in Canada. This goes double if your need for care is urgent.
Cream rises to the top.
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There is a lot more impact from supply and demand for hotel and flight pricing than there should be for healthcare procedures or especially drug costs. For drugs, outside of some seasonal exceptions (like flu medication during flu season), there are little changes over time in supply and demand so price fluctuation should not be linked to that.
Sure, there can be differences in insurance coverage but still there should not be that much difference in pricing. I’m sure this is not a unique experience, but when I get a new prescription, I basically have to use a third party app (GoodRx), lookup price at membership clubs (Sam’s, Costco), then call in a few pharmacies with my insurance details to check price with my insurer before deciding where to fill it. Through the process, for a 90 day supply, I’ll see prices going from $20 to $200 for the same prescription at different stores. And after all this research, I still cannot be sure I got the best price around. What other product that is not affected by supply and demand, do you see this much variation in costs? For me that point to two main things: 1) there has to be a simpler process than this; 2) this complicated a pricing scheme with this much variation cannot be the most efficient for society. I’m not sure what the best solution is but I know broken when I see it.
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It’d be interesting if, like healthcare, the airlines charged you after the flight. ‘Yeah, you’re responsible for it, but we can’t tell you ahead of time what it’ll cost. And it’s going to be different for every passenger. Good luck!’
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That’s different. I’m sure there is an underlying cost factor, but independent businesses are going to set their own markup. I dont see anything wrong with that; like any other product, if you want the best deal you do need to shop around.
The issue is when a single pharmacy charges you $100, the next guy $75, and the next guy $150. Sure, there’s the concept of volume discounts, but no one is buying anything in bulk (even if an insurance company is paying the bills of thousands of individual customers).
I totally agree that as with everything else shopping around is required. Actually way more so for prescriptions. But the shopping process itself is more complicated than any other. For travel or regular products, I can go online check prices openly available everywhere on the web. IMO the pricing transparency for other purchases leads to a reduction in profit margins due to increased competition.
To me the fact that this is not the case for drug prices leads me to believe that it is due to how opaque pricing is and/or how cumbersome the shopping process is. Otherwise, take omeprazole that my MIL takes. One grocery store pharmacy has it for $9.90 for 60 40 mg capsules. CVS has the same for $39.00, Walgreens has it for $121.36! Her insurer would ship it to her door for $12. I don’t think the usual economics explain this much variation. Imagine this for your next iphone? Priced at $990 at a nearby store, what store within a mile would advertise it for $12,000?
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Except it’s not $12,000 as the anomaly. It’s $990, or your local grocery store sells it for near cost at $100, since they just want to get you in the store to buy groceries. That’s the difference when a product is essential to the viability of one business, but merely an auxiliary product at another.
Or at least that’s my guess on the matter.
And these pricing shenanigans didn’t really matter so much when the average insurance deductible was a couple thousand bucks or less, and it paid 100% afterwards.
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The loss leader aspect is a fair point. But then in this case, the auto-refill from her insurer is also around the same price (once you factor shipping costs) and they don’t have any other side business to use a loss leader for. As such I agree that the grocery store probably sells it at cost or a loss considering the labor needed by the pharmacist to deliver it to you. For the insurer, since it’s a very common drug, they probably have an economy of scale aspect allowing them to price it that way. Fair enough that in both of these cases, the margin would be extremely small or zero.
But then, assuming cost is whatever the insurer/grocery store sells it for, that still means CVS markup is 300% and Walgreens markup is 1200%. Plus these would also surely like to have you in their stores to tempt you to other products as you pickup your prescription (candy, OTC meds, convenience items). I just don’t know what other industry has competitors working with these levels of markup routinely.
My guess is that some pharmacies price their medication expecting the people who shop for low prices to go elsewhere, but those who are on plans with fixed drug prices to go for the closest to home. If it costs the copay is the same $6 everywhere (that was my cost for generics on a previous plan), I’ll just pick the most convenient location and let the insurer foot the rest of the bill. The fact that there is no incentive for me to care about pricing (under this type of plan) and no price control along with price obfuscation, totally enables this inefficient system IMO.
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