[NA] Health Insurance. US vs. Elsewhere

[EdFred]

It's a complex problem, because your taxes in the U.S. already cover healthcare for a lot of people (the elderly via Medicare, the economically disadvantaged via Medicaid, and, IIRC, veterans via the VHA). Many countries with universal healthcare partner with private companies and still have deductions from paycheques.

The best thing to do is to look at the % of GDP different rich countries spend on healthcare, and what the public/private split is. It's all at https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS

Here are some examples:

• US: 17% of GDP (50:50 public/private)
  
• Canada: 11% of GDP (73:27 public/private)
  
• France: 11% of GDP (73:27 public/private)
  
• UK: 10% of GDP (79:21 public/private)
  
• Australia: 9% of GDP (69:31 public/private)

So basically, Canadian taxpayers are subsidising healthcare to the tune of 8% of GDP (73% of 11%), while American taxpayers are subsidising healthcare to the tune of 8.5% of GDP (50% of 17%). I think it's fair to say that there's no extra money added to my taxes for Canadian healthcare vs what you're already paying in your U.S. taxes.

Except % of GDP doesn't really address which segment(s) of the population are shouldering most of the health care / tax burden.

 

[charheep]

I am lucky in regard to my company insurance. I have the highest monthly payment for a family (~$600), but everything is covered. ER visits are $100, normal Doc visits are $20. Everything past that is covered. My wife had 2 thyroid surgeries, my cost was $20 and I think $15 for the meds. Makes financial planning easier.

 

[SixPapaCharlie]

I am lucky in regard to my company insurance. I have the highest monthly payment for a family (~$600), but everything is covered. ER visits are $100, normal Doc visits are $20. Everything past that is covered. My wife had 2 thyroid surgeries, my cost was $20 and I think $15 for the meds. Makes financial planning easier.

That's great. I think ER visit is 1000 out of pocket on mine.
Is your company looking for a VP of IT that lives in Texas by chance?

 

[Everskyward]

For every person who gets a good deal on their insurance, there are others who don't. Wait until you need to pay the whole premium with no subsidy. I considered this seriously before I retired/resigned. I knew I would have 3 1/2 years post COBRA until medicare.

 

[steingar]

the next year we saw similar shenanigans, and the following year went with one of the Christian sharing plans. What we save over our fraction of the health insurance premiums makes up for the expenses that supposedly were covered under the health insurance plan. It’s more like a “catastrophic” plan…we keep ourselves healthy, and will get help with expenses due to major illness (I.e., cancer) or injury.

John Oliver did a piece on Christian Health Insurance sharing plans on his Last Week Tonight show. I won't post it here, this is a really good discussion and Oliver is at best profane. But it can be looked up.

 

[MauleSkinner]

John Oliver did a piece on Christian Health Insurance sharing plans on his Last Week Tonight show. I won't post it here, this is a really good discussion and Oliver is at best profane. But it can be looked up.

Any particular reason to look it up?

 

[steingar]

Any particular reason to look it up?

He is funny, and has a larger view than most of us here.

 

[schmookeeg]

The disgust with the current system is happening at a corporate level too. One of my current clients puts companies together into a medi-share style pool, then backs the entire pool with re-insurance. The idea is that if premiums are not consumed in the pool, an employer can roll their saved money into the next year. The savings seem to run at about 15% in general, just by removing the insurance carrier's profit/overhead. They call it "Captive Insurance" and it's pretty fascinating, but one heck of a complicated structure to meet regulatory burden.

One of the more amusing pieces about it that I like is when a company brings its claims history to join the pool, particularly sick employees can be exempted and sent on to blue cross or whomever, so the pools are for genuinely "surprise" expenses and ordinary age-related care, not chronic super-expensive things once they're known. They're skimming the cream off of the top. Clever folks.

My wife holds a UK passport. I'm eligible for NHS the second I set foot on UK soil with intent to emigrate. That's our backup plan if things here get much worse. I've made a LOT of my career decisions in the last 10 years around healthcare, and I hate the gravity it has on our lives.

 

[Half Fast]

Insurance is really just legalized gambling. You're betting you're going to get sick or hurt, the insurance casino is betting you won't, and as always, the odds favor the house.

Interestingly, in New Zealand (my son in law is a Kiwi) car insurance is dirt cheap because it doesn't have to cover any medical costs.

Actually it’s more like parimutuel betting. You’re betting against other plan members and the house is taking a percentage of the total amount bet.

The largest expenses usually come late in life. As long as the US is willing to spend lots of money to help a 90-year-old make it to 93, our healthcare will be expensive. Whether we should do that is a value decision and a matter of opinion, likely without a “right” answer.

 

[SoonerAviator]

I'm a bit surprised Nate @denverpilot hasn't chimed in yet.

 

[danhagan]

Now we'd have to pay thousands of dollars just to meet our annual deductible. WTF?!

I blame Obamacare, because that's when the shift seems to have occurred, but it could be coincidental. Either way, where the heck is the money going? We are paying more, but getting less.

You are correct regarding Obamacare ... yes it is separate from private insurance, but they all bounce off of each other stating, "this is how medicaid, medicare, Obamacare handle this claim." Your premium covers those not paying and unhealthy. If you change to government insurance, there is an unwritten ACA restriction on major medical expenses after 75 years of age (I've had DOZENs of patients hit it and get denied). So get a physical to exclude need for hip or knee replacement as well as coronary artery bypass graft (CABG) prior to 75 years of age ... you need to have a secondary insurance to block the above, but not sure how long that will work ...

 

[Clip4]

I want to what happened? We used to pay for insurance and our deductibles were small. I had gallstones 20 years or so ago and our portion of the bill was something small, like $100 or $200. Now we'd have to pay thousands of dollars just to meet our annual deductible. WTF?!

I blame Obamacare, because that's when the shift seems to have occurred, but it could be coincidental. Either way, where the heck is the money going? We are paying more, but getting less.

Before I got married, when I was young, healthy and "indestructible", I got major medical insurance. It was effectively what we have now. I had a $5,000 deductible, so basically just good for hospital visits; which was fine as I rarely needed to see a doctor. It was dirt cheap. I forget how cheap, but it was so low I paid for it in one annual bill, not monthly.

So, where the heck is the money going? We're not paying two or three times more than that, we're paying 70-100 times more. It's nuts.

If you had any experience pricing employer health insurance you would realize passage of the ACA had nothing to do increase in health insurance costs. Check out the graph.

https://www.healthsystemtracker.org...hcare-changed-time/#item-usspendingovertime_1

 

[David Megginson]

Healthcare is never "free", but it can be overpriced.

Many Americans pay for their healthcare 2× — once through their taxes (to cover VHA, Medicare, and Medicaid) and again through their health insurance.

People in most other rich countries pay just once — other countries manage to provide healthcare for everyone at about the same cost the U.S. pays (population-adjusted) just to provide healthcare to veterans, the elderly, and the poor.

The ACA failed to fix that, because a big part of the problem is paperwork for all the different private insurance companies.

Back in the 1990s, there was a study (from memory; link long misplaced) comparing a Canadian and American hospital — at the Canadian one, nurses spent 90% of their time on patient care; at the American hospital, they spent 90% of their time on paperwork. It might be a bit better now with the HL7 automation initiatives, but I'll bet it's not much.

In Ontario, we're single payer — doctors, hospitals, and labs mostly aren't government-run, but everyone bills OHIP, so there's never any question about what's covered, what tests are authorized, what co-pay is required (none), etc. It's the same for everyone, from a billionaire to an unhoused person sleeping on a heat outlet. That lets doctors and nurses spend a lot more of their time with patients, hence the lower costs.

We have problems too, of course, so please don't take this as a claim our system is better in every way; we just don't make Canadians pay twice for healthcare, like Americans have to.

 

[Let'sgoflying!]

The only solution is to be broke.
Either that or so filthy rich you can self-insure.

 

[EdFred]

The only solution is to be broke.
Either that or so filthy rich you can self-insure.

There is a third approach...

 

[wayne]

If you had any experience pricing employer health insurance you would realize passage of the ACA had nothing to do increase in health insurance costs. Check out the graph.

https://www.healthsystemtracker.org...hcare-changed-time/#item-usspendingovertime_1

Not sure how that shows that as it starts went ACA was passed. Wouldn't there need to be some prior history data to show that?

 

[David Megginson]

The only solution is to be broke.
Either that or so filthy rich you can self-insure.

That's a good point, and it must make some Americans reluctant to leave a salaried job with health insurance to strike out on their own (consultant, entrepreneur, etc).

When I left a senior IT job in Ottawa, Ontario to go independent in 1998, we had two small children and a new mortgage and my spouse was working only part-time, but among all the other stresses I at least didn't have to worry about health coverage.

In the event, I earned more as an independent (hence airplane ownership 3 years later), and the government has ended up with more tax money from me to cover healthcare for the next round of independents and entrepreneurs. Socialised medicine strangely turns out to be a good fit with free enterprise.

 

[Clip4]

Not sure how that shows that as it starts went ACA was passed. Wouldn't there need to be some prior history data to show that?

Look at the 2nd and 3rd graphs, they go back to 1970 when health insurance rates started ramping up.

if you read further you will see prior to the ACA health care costs vastly exceeded inflation and now there are only slightly outpacing inflation.

 

[Clip4]

The only solution is to be broke.
Either that or so filthy rich you can self-insure.

Actually there are a lot of broke people for tax purposes with free insurance. When the market busted in 2008 the smart people switched their taxable retirement accounts to Roth and paid the taxes. They retired in their 50s when the market recovered and qualify for subsidized ACA plans because they have very low taxable income.

 

[wsuffa]

What I think we did with the ACA was have a massive national argument over the merits and disadvantages of capitalist vs socialist style health care models. (And to be fair they both have advantages and disadvantages). Then what we actually did after all the arguing was make a system with all the disadvantages of both and few of the advantages of either.

Something is going to have to change because whatever side of it you’re on, this is just ridiculous.

It does need to change, but just moving to government single payer isn't going to fix it. Much deeper fixes are needed. I have mentioned my thoughts in the past (elsewhere), but IMHO it's going to require "burning to the ground" quite a bit of the current system. And we all know how that sort of thing goes.

Here's an example: right now I have something in my craw about the state vaccine registry where I live. I can't get my own records without applying to the state registry staff, then having a phone call with them to explain why I might possibly want the records, beg if necessary, then hope they approve the request, then wait however long it takes to get them. That's just for simple medical records of what was injected into my body. And if it's wrong (or the state doesn't deign to give me my own records), I need to find a medical professional with access to get the records or request correction of the records - at whatever the cost is of an office visit. Yeah, I maintain my own records, but I want to make sure the two are alingned. And if I happen to move out of state, there's no easy way to transfer the records to the new state's registry. So *if* I need to prove the Covid vaccination beyond the handwritten card, I've gotta go through the hassle and hope that the provider of said shots into my arm entered the data properly.

Something that should be simple is now something much more complex, time-consuming, and costly. Even the Social Security agency is better (and they still use fax for submitting documents...).

Without fundamental change, the cost structure and functionality won't change. But achieving such fundamental change will (in our current political environment) end up not being in the best interest of the individual - it will be highly influenced by folks that may get their ox gored. It will make the fight over BasicMed look like child's play.

 

[Sac Arrow]

The last time I banged myself up in a motorbike accident in Vietnam, I went to the ER, and got several stitches and lots of bandages. I went to the high end hospital, the French hospital that caters to travelers and wealthy locals. My total bill was $250 and that was with no insurance, which, isn't really a thing there. If I went to the hospital the locals go to, the bill would have been more like $25 dollars, but the wait would have been longer.

Heart attack? Your hospitalization, and stint is going to be on the order of a few hundred dollars at the general hospital, which is basically your insurance copay for the same treatment here.

 

[kyleb]

It's a very important point in this conversation.

The point I was making is that insurance is downside protection.

I’m fully aware of where the money comes from, but that isn’t/wasn’t the focus of the thread.

 

[Palmpilot]

I see very few overweight people in San Francisco, probably for the same reasons as NYC. Not only that, SF has a more moderate climate. Rarely too hot, never too cold for outdoor activity. When I first moved here I was surprised at the number of people who didn't own a car. Even though I'm older, I'm in better shape than when I lived in Colorado and worked. As a pilot, the only exercise I got was loading baggage...

In the San Francisco suburbs, on the other hand, getting out of shape and becoming overweight are very easy!

 

[EdFred]

Socialised medicine strangely turns out to be a good fit with free enterprise.

Unless you don't want to take part in it. Which is where I am at. So no. It's not a good fit.

 

[Sluggo63]

I’m fully aware of where the money comes from, but that isn’t/wasn’t the focus of the thread.

Huh. I thought that was exactly the focus of the thread.

 

[overdrive148]

My dad thinks that anyone who gets cancer and can't afford insurance or treatment can just "go get a government job". Easy peasy.

 

[Llewtrah381]

A few thoughts as I see "socialized medicine" mentioned in this thread.

First, I'm not an economist. It has been handy, though, to think of socialism and capitalism as two tools - not two religions. Both tools are good - and bad - fits for different tasks.

Second, we have far more socialism in the US than people - including people "opposed to Socialism" - are aware of. In fact, those "opposed to Socialism" are often the most adamant supporters of our socialism. Our US military has got to be one of the most socialist entities in the world: the "government controls the means of production"; its members are provided with benefits - for life - regardless of stature or even performance; and other "measures" of socialism. Police, fire response - all socialized. We all get the benefits of all of those services ostensibly without regard to how much we paid into the system (I get police and fire "support" in a city far from home regardless of where I live and that I never paid into their coffers). Even education is socialized; public schools are available to all, and civilian/religious schools still must teach to a government-set curriculum for their education to be recognized.

Third, we WANT those services socialized. Fire departments used to be for-profit and competitive (go watch the end part of Gangs of New York). The only "capitalist police force" I can think of - is the Mafia (OK - rent-a-cops in the mall too - but I thought that was an interesting observation). And nobody can realistically "opt out" of them (you can't not be protected by the police or fire department, even if you're not a citizen).

With regard to socialized medicine, again, there is no more socialized medical system in the world than for the US military - TRICARE. And oddly enough, those who "oppose socialism" were the loudest voices calling for free TRICARE for life for retirees (I was on the front lines of that skirmish years ago). I see mention of a $1,000 ER copay. My copay is $63 for ER and $21 for Primary Care or Specialty visits for TRICARE. And catastrophic caps? TRICARE is upside-down compared with most other health plans. As a retiree my cap for my plan is $3,000. That means I won't pay any MORE than $3,000 in a given year. That includes enrollment fees(!), deductibles, copays, and pharmacy charges. Again, that's driven by national support for the military. One can say the military deserves it because of their service at salaries often lower than non-military plus their sacrifice. All valid. But still it's socialized.

All of the countries I can think of with better health outcomes than ours (life expectancy, etc.) are well-performing capitalist countries with socialized medicine (in addition to their socialized First Responders and education systems). As I mentioned in an earlier post, the US got here in an odd way, with healthcare insurance starting as a "differentiator" when salaries were capped.

I'm not trying to provoke an argument. I'm encouraging those who may not have seen these sides of the issue to be aware of them and give it some thought. Heck - I'm on TRICARE for Life, so I'm set (and THANK YOU for getting your taxes in on time! ). I just wish the rest of the country could have the same level of healthcare economic security I have. It would allow people afraid to lose their coverage for their chronically ill child the opportunity to more easily find a better job, among other things.

 

[Llewtrah381]

A thought for anyone who truly wants to "opt out" of carrying health insurance here in the US: what would your position be if the US didn't have EMTALA - the law that says, if you take Medicare payments, then ANYONE who comes into your ER (even non-Medicare) must be treated and stabilized? Even "not-for-profit" hospitals operate at a profit. They do not get reimbursed completely for the "free" care they provide because of EMTALA (the math is complicated but they typically don't get reimbursed even their actual cost in most cases, let alone their billed charges). No auto repair shop would fix your car for free if you showed up and didn't promise payment. No hotel would give you a room, restaurant give you a meal, etc. for free. Why would a purely capitalist hospital do so?

If EMTALA was suddenly repealed, I suspect there'd be a LOT more support for universal healthcare in the US. As it is, EMTALA creates a false safety net that, unfortunately, reduces the motivation to fix the problem.

 

[SoonerAviator]

A few thoughts as I see "socialized medicine" mentioned in this thread.

First, I'm not an economist. It has been handy, though, to think of socialism and capitalism as two tools - not two religions. Both tools are good - and bad - fits for different tasks.

Second, we have far more socialism in the US than people - including people "opposed to Socialism" - are aware of. In fact, those "opposed to Socialism" are often the most adamant supporters of our socialism. Our US military has got to be one of the most socialist entities in the world: the "government controls the means of production"; its members are provided with benefits - for life - regardless of stature or even performance; and other "measures" of socialism. Police, fire response - all socialized. We all get the benefits of all of those services ostensibly without regard to how much we paid into the system (I get police and fire "support" in a city far from home regardless of where I live and that I never paid into their coffers). Even education is socialized; public schools are available to all, and civilian/religious schools still must teach to a government-set curriculum for their education to be recognized.

Third, we WANT those services socialized. Fire departments used to be for-profit and competitive (go watch the end part of Gangs of New York). The only "capitalist police force" I can think of - is the Mafia (OK - rent-a-cops in the mall too - but I thought that was an interesting observation). And nobody can realistically "opt out" of them (you can't not be protected by the police or fire department, even if you're not a citizen).

With regard to socialized medicine, again, there is no more socialized medical system in the world than for the US military - TRICARE. And oddly enough, those who "oppose socialism" were the loudest voices calling for free TRICARE for life for retirees (I was on the front lines of that skirmish years ago). I see mention of a $1,000 ER copay. My copay is $63 for ER and $21 for Primary Care or Specialty visits for TRICARE. And catastrophic caps? TRICARE is upside-down compared with most other health plans. As a retiree my cap for my plan is $3,000. That means I won't pay any MORE than $3,000 in a given year. That includes enrollment fees(!), deductibles, copays, and pharmacy charges. Again, that's driven by national support for the military. One can say the military deserves it because of their service at salaries often lower than non-military plus their sacrifice. All valid. But still it's socialized.

All of the countries I can think of with better health outcomes than ours (life expectancy, etc.) are well-performing capitalist countries with socialized medicine (in addition to their socialized First Responders and education systems). As I mentioned in an earlier post, the US got here in an odd way, with healthcare insurance starting as a "differentiator" when salaries were capped.

I'm not trying to provoke an argument. I'm encouraging those who may not have seen these sides of the issue to be aware of them and give it some thought. Heck - I'm on TRICARE for Life, so I'm set (and THANK YOU for getting your taxes in on time! ). I just wish the rest of the country could have the same level of healthcare economic security I have. It would allow people afraid to lose their coverage for their chronically ill child the opportunity to more easily find a better job, among other things.

While I understand your point, I think calling Tricare/military "socialism" is a pretty big stretch of the definition. Lifetime medical benefits for military benefits/service is part of COMPENSATION for that patriotic duty. The only way it can be seen as socialism is because the US taxpayers fund the military (and every government entity). It's socialism in the loosest of terms. It's no different than a current private corporation having a defined benefit pension plan, which provides a benefit for life. Police/fire/etc. sure, it's a socialized emergency service which is better served that way (even for a small-"L" libertarian like myself). The area where socialized services starts to become a preferred mechanism is when you have a monopoly or severely-limited choice (like life-saving medicine) when shopping around is feasible or possible. If my house is on fire, I don't really have sufficient time/opportunity to call up 3 different fire departments (assuming there were that many in proximity) in order to keep my house from being a total loss. Same goes with an intruder in my house. I would love for there not to be our current system of health insurance, especially not linked to my employer. Cutting out the middle-man (insurance companies) would save a TON of paperwork, cost, and unnecessary bureaucracy, but it would just get replaced by gov't bureaucracy and their pretty-much guaranteed track record of making things worse.

 

[Llewtrah381]

It's no different than a current private corporation having a defined benefit pension plan, which provides a benefit for life”

Actually, I’d say there is a difference and it’s the difference in definition between socialism (government-provided/controlled) and capitalism (privately provided/controlled). There are laws very strictly defining the benefits for TRICARE, pay, military retirement - even promotion. There aren’t the same laws on the private side for those things - at least to the same level of detail and execution.

Food for thought…

 

[SoonerAviator]

Actually, I’d say there is a difference and it’s the difference in definition between socialism (government-provided/controlled) and capitalism (privately provided/controlled). There are laws very strictly defining the benefits for TRICARE, pay, military retirement - even promotion. There aren’t the same laws on the private side for those things - at least to the same level of detail and execution.

Food for thought…

Lol, I agree that the military itself is an example of a socialized service. I do not believe that them having lifetime military health benefits is socialism. I think that's where I differ with your point. If the US military suddenly started using BCBS as their healthcare insurance instead of Tricare, would it suddenly stop being socialism?

Also, I'm very aware that there are lot's of laws/regulation in regard to military (or any other government job) pay/retirement/promotion. It's not exactly secret knowledge.

 

[wayne]

A few thoughts as I see "socialized medicine" mentioned in this thread.

...

I'm not trying to provoke an argument. I'm encouraging those who may not have seen these sides of the issue to be aware of them and give it some thought. Heck - I'm on TRICARE for Life, so I'm set (and THANK YOU for getting your taxes in on time! ). I just wish the rest of the country could have the same level of healthcare economic security I have. It would allow people afraid to lose their coverage for their chronically ill child the opportunity to more easily find a better job, among other things.

First, thank you for your service. You are welcome to the benefit.

Those are not socialism, other than maybe the Fire Department. We've largely shifted to thinking of that as a function of government, like the police. For those that don't know, long ago the for-pay fire companies would sell their service like an insurance plan. You would put a medallion / plaque on the outside of your home / business. If there was a fire the fire companies would all rush to the fire. If their medallion was there they would put out the fire. If not, they wouldn't. Yes, they would stand around and watch, or go back to there "station". If a nearby structure was covered by them they would stay and protect that structure and customer. Most likely they went away from a combination of too many structures too close together risking the whole town if a fire got out-of-hand; which has happened to pretty much all cities over time, often multiple fires destroying large parts of the town, plus the inefficiencies of multiple fire companies having to show up to see if it was their customer. Plus there could have been some bad companies and people losing their homes / businesses to fire companies that couldn't save them. Nowadays Fire Departments spend far more time doing rescue and EMS work than fighting fires.

Countries have tried mercenaries, and some still do in small parts, but largely they have found it doesn't work. Hard to get someone to put their life on the line for money. Plus, it's easy for someone else to pay them to not fight.

For profit police? That would make the corruption of third world country police look like child's play.

The military and the police are functions of government. They are the enforcement arms of the State Department and Legislature. So, definitely not socialism. TRICARE is a benefit for those that have worked for the military. Another form of compensation.

Fire Departments could be for-profit, but we have decided they work better for society as a whole as a function of government; for right or wrong. Seems to work well.

Education is definitely socialism. There are those that argue it is not working well. There are certainly options, but unfortunately largely only to those at higher incomes. Even home schooling is expensive as some adult has to not work for a living to education the child / children. Like Fire Departments, this also was not always the way it was done in the US.

 

[David Megginson]

It has been handy, though, to think of socialism and capitalism as two tools - not two religions. Both tools are good - and bad - fits for different tasks.

Couldn't agree more. Experiments in extreme "capitalism" (free markets) and extreme "socialism" (Soviet collectivism) both crashed and burned in the 1930s with the Great Depression in the West and the famines in the USSR. Since WWII, all rich countries — including the U.S. — have been social democracies, combining socialism (government spending) and capitalism (private spending) in roughly equal measure, and it's worked well.

Each country makes different choices — Canada has privatized ATC and socialised healthcare, for example, while the US has socialised ATC and privatized healthcare — but in the big picture, the differences aren't nearly so significant as the loud left/right political zealots want us to think.

 

[Llewtrah381]

I do not believe that them having lifetime military health benefits is socialism.

Again (and, again, not intending to be argumentative), a lifetime, government-guaranteed and government-defined ENTITLEMENT to health benefits fits into most understandings of socialism I'm familiar with but I'm not a political science major.

If the US military suddenly started using BCBS as their healthcare insurance instead of Tricare, would it suddenly stop being socialism?

Not sure how familiar you are with TRICARE but, indeed, BCBS was the administrator of several TRICARE regions several decades ago (when there were 12 - or 11 - depending on how you counted). Their claims processor, PGBS, was the primary one for TRICARE, too. In any case, to your point, there still are contracted program administrators for the two remaining CONUS regions. Those contractors administer a legislatively-controlled benefit and entitlement (which, IMHO, makes it "government-controlled production of healthcare for military beneficiaries" and therefore "socialized"). BCBS, as do all health insurers, administer benefits for others. Sometimes "others" (employers) pick from a menu of benefits BCBS has set up and sometimes that menu is altered. They also have plans for those buying insurance on their own. In any case, I don't see the government ever saying "TRICARE beneficiaries can go pick whichever BCBS plan they want and we'll pay for it".

At the risk of getting in the weeds, there are also some "carve-outs" for what are called USFHPs - but their benefits and eligibility mirror TRICARE's.

Also, I'm very aware that there are lot's of laws/regulation in regard to military (or any other government job) pay/retirement/promotion. It's not exactly secret knowledge.

But those laws are what make the US military socialized, IMHO. Similar for police, fire, etc. They don't exist to anywhere near the same degree for private "capitalism" jobs.

 

[Chip Sylverne]

Just a little story.

By dint of luck or lifestyle, both my in- laws have pretty much the same heart condition. both are retired educators, and as such have excellent insurance. . My MIL goes to an independent heart specialist, has been on the same regimen of drugs for years and is doing quite well at 92. No surgeries, no devices, just some medication and mild exercise. Sees the Doc every 3 months for a meet and greet.

My 91 year old FIL on the other hand, goes to a large practice in a big, shiny building. Over the last couple years, he has been admitted to the hospital may 4 times for procedures, but nothing emergent. Between the hospitals, labs, imaging, surgical and other sundry items, the tab has been close to $2 million, with maybe $2k out of pocket. They jack with his meds constantly. This last time around we all thought we'd be hanging crepe in weeks. He's doing well now, knock wood.

You will never convince me medicine as practiced by a large portion of the industry in the US is about keeping people healthy. Changing that cash-cow culture would take goring a lot of oxes.

 

[Llewtrah381]

The military and the police are functions of government. They are the enforcement arms of the State Department and Legislature. So, definitely not socialism.

Can you tell me how you define “socialism”? I thought I knew until I looked it up - and got even more confused.
It’s not the same as communism and, like capitalism, there are different types (e.g. laissez faire). And it’s not “if it’s bad government it must be socialism”.
Again, I knew full well at the start of my post that it would be hard for people to step back and think about - and I’m not saying I’m right. It is good to ponder, though.

 

[Llewtrah381]

You will never convince me medicine as practiced by a large portion of the industry in the US is about keeping people healthy. Changing that culture would take goring a lot of oxes.

The US system is heavily skewed towards “doing” - not “preventing”.

By contrast, although firemen are real heroes and deserve recognition for putting their lives on the line, PREVENTING fires is far more effective. And that’s done with mundane things like the electric code, UL listing, fire inspections, etc. Our health system values the interventional cardiologist who put in the stent more than the dietician who cajoled a patient into eating properly, the gym coach who teaches a kid a lifetime of good physical fitness, etc.

 

[172andyou]

Ours system is certainly broken and a very poor system, its just better than the rest.

By what metric?

It's twice as expensive as the rest.
It's last among developed nations in equity (meaning you have to have money to get decent care)
We are last among developed nations on life expectancy
We are last on among developed nations on efficiency
Our obesity is twice the OECD average
We do ok at screening, but it doesn't translate to life expectancy, so does it matter?
We have better access to MRIs, new hips and things like that, but only if you're wealthy. And, guess what, if you're wealthy in other countries you can get that stuff too.

I really have a hard time saying that the US is better than the rest in much of anything, much less enough to justify that it's twice as expensive.

 

[EdFred]

What's the population of those other countries again? Easier to do things more efficient and cheaper on a smaller scale with certain things. Then add in lawyers and malpractice. Let's make the starting data equal before we start making comparisons.

 

[Chip Sylverne]

By what metric?

It's twice as expensive as the rest.
It's last among developed nations in equity (meaning you have to have money to get decent care)
We are last among developed nations on life expectancy
We are last on among developed nations on efficiency
Our obesity is twice the OECD average
We do ok at screening, but it doesn't translate to life expectancy, so does it matter?
We have better access to MRIs, new hips and things like that, but only if you're wealthy. And, guess what, if you're wealthy in other countries you can get that stuff too.

I really have a hard time saying that the US is better than the rest in much of anything, much less enough to justify that it's twice as expensive.

Profitability?