FYI: Parents are not forced to carry their adult children on their medical. ACA only requires that insurance providers who offer dependent coverage are required to offer the coverage until those children are 26. The parents can kick them off if they choose as well as those children can quit the same coverage. Perhaps you may want to recheck your facts.
[NA] Health Insurance. US vs. Elsewhere
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Morgan3820
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For 89bil/yr we could have covered that small slice of adults in the 55 to medicare bracket that didn't have access to a employer plan many times over.
Lumping the kids on their parents employer plan just drove up premium cost for everyone. While young adults are cheap, they are not free. All it did is to further the trend that sees everyone up to age 30 as overgrown children who live in their parents basement and leech off dad's cellphone plan.
And whether the parents are 'very happy' is honestly quite irrelevant when it comes to deciding issues of healthcare policy.
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danhagan
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I've worked on patients from many countries, and their systems are horrible - and we're heading their direction. I was averaging 5-6 from Canada per week way down here on the SOUTHERN border as NY, Chicago etc. were too full (pre-COVID, now they can't come). ALL of mine were breast cancer patients that didn't want to wait on a list for 1.5 to 2 years for treatment. Some were mismanaged and in their country you get "one bite at the apple" for treatment ... if you're foreign doc screwed up, too bad no more treatment.
Had a USA ACA breast cancer patient here a last month that her father sold retirement assets to pay for breast cancer surgery at MD Anderson as only one surgeon here locally accepts ACA and he now has a one year wait ...
Morgan3820
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Hmmm, UNC Chapel Hill, thanks for the out of state tuition.
172andyou
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Nope. Other developed nations live longer *and* cost less.
172andyou
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The median wait time for breast cancer in Canada is 16 days.
https://www.cancercareontario.ca/en...ng-appropriately-assigned-surgical-wait-times
EdFred
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Define cost less. Costs less to the individual at the time? The procedures cost less whether I pay for it out of my pocket? Cost "less" because it's "free" but paid for by a higher tax rate? Less because doctors else where make much less?
If I pay, say $1,000,000 in taxes that goes towards "free" health care over the course of my life, and I only use the system once and the out of pocket at the time would have cost me $5,000, $50,000 or even $500,000 that certainly didn't cost less for me.
So how are you defining less?
PaulS
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If you self pay insurance, carrying an adult child costs more than ejecting them. The first year or two after this was allowed, it didn't matter, but then the insurers smartened up. My son didn't want to pay for the insurance he had at his job during the that time, which was like $50 a month. The next year, we got the quote both with and without him and it was about $600 more with him. I gave him the option, if he wanted to stay on my plan he could pay me the $600 or what ever it was. He chose his company's plan. The job he has now he pays nothing.
172andyou
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Meaning the total cost in most developed nations is about half the cost of total cost in the US. I was talking about the money spent, not how the money was gathered.
And, yes, if you buy insurance for your whole life (or pay taxes) and never get sick, then you will have spent money you didn't benefit from.
And, yes, if you buy insurance that costs you a million in your lifetime and your lifetime medical costs are two million, then you avoided medical bankruptcy.
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The US is pretty far down the list as far as life expectancy is concerned. Some of the Asian demographics have many countries beat by a landslide. My guess is the wide array of lifestyles found in the US.
EdFred
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Cost of what though?
It's cheaper to live in Haiti than it is the US. So what's this "total cost" exactly in reference to?
Also edited my previous post.
172andyou
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172 Guy
Cost of care.
172andyou
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Yeah, it's a complicated issue to disentangle.
EdFred
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Specifics please. And a better definition than that.
How is the cost being defined? And how does that related to the average pay for those providing the services?
How is this cost being paid for? Who is paying for it? And how is it less?
David Megginson
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There's a lot of special pleading around health statistics for the U.S. Everyone time someone finds a negative one, there are a pile of special, overly-elaborate explanations about why it's not really true and the U.S. is a special case. Every country has unique circumstances, but most of them cancel each-other out in the big-picture statistics, and if a lot of different indicators are pointing the same way, it's time to admit that maybe the problem is real.
My own country, Canada, should also be taking a hard look in the mirror. We're also behind other countries on some health indicators, but having the U.S. as a neighbour lets us get away with pointing south and saying "at least we're not that awful" instead of actually getting off our behinds and doing something to climb up in the OECD rankings. If the U.S. ever actually cleans up its act with healthcare, we'll be forced to clean up ours, too, and that won't be a bad thing.
172andyou
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This was posted earlier and answers those kinds of questions. tl;dr the US is very expensive compared to nations of similar economic maturity.
https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
EdFred
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That article in that link is still too ambiguous. There are no specifics as to treatment X costs this in country Y and costs this in the US.
"Health spending" could mean anything.
For poops and chuckles I just pulled up our neighbor to the south.
Cancer treatment in Mexico costs 50-70% less than here in the US, but the GDP per capita in the US is 3.5 times higher than in Mexico. So does it really cost less?
172andyou
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https://www.investopedia.com/articl...healthcare-costs-compared-other-countries.asp
There are thousands of articles like that.
"For example, the average cost in the U.S. for an MRI scan was $1,119, compared to $811 in New Zealand, $215 in Australia and $181 in Spain. However, data showed that the 95th percentile in the price of this procedure in the U.S. was $3,031, meaning some people are paying nearly $3,000 more for a standard MRI scan in the U.S. than the average person in Australia and Spain.
Or take a standard hip replacement procedure. The average cost in the U.S. is $29,067, which is $10,000 more than the next highest-cost country, Australia. However, the data show that the 95th percentile cost in the U.S. reaches $57,225, $50,000 more than the average price in South Africa and $42,000 more than in New Zealand. The results for knee replacements are much the same. Sackville added that the study suggests that the more expensive procedures are no better than the average or cheap ones."
Yes, it really costs less. Which is why tens of thousands of americans go to Mexico every year for medical care.
EdFred
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As a raw number, yes, but not as it relates to income. I can't believe I have to explain that.
As far as the rest of the numbers, you haven't answered WHY it costs less. I'll let you simmer on that for a while.
172andyou
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Correct. Affordability and cost are different things. Which is why it's more useful to compare economically similar nations, rather than the US to Mexico. When comparing to other developed nations, the US is very expensive.
EdFred
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Why is it more expensive though?
An MRI machine is an MRI machine whether it sits here or in Switzerland. So why is it pricier here to get an MRI done?
172andyou
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Correct, your question was "define less". So we've been talking about costs. If you understand that now and want to move the discussion to another topic, then have at it.
EdFred
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Less is also a red herring because you can't just look at raw numbers. And from the article you quoted....
the 95th percentile cost in the US is 3,000 more than the 50th percentile cost elsewhere. Wellll....DUH. I can't trust anything else articles like that might have when they write misleading snippets.
Plus the US has one of the highest incomes for doctors. Probably for nurses and techs too. Probably should just cut the incomes of those people.
172andyou
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If you want to propose that, go ahead. I mean, we have worse outcomes in the US, so it's not like we're getting any benefit by paying more, so I do see your point.
EdFred
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I'm just looking at it as having to factor a whole lot of why's into the reasons it costs more here. And not as a raw cost, but as a percentage of cost of living etc. Same reason an acre in Alabama costs cheaper than an acre in some big coastal city. Yeah as a raw number, but when you figure in local factors it might not be so far off. (OK it still is, but just a quick example)
College costs more, so doctors have to make more to pay off college which means they have to charge more.
Then we have FDA mandates for paperwork that does nothing to help with the costs.
Malpractice/liability
It's just not easy to say it costs more here and that is bad without looking into why.
172andyou
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If you want to propose that access to education shouldn't be as expensive as it is, I would understand your point on that also. It doesn't seem like the nation benefits by making education only available to the wealthy or those willing to take on tons of debt.
EdFred
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It also doesn't benefit us to say college education is mandatory for 90% of jobs out there. But that's what the past 30 years have been and the costs have gone plaid. It's become less available than it was 30 years ago.
And just to add, one of the main reasons for the disparity in comparing medical costs of the US to other developed nations is the US Tort Liability system. No other country has one similar. As I recall 5 or 6 years ago direct medical tort costs were over $19 billion to that sector. So while comparisons show other countries are "cheaper" when compared to the US, what would their costs be if they had the same tort associated costs? Even with the tort reforms passed in several states those costs still rise and someone pays for them usually through higher operating costs. So unless you can break out the effects of these tort costs on the US side any comparison is tainted. And same with any other large industry.
David Megginson
Pattern Altitude
11 years ago, liability costs accounted for about 2.4% of annual healthcare spending, according to this Harvard paper:
https://www.hsph.harvard.edu/news/press-releases/medical-liability-costs-us/
Because healthcare is a big-ticket item, that's a lot of money (into the billions), but just a sliver of the disparity in U.S. health costs.
I no longer enjoy access to the data or people, but I recall the total effect of tort on medical spending was closer to 6% or 7% per annum due to defensive medical costs and other external costs driven by tort actions. I could be mistaken, but I also recall the discussion back then was also driven by the average state of health in the US drove costs higher given other countries. I'm sure its still valid today, but one statistic I found interesting is that the US has more obese individuals than most other developed countries have total population. Regardless, having compared medical availability in several countries and my experience with the current ACA system here, I don't think the US system will get fixed until there are hard caps on tort costs and medical insurance providers are allowed to compete interstate vs the current intrastate.
David Megginson
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To account for the difference between (e.g.) Germany and the U.S. in total healthcare spending as percentage of GDP, the effect of tort would have to be in the 33% range. The U.S. spends about 1½ times as much as other rich countries (it used to be double back in the 1990s, so the gap has closed a bit). Also worth remembering that Canada and the U.S. both have relatively young populations compared to many other rich countries, especially Japan and some in continental Europe, so we're not facing the same level of geriatric medical costs that they are.
It's not liability premiums or payouts for medmal cases that are the problem with the liability situation. It is the way how it corrodes the practice of medicine and causes reasonable and competent physicians to practice in a entirely unreasonable and expensive manner. The outgrowths of that stupidity pay for most of my flying and a early retirement, but I still recognize that it is stupid.
kyleb
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Drake the Outlaw
Don't conflate the two issues. Living longer is largely a lifestyle choice. We eat more sugar and processed foods and are more sedentary than almost all other cultures. That isn't the medical field's fault.
The expense? Sure, it is much more expensive to have medical care in a society where you can easily get a joint replacement, a stent, an MRI or whatever. Those things are all expensive and almost nobody else has similar availability. Medical care in Crapistan is cheap. There's no access there, therefore no cost.
David Megginson
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We're comparing medical costs only with other rich countries. And eventually, it will be time to give up on making up excuses for every failure and accept that the U.S. healthcare system is in crisis (as is the healthcare system in most countries, but in different ways; in the U.S., it's a crisis of inflated costs and unequal socio-economic outcomes; in Canada, it's a crisis of capacity and unequal remote-community access; in Japan, it's a crisis of an aging population with too few young people left to pay the costs; etc. etc.).
PaulS
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Part of the problem with US runaway prices is that procedures and drugs that were once elective are now required to be covered. More and more things that used to not be covered are covered. Politicians are involved and it hasn't helped.
kyleb
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I don't question the fact that the US medical system has high costs. But there are systemic reasons. An MRI machine that runs 6 hours a day is an inefficient way to use an expensive machine. But US customers aren't gonna come to the lab at 10 at night to get an MRI, even if it saves the insurance company $500 because using the MRI 16 hours a day helps with overhead costs, since you need fewer MRI machines. The availability of medicine to people with money/insurance here is second to none and that ain't cheap.
kyleb
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And the level of service has changed. Again, Eisenhower got bed rest and nitro pills after his multiple heart attacks. Today, anyone with a pulse will get at least a stent and a multi-day stay in the ICU. The cost difference is astonishing.
David Megginson
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But again, is that drastically different from other rich countries in 2021?