Warren Buffett Says America Is "So Rich" It Can Afford Single Payer

[Gotcha]

Lets compare healthcare to police or firefighters. Imagine if you had to first pay up front before a cop ran after a bad guy for you, or pay the firefighters before they even put on their suits and started the truck even though your house was already on fire. This would seem crazy!

Yet, its like this with healthcare in the US. All this bickering back and forth that the politicians are doing is missing the first question, does everyone matter? Its obvious not everyone matters, but they want to make it sound like they do. When you call the cops or the firefighters, they usually don't know who they are going to help. The guy shot on the corner in New York could be a homeless man or some rich broker. (of course in poor cities, its a bit different cause clearly everyone is poor) But nevertheless, for the most part, anyone in need of police or firefighting gets it because its obviously a general good for society as a whole to catch bad guys and put out fires.

So I think before any major changes to healthcare happen, they need to just put it on the table that some people don't matter and hence aren't going to be included in how healthcare gets fixed. (In some ways, I almost think it costs more money to exclude people than to offer everyone basic services.)

If the government started with the mandate that everyone will get healthcare, no matter what, industry would find a way to make it work. It would either involve higher taxes, less corruption, smaller wages for overpriced doctors, more pushback on expensive meds or supplies, etc. But you can damn well bet that if you start with a clean slate and state the fundamental factors, that each person will have access to basic healthcare, things would be different. I really do believe it would be cheaper to offer everyone free healthcare and get on with it, than spending so much time and effort trying to figure out who to leave out and how to do it.

 

[beerntrading]

True the cost of medical malpractice is about 2%, but the 0.5% I am referring to is what the insurance companies actually pay out in claims and legal fees. The 2% is what they collect in premiums. A very profitable business.

As for unnecessary tests, fear of malpractice is not the only reason. More than 50% of the time that a doctor sends a patient for a test, the doctor has a financial interest in the lab or hospital where the he sends the patient to get the test done.

Well, "cost of malpractice" is the additional out of pocket to patients. Arguably, this is north of 50% of the cost of medical care.

Consider one doctor who rather than diagnosing definitively, cheaply treats as though it's the most likely culprit given the symptoms. Compare that to another doctor who rules out every possibility through tests, definitively diagnoses and provides the exact same treatment. The outcome is the same for the majority of patients. For those that have the rarer disease, they only lose out if the disease advances faster than the time between the prescription, and determining it's not reacting to treatment plus the time for the test. For less likely, but severe and fast spreading diseases, you rule these out up front, or treat in parallel with the likely disease.

In aggregate this will provide effectively the same level of care in either situation, but will be cheaper AND less invasive in the former. Comparing Cuba and the US provide a reasonable jumping off point to consider this dichotomy. The difference in cost (as a percentage of gdp) is about equal to the cost of malpractice as born by the patient.

 

[tommcginnis]

...So in essence what this has created a situation where we have gone from the following in a twenty year period:
1999 - minimal treatment available - people died quickly after receiving low-cost subpar generic drugs.
2000 - my former company launches wonderful life-prolonging drug - people live longer, but payers are now shelling out $60,000 for treatment.
2017 - 9 competitor products have emerged - people live as if they do not have the cancer, but often receive numerous types of therapy, each requiring payers to come up with $100,000 per therapy.
... When you think of things in those terms, it is no wonder healthcare costs are skyrocketing.

Except that pharm companies know that pricing in the U.S. is grossly price-insensitive -- argue it eight ways to Sunday, it's still a fact that going outside the U.S. will (DOES) benefit the patient. So who pays? Those who cannot afford to travel -- those who have no viable alternatives -- those who are sickest, those who are poor.

Again -- an issue addressed by getting intermediaries OUT of the medical service money-flow. Get a freed end-consumer a mouse and a PayPal account, and everyone globally will pay the same price. Again -- the U.S. has constructed this problem over the last decades, by interfering between the consumer/patient, and the doctor/allies.

 

[DaveV]

Comparing Cuba and the US provide a reasonable jumping off point ...

When it comes to healthcare, you may not want to compare Cuba to the US -- it may make the US look bad.
Cuba average life expectancy 79.4 years;
US average life expectancy 78.9 years.

 

[beerntrading]

When it comes to healthcare, you may not want to compare Cuba to the US -- it may make the US look bad.
Cuba average life expectancy 79.4 years;
US average life expectancy 78.9 years.

Well, that difference is tiny and modest compared to the cost difference.

 

[NeoTrader]

It's sad to see that americans are going down that road, just as Europe did. I'm not american. I'm a physician from a shitty latin american country that has it written its constitution: "A saúde é um direito de todos e um dever do estado.."(Healthcare is everyone's right and a duty of the state...). That single sentence destroyed everything from the start. Something that had always been a disaster, got much much worse. I was taught that BS like a mantra all the way through college and the result of this? A health system that is a total catastrophe, with countless people getting horrible services, literally dying and/or getting permanently damaged because of this fairy tail(along with all the other socialist fairy tails that rule here) that sound beautiful, but have monstruos consequences. I have lived in Europe as well, in more than one country there, and despite what people normaly believe, they have "amazingly" the same flaws, only in different proportions, which is in the process of changing too, for the worse, of course. More than 50 years ago, Milton Friedman already spoke of the disastrous path the USA was in. Things like licenciature for doctors, the AMA as the "doctor's Union" and one of the strongest unions in the country, despite most people not regarding it as such. Restriction on immigration(which could bring doctors from abroad to compete with american doctors, lowering prices and making services better, but was a "necessary evil", because of the welfare state...) And the list goes on. Since then, despite all the logic in his arguments, which were based on concepts that made the USA the great country that it was and, in a way, still is, things only got worse. These things I mentioned and from which he spoke are not even brought up anymore, which shows the level of ignorance that rules today, even in a country that was built based on freedom. Here's an interesting video on the subject:

 

[java]

No kidding, once you claim healthcare is a right and people can't get it without government assistance we're not even arguing in the same century anymore.

 

[tommcginnis]

No kidding, once you claim healthcare is a right and people can't get it without government assistance we're not even arguing in the same century anymore.

Is it your right to travel on safe, speedy roads and bridges? No.
Is it your right to have somebody blasting the atmosphere for meteorological study? Does the Constitution mention "weather"? Space/NASA? Geology?
Not directly!
And yet the stretch is not too far, to say how much better our society is, with such things. I used to point my students to early private-sector space efforts, and tell my students, "Within your lifetime, "space" as we know it, will be a *private sector* deal." That was in the eighties -- things have happened a lot faster than I thought!
If you lived in Tornado Alley, you would definitely observe how much positive impact has come from NOAA.
And roads! Sheeesh.
At one point, three of my favorite Nobel Laureates were alive and had one the Nobel -- these three all had time in publicly-funded community colleges as students. Hello.

But here's the thing you already know:
Having or claiming "a right" does not make anything into someone else's responsibility.

Making that conflation is a lie.

g'night.

 

[ET180]

smaller wages for overpriced doctors

What makes you think that doctors in the US are over-priced? Because they make a lot of money? My brother is currently in med school and doing well, but has worked harder for the past 4 years than I have ever had to work in my entire life. Doctors deserve every cent they make. Malpractice risks / high stress, decades of school, decades of debt accumulated before even the first paycheck, several 9-hour qualifying exams, tests every week for the first year, not knowing which medicine one should practice, not knowing for sure whether one will even like being a doctor, working around sick and dying people, working through the night / odd and long shifts, not knowing or always having a choice where one will be placed for residency for several years of one's life...yeh, they earn their paychecks and I would be completely fine with them going on strike every few years for higher pay as many with a small fraction of their work-ethic do to extort higher pay. Doctors have to be pretty sharp. Few smart people would be willing to face such risks when there are many other things that they could be doing which would generate more money for less risk and stress.

The rich will always have access to better medicine if they are willing to pay cash.

 

[java]

The rich will always have access to better medicine if they are willing to pay cash.

That's the socialist way. One for the people. And a second one for the government, their friends and the people they helped get wealthy. The one for the people will be the bare minimum better than nothing one. The so called private one will be state of the art.
Buying healthcare could be as simple as buying a muffler for your car because most muffler repairs are not covered under car insurance. There is no reason I can't get a check up in about an hour at the mall. I can get an eye exam and glasses there. Oh, most eye care is not covered under insurance. Now they charge an arm and a leg for bodywork, and everybody knows it is not priced right, and before they even look at the damage to give you an estimate they ask what your deductible is.