It's not just unsustainable, it's absurd! $25,000 USD is most of, if not the entirety, of the TOTAL income taxes many people pay in other OECD nations. How are these other nations providing all of the functions of government, including universal health care, for what Americans are paying just for insurance? This shouldn't be a partisan issue - even the most conservative of Americans should be outraged that we are being ripped off.
https://data.oecd.org/healthres/health-spending.htm - the US spends $9,800/year per capita, clearly an outlier, and yet we still can't cover everyone in a reasonable way?!
I took my child in for a regular 15 minute doctors appointment recently and the cost of seeing the provider (no tests) was $350. Does it really cost $1,400/hour to operate a medical clinic? Google tells me that the average GP salary in the US is $189,000 ($90/hour), average salary for a nurse is $67,000 ($32/hour), and average for a receptionist is $27,000 ($12/hour). Add another nurse for administering shots/drawing blood and the total payroll per hour is about $166/hour. Where is the other $1,234/hour going?
I'm sure there are reasonable explanations for some of it (cost of the building, cost of medical equipment in the clinic, professional insurance, and maintenance on the fish tank) but the ridiculous cost of everything is the elephant in the room that no amount of "cracking down on fraud" or "incentivizing healthy behaviors" will solve.
As an immigrant to the US, it's maddening. It just doesn't have to be this way, there is half a century of evidence showing that alternative systems are cheaper and more effective. I also look at that $9,800/year per capita and wonder what our economy looks like if everyone had an extra $2-4,000/year in their pocket. Or if we eliminated the burden of health care from businesses and individuals trying to start a business.
This is similar to private universities charging rich students the full sticker price, while giving poorer students scholarships and financial aid.
http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf
(that's charity care and non payments but not any unfunded expenses due to Medicaid and Medicare)
Cost is the key word there and is bolded in the link. The billed amount they would have lost would be much higher. Most hospitals collect about only 25% of patient payments owed to them. When they write it down, they use the cost to the hospital not the amount billed.
What is interesting about the amount they attempt to bill?
In any case, if the patient gets charged $10 and doesn't pay, the hospital only writes off $5 as uncompensated care because that's the requirement for government reimbursement. But really they lost $10 on gross patient revenue. It scales up much higher as you can imagine. The point is that the financial cost of uncompensated care is much higher than the dollar amount and why so many hospitals are in financial danger today.
The stated "cost" of say, taking an x-ray, should be the fully loaded cost, the facility space, the equipment depreciation, any consumables, the time, etc.
The point is that providers are far more invested in maintaining the huge margins rather than minimizing the cost.
Problem is the payer mix has been shifting from insurance companies to patients via high deductible health plans over the past decade so it's starting to wreck their margins, even though the cost doesn't change.
A 30 minute visit with my primary care doctor is ~$160.
I now realize my local hospital is fairly reasonably priced.
Also don't forget to factor in the small army in the billing department that has to deal with the insurance company. And the third party payment provider that runs the online web portal that you pay through.
Interestingly enough, in Washington State all hospital finances are a matter of public record[1]. I am somewhat amused that health insurance for employees make up ~5.7% of the hospital's total expenses.
Charity care was only .87% of overall expenses.
[1]http://www.doh.wa.gov/DataandStatisticalReports/Healthcarein...
In most European countries (probably in all of them, but I do have motivation to check) the cost of the health care is paid based on the solidarity principle. This means that the amount that goes for the state level insurer is proportional to the income amount (private insurances for the extra coverage usually work on the fixed amount basis).
Around 500 per person in month is probably not on the very high side considering decent salary levels. The difference is that the health care of the minors is free. This splits the amount in half.
This covers you, your kids and your partner if he/she is not working. If your partner is working, he/she pays like you.
So, imagine you are a family of four, both self employed, the maximum you pay is 656.85€ x 12 x 2 = 15764€/year. This covers 100% of the kids medications, 70 to 100% of the adult medications, 100% of the visit to the doctor and stay in a hospital. You do not have to pay and get reimbursed, you just provide your insurance card and the doctor/hospital will automatically charge your insurance (Krankenkasse).
The system is working a bit differently if you opt-in for a private insurance.
Edit: I cannot reply to the question about the maximum, so, answering as an edit. Yes you have a maximum and the values I gave are at this maximum.
Where I live - there is no limit.
If your _payroll_ is ~1315eur, that means your _income_ is 1000eur, because you've paid (or employer did that for you):
- 15% income tax (~197eur),
- public health insurance 6% (~79eur),
- public retirement fund 3% (~40eur).
- employer pays 31.18% of the _payroll_ to public health insurance (~410eur).
Making the __whole employment price__ - 1726eur, of which 489eur goes to public health insurance. If your __income__ is 10 000eur - everything is tenfold.
I do not know nuances of self employment, but you pay less for the public health insurance. From 1726eur, you'd pay ~234eur for public health insurance and ~181eur income tax - leaving you with ~1311eur.
by america subsidizing their defense spending
https://www.cato.org/blog/us-taxpayer-subsidies-european-wel...
I hope we can devise an alternative to the current system, as $25,000 is more costly than just buying everything up front!
I did some research and found that an apendectomy is one of the most important things insurance can pay for, as it is sudden, life threatening, and generally not easily controlled by lifestyle choices.
The quoted cost of an apendectomy from a variety of different countries and hospitals?
"Between $3,000 and $150,000 USD"
It might as well be "blank check", if this price gouging is allowed in the US.
So no, $25,000 isn't more expensive than buying everything up front for 4 people.
It's expensive, but the US spends something like $10,000 a year per capita on health care, so it isn't an outsized chunk.
I was uninsured at the time, and at the end was given a bill for $18,000.
Gallbladder removal is the simplest major surgery that can be done on a person; it's a simple organ to remove, and rarely presents any challenges.
I could easily see surpassing that dollar amount for anything more complicated.
For comparison, the total cost to do the surgery in a developing nation (where I spent several years in my early 20s) would have been $300-400, according to friends there.
With different insurance, different state, a few years later, my wife had to go to ER with pneumonia. 5 hours in total to draw some blood, xray, and a drip. Bill later - with blue cross insurance - was ~$3000.
Health "care" here is insanely priced and managed.
https://docs.google.com/spreadsheets/d/1vPg1jtV8CK3pAs5EXC48...
Source:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
In the UK we can charge foreigners for use of our NHS. I believe that using this private service, is significantly cheaper than the equivalent in the states. Flight costs are trivial when looking at US healthcare costs. Of course this can only deal with non-urgent and (relatively) well off people.
We're young, healthy, with no chronic issues. Just the type of people insurance companies would want to insure.
[1] https://obamacarefacts.com/health-insurance/out-of-pocket-ma...
Not sure if only plans in the ACA system must meet this requirement or that private companies cannot even offer say a $50,000 deductible plan with a $3 mil cap.
But then you either get hit with a penalty for not buying insurance, or you get hit with a penalty and also a bill for $500,000 when you find out you've got some illness you didn't know about and hospital bills bankrupt you.
I'm self employed and have been for about 15 years. We purchase health insurance from the state exchange. Prior to this, I'd purchased it as an individual directly from the insurers, or used the plan my wife had through her employer. Those options are no longer available to us, so we use the state exchange.
My family's health insurance rates increased 17% last year. This year, my state has approved an increase of 27% for the provider I use and a 31% increase for one of the other providers in the state.
To insure our family of four, we'll pay around $25,000 for insurance before a dollar is spent on deductibles, co-pays or other associated costs. We're generally all healthy. Have no pre-existing conditions to speak-of. We earn more than the level where you qualify for any subsidy.
This is unsustainable.