If you don't have to worry about health care, it becomes much easier to start and run a small company.
I've been a freelancer for 10 years and have always purchased my own health insurance in the US. When I was single, it was only around $150/month (even only a few years ago). This included Doctor visits, prescriptions, and if I had an emergency..I wouldn't go bankrupt.
If Canada and Europe are great places for startups, why do they lag so far behind the US? The reason is because while it seems great that you get free healthcare, as your company grows, it's many more times difficult survive because of the taxes and regulations imposed on you.
An increase in taxes and regulations only helps large companies because they have the attorneys and employees to handle all of the paperwork and can still survive when a large percentage of their revenue is given to the government.
The U.S. does great with these “bet the farm” business models because most of them can fail, and the few that succeed can pay off the capital class handsomely.
Personally, I would rather live in a world where all of my most talented friends can start lifestyle businesses that allow them to do their best work, and be healthy.
The success of startups has some nice macro effects on GDP, but does not solve the problem of labor exploitation that, for me, is just as important a goal of entrepreneurship as making a windfall for the capital class.
What Europe lacks is private funding. I don’t find the article now, but years ago read that there’s 5x as much funding in the US market as compared to the EU market. Seed funding is 3-5x less than you would expect in the US.
1. In the U.S., there are many pension funds that put some of their money into venture investment. In general in Europe it is illegal for a pension fund to invest in such risky assets at all.
2. In the U.S. there are many more private foundations and private universities that have large investment funds, and some of this gets put into VC. For a variety of reasons, there aren't many large private foundations and there are few private universities with large endowments.
If I were doing industrial policy in a European country, the first thing I would do is to start to invest a couple percent of the state pension funds into VC like vehicles. Given how underinvested it is, the returns should be great, and the extra economic activity should help the fiscal health of their economies a lot.
There are several things going on here:
* "Europe" isn't one place.
* It can both be true that there are higher taxes and more regulations, and the health care system is better. You're still paying less for health care as a % of GDP, so it's not like you're paying the same amount, just through taxes.
* There are a lot of other factors such as universities, access to capital, and simply 'culture'.
From experience in the UK Private insurance is not worth it as an employer benefit as you get taxed on it.
Currently I am in Germany, and I had a serious health issue. The sort of thing that makes you go bankrupt in the US. I had surgery and months of treatment for free. I stayed on my own private room in the hospital, and it looked like a hotel room, with a private bathroom. I payed zero euros, this was all on public healthcare. They even offered me a few days in a SPA to recover after surgery. They even funded the metro tickets to go from my house to the place where I received the treatment.
Some other EU member states do not have the resources for such niceties, but you will absolutely get the treatment you need.
I feel sorry for people in the U.S. I read about all sorts of situations that are heartbreaking, and it confuses me that most people there still vote against universal healthcare. This serves nobody except the very rich people exploiting the situation.
I listen to North American podcasts and such, and I am still surprised to hear educated people repeating lies about the situation in Europe, as if we were some almost-communist repressive society about to collapse. The most common assertion is that, after all, the US is the only country with "real freedom". To my European ears, this sounds exactly like the sort of propaganda you get from any authoritarian regime. As if "freedom" is some simple one-dimensional things that can be measured like this.
I think it would be good if U.S. citizens had a more realistic picture of how the rest of the western world lives.
To quote for the non-Hebrew readers: "83% of the people paid for extra insurance in addition to what they get from the government"
Also, it's not "private" insurance in any meaningful sense. It's out of pocket adjustments for exactly the same services. This is what I was alluding to.
Also to make things clear, when you say people in the US pay hundreds of dollars a month, that's also true for many Israelis. The public insurance is not free if you have a job. The more you make the more you pay. If you work in tech it's likely you're also paying hundreds of dollars a month. (don't get me wrong, I think this system makes sense, it's the same as income taxes). The situation in the US isn't great but it's been much better in the last decade. For example, I live in Massachusetts and everyone in the state is required to have health insurance. If you're low income then you get your insurance from the state.
Americans are more entrepreneurial in spite of their healthcare system, not because of it.
I’ll grant that in the Biden/Buttigeig/Warren plans, there’s a lot of room (and incentive) to tank things like this or in any other number of ways.
Similarly the opioid/meth epidemics of the last 2 decades are not (just) healthcare problems.
The same thing goes for quality of medical care - when they mess up they get to fix their own mess and charge for it.
For example when our first kid was born, the gynecologist had her trainee pull our son out with their rope thing. She was supposed to apply pressure during the contractions, only she panicked and pulled my son out in one go (she was using her legs to push for force, you can't make this up). The result is that the baby was born quickly and my wife was ripped open. She required urgent surgery to put herself back together, then a month stuck laying in bed and about three months before she was mobile. She still have problems because of it.
The hospital were happy because they could charge three times as much for the corrective surgery than they charged for delivery.
My example was in The Netherlands, where the healthcare costs are well under control and the culture isn't quite so brutally selfish ("free market") as other countries. I can't imagine what it's like living in the US.
>A report issued by the US Department of Health and Human Services estimated the cost of malpractice insurance to doctors alone at $6.3 billion in 2002; with an additional cost of $60–108 billion related to the practice of defensive medicine, i.e., costs related to physician behavior in response to the threat of a lawsuit alleging medical negligence
Not to mention that malpractice claims paid has decreased substantially (55.7%) in the last 2 decades [1].
[0]: https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
https://www.wbur.org/commonhealth/2019/01/08/medical-marketi...
> Mean compensation amounts and the percentage of paid claims exceeding $1 million increased
I'm not saying it's a huge component of healthcare costs overall, I'm just saying malpractice not a good profit motive.
I'm curious how you know the hospital was "happy" about it though. I ask because a close friend is a nurse/midwife who delivers a lot of babies and I find it very hard to believe that caregivers, at least, would be happy about this outcome. I also find it hard to believe that the hospital administration would reward them for this outcome; indeed, hospital administration usually inclines toward bureaucracy aimed at preventing mistakes, rather than incentives to create mistakes.
Under a single-payer system, new providers would still need to train on the job; mistakes could still happen; and the provision of care to mitigate those mistakes would still cost money. Doctors and nurses don't work for free just because of a mistake, even under a single-payer system. Administrators would still get paid too. In general, medical employees get paid to treat people; that is true regardless of how patient insurance is structured.
I don't think customers should pay extra for medical mistakes; but I also don't think providers in a for-profit healthcare system intentionally and happily create medical mistakes for the purpose of profit.
US hospital did a terrible job of splinting it, told me to come back following day to see a surgeon. (Cost $1000+, high copay since I didn´t yet have my work insurance which didn´t kick in for another month etc.)
Went back home and googled it. NHS treatment, splint for 6 weeks do not disturb splint under any circumstances, followed by simple physiotherapy. I re-splinted using a plastic spoon handle (which is perfect for this btw.) and today the finger is completely recovered.
A year after all this, I ran into a guy at a rental place in the US who had a little finger sticking out at right angles, and which was functionally immobile. He´d had the operation - several years previously, you could see the stiches. Finger had never recovered properly.
But you can see where the profit incentive would lie for the American hospital.
> Without tackling the obesity/sedentary/nutrition problems the healthcare issue will persist. > Similarly the opioid/meth epidemics of the last 2 decades are not (just) healthcare problems
I've just been called in for a check up on my blood pressure and if it had worstened, I would on the end of quite a lot of dietary and excerise advice in an attemp to avoid additional medication. Many GPs in the UK has teamed up with Parkrun and now prescribe park run participation for certain patients and conditions.
In terms of Parkrun, there's no data sharing. GP Practices simply encourage patients to go running and have all the details of their local parkrun to hand https://www.runnersworld.com/uk/a776238/parkrun-uk-teams-up-...
Medical privacy is one of those places where I wonder if a personal desire for privacy might hurt society as a whole — Almost, but not quite, like the tragedy of the commons.
Still, it’s easy for me to say that, none of my embarrassing aspects have medical consequences.
Unlike Private companies sharing our data with other private companies?
Disclaimer: Medicare For All (single payer) supporter
https://www.forbes.com/sites/brucejapsen/2019/08/04/as-sande... (As Sanders And Warren Attack, Health Insurer Profits Soar; "Take Humana, which last week said it made more than $1 billion in profits in the second quarter and raised its earnings and revenue forecast for the rest of the year thanks to growth of seniors signing up to Medicare Advantage plans. Cigna, too, which said it made more than $1 billion in the second-quarter, also increased its earnings forecast last week for the rest of the year. And the week before, Anthem, which operates Blue Cross and Blue Shield plans in 14 states, also reported more than $1 billion in profits in its second quarter and said its profits are ahead of expectations for the year due in part to the money its making off of government contracts with Medicare and Medicaid programs. Meanwhile, UnitedHealth Group's UnitedHealthcare health insurance unit reported last month $2.6 billion in earnings from operations in the second quarter and the parent company boosted its earnings forecast for 2019.")
https://www.cnbc.com/2017/08/05/top-health-insurers-profit-s... (As Obamacare twists in political winds, top insurers made $6 billion)
https://www.gq.com/story/eat-the-health-care-ceos (Last year, 62 CEOs of health-care companies made a combined total of $1.1 billion in compensation. That's according to a new report out from Axios, which coincidentally notes that CEO compensation eclipses what the Centers for Disease Control spent on chronic disease prevention by $157 million; The average CEO makes $18 million annually while one out of every five Americans is struggling with medical debt.)
Those profits (which you mention they're optimizing for) are dollars that could be used to improve healthcare delivery. That's actual care someone could receive, instead of going to unnecessary middlemen and shareholders.
Likewise, you aren’t going to get a healthcare system which can make a meaningful impact on improving the lifestyles of the kinds of people you’re talking about without changing the current economic incentives.
Without healthcare system improvements, you aren't going to succeed in tackling those.
But, yes, it's true that there are more problems with US health than the health care system (though the issues in the broader economy that are at issue are very similar to those effecting the helathcare system.)
For example: https://www.youtube.com/watch?v=fISgKl8dB3M
I spent the last week in 4 different states and airports. The BMI variety between them was staggering. Diabetes rates aren’t soaring because some healthplan is expensive.
People blame opoids like they’re causal. Those people have always been in physical agony, there’s just a magic pill now for their disability and as more people make worse choices that population is only going to grow.
Until K-12 diets and physical activity become mandates I don’t see how we get ahead of this problem with tech or cheaper healthcare.
The R&D, which costs millions (and sometimes billions) still needs to be paid for by someone..and the government just isn't efficient enough to do this effectively and within a decent time frame.
The problem isn't for-profit healthcare. The problem is the insurance companies. They create an un-needed middleman that inflates the cost of everything. A better alternative would be to get rid of insurance for most things, allow doctors and hospitals to charge directly to consumers (which would bring the costs way down).
Surgeries would also come down in cost because of competition. The ones that don't come down are most likely because they are rare and have little competition. These can be covered under insurance.
So all those Swiss, German and French pharmaceutical companies are a figment of my imagination then.
https://en.wikipedia.org/wiki/List_of_drugs_by_year_of_disco...
And the information on the pharmaceuticals involved fails to mention the feeder research that comes from universities in Cambridge, Zurich, London, Tokyo, etc. Most of this had gigantic participation of state research institutions, and if you look at the American pharma companies, almost all are based and house most of their research efforts in the state of New York and New Jersey, Massachussets, and the Bay Area, to the exclusion of pretty much everywhere else.
That makes for a great case of the utility of the well-funded research universities in forming staff for pharma, but it's not exactly a proof that any particular model of funding for pharma works better than others.
It's also interesting to note that most of these pharmaceuticals target and _incredibly small_ number of people worldwide at outrageous costs. Not to take merit away from the huge research efforts, but honestly it just shows where profit-driven research efforts go instead of rational, nation-wide public health initiatives that are objectively far better at increasing quality of life for entire populations.
Yes, at their US research labs. Most of these companies do a lot of their research in the US these days and continue to move more R&D to the US. If it's developed in the US by individuals working in the US because the opportunities are in the US, that makes it a US-developed drug. I went through each and every WHO essential medicines drug developed since 2000 and verified where each was developed.
> It's also interesting to note that most of these pharmaceuticals target and _incredibly small_ number of people worldwide at outrageous costs.
As someone that uses an orphan drug developed in the US to improve my quality of life, I'm glad. Do you want to take that option away from me and others like me?
I don't believe that medicine is a zero-sum game, but I _really_ wonder if a country where thousands of people die from not being able to afford relatively accessible medication is spending its money wisely.
It's not zero sum, but there absolutely are tradeoffs and everyone championing the national healthcare model used in countries like Canada and those in Europe are being willfully blind to the collateral damage to US-developed medical innovation.
When thousands of people die because treatment doesn't even exist for them, where is that accounted for? My father has a disease that he is likely going to die from and most of the research done on that disease is done in the US and almost everything I read on this disease is published by US-based researchers.
https://www.abpi.org.uk/facts-and-figures/science-and-innova...
So I think at some point or threshold there will be more elaborate effects than simply "healthcare costs up, people's lives suck".
The medical profession is cripplingly dependent on trust. Decreased faith in the goodwill of medical practitioners may lead to people not doing things that have major impacts non overall public health, like getting immunizations.
I'd expect a potential rise in suicide rates due to mental problems becoming more prevalent; if not because of escalating paranoia due to "don't get hurt, you can't afford the medical costs", then due to the over-time integration of the assumption of not having any societal value assigned to some injury being fixed. I think this is an oft overlooked aspect of the social experience of having a problem. There are many who look at people with medical issues that are dismissive that it must somehow be all that person's own fault. While the argument can be made in some cases, in the case where you can't afford medical treatment, the message is sent that your (the injured party's) suffering doesn't matter at a social level unless somehow you can demonstrate you can produce X amount of worth where that worth becomes at least strongly correlated to some significant fraction of whatever the Medical Industrial Complex decides.
It is funny, because I'm reminded of the story Erehwon, where physical ailment vs. Social ailment was flipped around in how it was handled. If you had a chest congestion, you'd be locked away in a prison, away from everyone else, but moral failings like stealing things were not crimes, but things treated as being in need of slight adjustment. The argument put forth against "Doctoring/Medicine" in the story is that eventually, a medical Doctor would accrue too much power over too many people's lives. It seemed ridiculous to meat the time; but as I look at what we have now, I see echoes of it.
If you can't afford to exist in the system, you are cast aside. Can you receive treatment? Yes. Will you financially weather that storm without the advantages of full-time representation, negotiation, and legal counsel? No.
"First, do no harm" means something; and harm comes in many forms nowadays. I know not where the capacity for ruinous financial inflation is being introduced; the exorbitant costs of medical schooling, the production and certification of medical equipment/research, administrative overhead and profit skimming; but it needs to be addressed and evaluated at each point.
Prescription drugs are a start, but the entire infrastructure needs an audit and readjustment in my opinion to bring it back within some semblance of sane operating parameters.
It can always get worse
All doctor offices in Canada are private corporations, for whatever reason the hospitals are not and that is where the worst of our problems lay.
Was it a failure?
There are always consequences and tradeoffs - if we had actual numbers about the magnitude of the impact, we could start to discuss if ACA was worth this particular tradeoff.
Every time something is screwed up in the US, there’s a bunch of people who scream “See! Capitalism!”
This, to my mind is unproductive and rather transparent advocacy for an underlying ideological inclination.
Sometimes things can be fixed without resorting to “Socializing” them.
Here’s something broken under a socialized mechanism: every piece of NYC infrastructure.
And you're not ideologically inclined in the opposite direction?
Look at what is already socialized: fire departments, court system, police service, the three-letter agencies, military, politicians presumably?, a lot of education (despite student loans), a chunk of the health service already, road network, probably a lot more things.
I put it to you – given that so much related to the public good is publicly funded and given that examples from the rest of the world abound that public health services are cheaper why wouldn't you socialize the bulk (> 90%) of health.
Clearly, to my mind, the reason why it hasn't yet happened in the States is down to government capture, a.k.a. lobbying, a.k.a. legal bribery.
Stop blaming the other, its not making you stronger or better. Better healthcare will not stop you from drinking too much , eating too much, not exercising enough. No drug is going to fix your social anxiety. Drugs fix symptoms not causes.
This "health disadvantage" what is it exactly. I bet its lung and diabetes issues. We do it to ourselves. Once you accept that you will see the fix. Its not some billionaire giving you money , it you not giving money to the drug dealing (alcohol, unhealthy food, weed/tobacco/vape) billionaires and getting active.
Religion used to be a good way to get out before, a secular nation needs to find a similar motivation that gets people out of their houses. Maybe the worst drug is the media keeping us planted in our chair. Either way I dont trust the gov. so even if we put more money into "healthcare" they would fuck it up. Prove me wrong.
But access to afforable medicine will definitely fix a big chunk of my anxiety about not being able to afford medicine!
"I bet its lung and diabetes issues."
It's really hard to take care of diabetes in america, due to the costs of adequate insulin and related medical purchases such as bloodwork and glucose testing devices.
The majority of the world still has, to my knowledge, for-profit health care: Britain, Germany, France, Switzerland , Sweden and Italy all have at least some form of private health care.
The United States definitely have a problem with health care prices. It doesn't appear from where I sit to be an issue with individual bad actors (although of course they do exist) but rather structural. In part, the well-intended federal and state attempts to improve things have backfired — as they tend to do — and made things even more expensive (which reminds me of federal student loans, another instance of well-meaning attempts to help the lesser-off which somehow seem to benefit the upper middle classes most of all; cf. also federally-subsidised mortgages).
While private health care exists in all of those countries, and in some of them it's a significant part of the system, a lot of what exists isn't actually _for-profit_.
For instance, in Ireland we have a dual public and private system (primary care is private unless you're old, very young, or low income, private hospitals exist as an option), but most of the private system is either outright non-profit (most private hospitals, the statutory VHI health insurer) or is heavily constrained by the existence of the non-profit portion and regulation (private insurers have to compete with the VHI, and are not allowed charge risk-based rates for most customers).
another example, in Russia, you have _theoretically_ the same system, but the level of treatment covered by the mandatory insurance is totally insufficient by any reasonable modern standards, so you have to pay all the way. And it's not about debt, it's often about not getting live-saving treatment before you cash out.
The question is whether a good publicly-funded alternative should be available, to allow everyone treatment for the vast majority of conditions and illnesses that are lethal or significantly affect quality of life.
Most countries that have the latter, also turn out to have much cheaper healthcare overall.
This system doesn't solve or treat every problem, and the US system manages to provide better quality of care in some cases, but there's a serious morality issue here that it does fix. Along with many pragmatic socioeconomic benefits (e.g. healthcare for retirees, early-stage and failing entrepeneurs)
From the outside it seems that government attempts to shape the market (by the measures you mention) seem to work out worse and more expensively than measures to make the market (e.g. NHS). We have this in the UK with the government providing subsidies to buy private houses rather than just build enough public houses. I'd be interested in some economic insight into this if anyone has any.
[1] https://www.theguardian.com/society/2019/nov/08/private-surg...
a very tiny proportion of them yes, in the US the whole thing is private
The US has several public insurers.
About 72 million Americans are enrolled in Medicaid or CHIP.
About 60 million are enrolled in Medicare.
The MHS covers about 9.5 million people.
The IHS covers another 2.2 million people.
21% of US hospitals are government owned.
Scenarios range from completely free at the point of use, to 100% out of pocket, and everything in between.
The 5 programs I mentioned above are just the largest federal programs. States and localities in the US often implement their own programs. There are hundreds of government healthcare programs that someone in the US might take advantage of, depending on where they're at.
The problem with healthcare in the US is not that there is no government healthcare initiatives. The problem is that we have too many. Fragmentation is inefficient and expensive.
Governments in the US spend $4,854/person/year on healthcare. The NHS spends $4,192/person/year.
https://www.cms.gov/research-statistics-data-and-systems/sta...
https://www.nhsconfed.org/resources/key-statistics-on-the-nh...
1. In the UK the number of people with private medical insurance was (a couple of years ago) around 12% (according to one source). I don't know anyone who has it personally, I don't (and I can afford it). Do you know what the figures are for other European countries?
2. Is it possible that having a (relatively) cheap and functional state provided health care system keeps insurance costs down? If you're charging some large amount of money for health insurance and the alternative is effectively free* then you'd think that people wouldn't bother with it.
* you pay for it anyway in taxes, it's not a lot of money, or it's free, depending on your income level.
source, WHO: http://www.euro.who.int/__data/assets/pdf_file/0005/310838/V...
The phrase “the public European model” is misleading, because there are lots of European models which provide universal healthcare, and while almost all of them involve a vastly greater public share of all expenditures than the US system which fails at universality, in some, IIRC, a substantial share of that is through publicly subsidized private insurance. The British model is not the French model is not the German model, etc.; the two things they have in common is universality and not being as ludicrously inefficient as the US model.
If you wait 3 days, go deep in to debt, and get the exact same outcome, how is that better?
Obviously, people are not dying as they wait for their appointments throughout Europe. Otherwise their health metrics would not be so consistently better than in the US. Maybe focusing on wait times is not the right way to look at the issue.
Israel is not in Europe, but anyway the rate there is 10.3%
This indicates to me that the circle of people that you know is not representative of the population at large at least when it comes to health insurance coverage.
There's no need to infer statistics about the whole of Europe from your small sample size. All you have to do is look up† the data.
Page 4 (Figure 2.1) here: http://www.euro.who.int/__data/assets/pdf_file/0005/310838/V...
The majority of countries (38 versus 11) are below 5%, only 5 are above 10%
---
† I googled: percentage private health insurance european countries
See Figure 7.2: https://www.oecd-ilibrary.org/docserver/health_glance-2015-3...
Israel is 83% and not 10%...
Total public coverage: Israel 100%
Figure 7.2, Private health insurance coverage, by type, 2013 (or nearest year) Note: Private health insurance can be both duplicate and supplementary, in Australia; both complementary and supplementary in Denmark and Korea; and duplicate, complementary and supplementary in Israel and Slovenia
Israel: type = Supplementary = 82.9% .
What is supplementary?
“Most OECD countries have achieved universal (or near-universal) coverage of health care costs for a core set of services, which usually include consultations with doctors and specialists, tests and examinations, and surgical and therapeutic procedures (Figure 7.1). Generally, dental care and pharmaceutical drugs are partially covered, although there are a number of countries where these services must be purchased separately (OECD, 2015)”
“Private health insurance offers 95% of the French population complementary insurance to cover cost-sharing in the social security system. The Netherlands has the largest supplementary market (86% of the population), followed by Israel (83%), whereby private insurance pays for prescription drugs and dental care that are not publicly reimbursed.
So this doesn't mean that 83% of the market is private, you understand? It means that 83% of the market (whatever that market is) that isn't covered by government access is covered on a supplementary basis. How large is that portion? If you look at the 2019 publication: https://www.oecd-ilibrary.org/docserver/4dd50c09-en.pdf?expi...
Figure 7.11. Health expenditure from public sources as share of total, 2017 (or nearest year)
Israel: 64%
What's important here is that the % in the US (wealthiest country in the world) is 50%, far below the OECD average of 71% which is the point being made here.
don't view the world through the anecdotes of your friends and family. They are not a representative sample of the world's population. When quoting statistics make sure they are the correct ones.
While every developed country (and every OECD country, which are overlapping but distinct sets which are not subsets of each other in either direction), except the US in both cases and maybe Mexico in the OECD case, as I've seen sources going both ways on Mexico and universality, has a healthcare system providing universal access to comprehensive medical care with a substantiallty larger percentage of total healthcare funding coming from public sources than the US (though often not more per GDP or especially per capita public spending), there is not, whether in Europe or more generally, single model for this, there are many, fairly radically divergent models from the government-as-provider model of the UK NHS, to the government-as-exclusive-insurer-of-core-services, to mandatory-and-need-subsidized-insurance-with-a-default-public-option, among others.
So, except for “don’t emulate the US’s broken system”, there is nothing even approximating a single “European public healthcare model”.
Unfortunately it is very likely that this will never happen. Realistically we're getting Boris as the next Prime Minister.
To be clear, I don't want this, but Corbyn getting in is a long shot. The best thing he could have done for the Labour party and the left in general was to stand down years ago.
For profit healthcare in America is devouring its people and economy, full stop. We can either have a society where half a million people go bankrupt from medical debt each year, thousands die from treatable illnesses and lack of access to medicines, while hospital CEOS and insurance execs walk away with millions. Or, we can have one that excises their parasitism like the rest of the developed world figured out was necessary decades ago.