Can the USA Afford Universal Healthcare?

[Zardnaar]

I live in New Zealand and over here we have universal healthcare. Its not perfect and I will give some pros and cons of it below but I'll look at the question of the thread title.

Now the other day I looked at some interesting charts.

Government Spending USA
https://www.nationalpriorities.org/budget-basics/federal-budget-101/spending/

Scroll down to the total federal spending chart down the bottom the 3.8 trillion one. Note this was for the year 2015 but its what I found with my google fu.

Government Spending New Zealand Budget 2018

https://www.interest.co.nz/news/93792/budget-2018-summary-all-spending-plans

Put simply ver half the USA is spending on things like medicare and social security.

New Zealand spends less than half on welfare and health (our equivilents), a big difference is our education spending vs the US military spending.

Around about now the most obvious thing is US health costs are probably similar to NZ at least as a % but the US probably has less income proportionally due to lower taxes.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

NZ per capita $3590
US per capita $9892

This site might be more up to date than 2016.

https://www.healthsystemtracker.org...-spend-half-much-per-person-health-u-s-spends

USA $10 224
Not 100% exact but in the same ballpark

Note I expect healthcare to be more expensive in the USA even if everything else is the same. Things cost more in bigger richer countries. I would expect healthcare to be cheaper in India for example than New Zealand.

Note that in New Zealand you an still get health insurance so its not a one or the other choice. Why would you want health insurance in NZ if we have universal healthcare.

1. Better quality hospital treatment. Private rooms, better meals etc.
2. Skipping things like waiting lists
3. Better/faster treatment of non critical medical conditions.

The state will also pay for private health care in some situation to clear backlogs or if the private health care can do it cheaper. Its pragmatic not ideological i that regard.

Note that private health insurance here is also cheaper than the US, in effect its subsidised by the state health sector. So what are things like waiting lists. One of the downsides of the NZ system is if it is non life threatening you may go on a waiting list for non urgent care. Even in the emergency room you might have to wait several hours before you get attended to. If you are in pain eg a broken arm/leg, or have been assaulted this could suck as you probably won't even get any painkillers.

Also note the NZ doctors also do not generally prescribe opioids a'la the US system. Our painkillers tend to be milder and things you can get in the US are only prescribed for terminal cancer patients or severe cases. I damaged by back and had to make do with paraco (paracetamol+ codeine). It took the edge off I still hurt like hell. You might get the good stuff in hospital after an operation but you're not going to be able to take it home with you in any serious way (we do have stronger painkillers IDK how you get legally or not).

On the flip side of the coin for things like cancer generally you can get treatment fairly fast. IDK what counts as fast as overseas but when mum was diagnosed with cancer she was on chemo the following week or the one after that. For ongoing care though she had to make appointments to be seen by specialists and to get scans. People with higher priority can jump the line and in one of her visits a 2 day hospital trip turned into 5 days. Specialists also phone in sick and things like that. She was 76, retired and on a pension, financially it didn't really make much sense to treat her. She didn't make it but the state probably spent tens of thousands of dollars trying to save her life over 3 years. Its part of the social contract here though the knowledge that your parents of grand parents will need help at some point.

People also fall through the gaps however and doctors diagnosis are not 100%. Here it is very difficult to sue a doctor for a misdiagnosis or negligence and you can generally only do it in cases of gross misconduct (say if your doctor was drunk on the job). Put simply its very difficult if not a waste of time and even if you win you won't get a multi million dollar payout. Also the quality of treatment might vary where you live, I've never had much trouble but apparently some parts of the country are over stressed and people will fall through the cracks. Note you can still go private to avoid things like this and its cheaper than the USA.

The other downside is you do pay more tax here as well.

USA tax rates
https://www.bankrate.com/finance/taxes/tax-brackets.aspx

NZ tax rates
https://www.newzealandnow.govt.nz/living-in-nz/money-tax/nz-tax-system

Personal income
33% from $70,000

30%: $48,001 to $70,000

17.5%: $14,001 to $48,000

10.5%: $0 to $14,000

15% goods and services tax (GST)

Company income 28%

At the top NZ rate (at 70k+) you pay 33%, while in the USA you pay 32% at $160 000. For the most part at most tax levels you would have to pay an extra 5-10% more tax+ a 15% tax rate which I believe in the USA is state by state and a lot less than 15%.

To avoid GST you can save money or be an investor. NZ lacks a capital gains tax so property/housing here is a popular investment outlet.

These are the main differences, both countries have lots of other taxes. Things like tobacco and alcohol are taxed heavily here and tobacco is 4-5 times more expensive than the USA. Consumer goods due to economy of scale, distance, tax etc are also very expensive. America could avoid most of that with the NZ model but I am guessing things would go up in price by 5-15% with a GST type federal/state tax. Prices would also go up with more corporate/wage taxes as costs are passed onto consumers.

In previous threads I have noted while Elizabeth Warren's wealth tax is stirring up debate the 2-3% she is wanting is still a lot less than a few years ago when the Labour government put up the top tax rate from 33% to 39% and that tax kicks in at 70k not millions. Also note that our tax rate also gives universal welfare, free doctors visits for children, working for families (cash for kids), education (school is free not tertiary though) retirement pensions and the unemployment benefits so the US could put taxes up for universal healthcare and still probably have lower tax than NZ.

So can the USA afford universal health care. Yes easily IMHO, in theory you should not even have to pay extra tax for it as I suspect drug companies and insurance companies along with legal threats are the main causes of the price of US health. I don't think doctors and nurses are getting 3 times the wages than NZ. Reforming the health sector and drug companies might do it by themselves.

If you put taxes up from where they are now, repealed Trumps tax cuts you could probably afford it without even cutting military spending. NZ levels of tax you could probably have all of the above and increase military spending as well (education costs are on the state level?).

There are other problems we have here, homelessness is a fairly new development at least en masse but that is more to do with immigration and housing costs. You can also probably find other examples of nations doing it better than NZ, IDK if the NHS in the UK is better or worse than our system.

Culturally however Americans really don't like paying tax going back to the 1776 great tax dodge of Washington, erm I mean the American War of Independence. We have stayed loyal to the crown over the years (in NZ the Queen could fire a NZ Trump). God save the Queen!!!! Or to quote Star Wars Rebel scum.

 

[onejayhawk]

The short answer is yes, for some values of healthcare. This should not be in any way confused with the Affordable Care Act (ACA) sometimes called Obamacare. It is neither universal nor affordable.

J

 

[hobbsyoyo]

I'm half way through but I have to point out that waiting lists are very much a thing in the US. It's rare you can get into a doctor inside of a week here and it's also common to be stuck in the emergency room for hours waiting to be seen. It may be true that world class treatments are more readily available here but that's out of reach of most people and doesn't mean squat when you're sitting in the lobby of an urgent care for hours on end waiting for treatment for the screaming ear infection that's driving you mad.

 

[mitsho]

Yes, just buy one or two jet fighters* less and it should be doable.

(*military spending in general of course)

Universal Health Care also isn‘t solely a negative. You can get efficiency gains, better central hospital planning, less stress on families having to fundraise and the amount of fundraising money on itself helping the economy. A huge part of health costs are also the emergency services which you can train people to not use when they can go to a regular doctor (although to be fair that is a hard cultural fight we are even losing over here as well, people love their emergency services just so much...).

As said above, you can cut spending in other areas as well and on the tax side, you don‘t necessarily have to raise the regular taxes, a financial transaction tax would be very efficient in raising money and slowing down Wall Street. In Short: It can‘t be done is a very easy answer.

 

[Peuri]

I tend to veer on the side of huge health care companies being a moral hazard. Local and small providers are ok, but when it's big stock companies there is incentives to increase revenue by providing more services, rather than health, because you monetize on services, and not on the health of the customers, the latter of which should be the object of health care. This is because the customer relies on the provider about information concerning their health, so you can sell them redundant services, that the customer assumes will increase their health, but because the customer lacks knowledge, they in the end can't judge what they bought.

 

[Cutlass]

Don't you mean, "can we afford to spend less money than we are currently spending?"

 

[Hrothbern]

An example on health industry:

The price of insulin more than doubled in the US in the last decade.
Insulin is needed for Diabetes 1, and is needed for progressed states of Diabetes 2. The rate of people with Diabetes 2 (and obesity) still increasing.

"Between 2007 and 2017, the average wholesale price of four of the most popular insulins has more than tripled in price," wrote Rosenthal, editor-in-chief of Kaiser Health News.
"Between 2010 and 2015, the monthly wholesale price of Humulin, the most popular insulin, rose to nearly $1,100, up from $258 for the average patient," she added.
https://www.cbsnews.com/news/high-cost-of-insulin-some-diabetics-cut-back/

A huge market for Big Pharma.
But why does the price increase so much ? Simply the bigger demand ?
It is not that easy to make and improvements in the process are still done. Improvements in quality as well. But who cares about the "lack" of quality of insulin from 1980 quality when he cannot afford the quality of today ?
http://www.madehow.com/Volume-7/Insulin.html
But it looks more like a traditional example of big profits from patents and outflanking generic insulin.
https://www.webmd.com/diabetes/news/20150318/why-isnt-there-any-cheap-generic-insulin#3

An addiction to unhealthy life styles (incl products from unhealth food processing industries) and a desire for longer (healthy) lifespan combined with a for profit health industry.
It's like new computer games with moar of everything especially graphics, forcing you to buy newer higher performing computers.

Leave everything unregulated, except those regulations that are part of the commercial rivalry whereby the consumer pay ofc the price.
And especially forbid universities to develop patents. Universities are for the unprofitable fundamental research that Big Pharma can use for free. And ofc to be part of the PR of the Big Pharma to get usefull reports on their latest products.

The fundamental question is:
Is the health care and health industry the servant of the common good, or just a tool to segregate, to give some people the idea that they are "better" and more sucessful than other people. The darwinian competition to show off: I have a bigger car than you have.

 

[Estebonrober]

The real question is can we afford not to provide universal healthcare? If anything cost per person will drop dramatically. I cannot tell you how many people we see in our ER for flu (not severe) and stomach bugs. Its insane and the moment those people walk in they costed someone (usually not themselves) about 4000 dollars. Just fixing that alone with everyone having a primary care doctor would save us billions per year. I can go on and on about this but lets jsut starrt with that bloody daily x100s example we see at my hospital.

You don't need to levy some new huge tax. The fact is people are already paying for this. I have family of five. The total health insurance cost for me is roughly 1300 per month here. We are young and healthy. All you have to do is move that over to the medicare tax bracket. We should be able to derive a discount off what a lot of us are paying.

Finally no matter what system is developed the wealthy will still be able to afford premium additional coverage, nothing stopping that. Just like nothing stops them from getting on a jet and paying a doctor in Singapore or wherever to transplant a stolen kidney into them either.

 

[Hrothbern]

The real question is can we afford not to provide universal healthcare?

That's I think as well the rock bottom reason to start a change by now.
Pityful as it is.

A better health care started in my country when the contagious diseases from the higher urbanisation degree, from the poor neighborhoods, started to threaten the health of the richer people, living in better neighborhoods but still nearby.
And somehow we were lucky that in the phase directly after WW2 a universal health care was seen as essential.
Roosevelt was earlier but did not get through the resistances enough.

Just like with Climate... can we afford to neglect.. to not change ?

Who is we ?

You don't need to levy some new huge tax. The fact is people are already paying for this

Underpinning that obstructing a universal healthcare is not a matter of saving cost for the we, but a matter of principle for the ones not needing that universal aspect of healthcare.

 

[Lexicus]

The question that is relevant here has nothing to do with money and everything to do with medical resources. Does the United States have enough medical resources to provide everyone with an excellent standard of care? I think the answer is, it obviously does, or it can in fairly short order if it makes the right investments.

 

[Bamspeedy]

I'm half way through but I have to point out that waiting lists are very much a thing in the US. It's rare you can get into a doctor inside of a week here and it's also common to be stuck in the emergency room for hours waiting to be seen. It may be true that world class treatments are more readily available here but that's out of reach of most people and doesn't mean squat when you're sitting in the lobby of an urgent care for hours on end waiting for treatment for the screaming ear infection that's driving you mad.

I have repeatedly been able to see a doctor for myself or kids the same day or next. Urgent care May be 45 minutes if there are more serious cases being seen. Specialists though.....that can be a 2 month wait.

 

[Zardnaar]

You can usually get a doctors appointment here same or next day, one exception might be if there is the flu going around and they are busy.

Specialists depending on how urgent can take a while,doesn't seem that different to the USA. I suspect with what you are already paying.

One thing here is if you need experiemntal or obscure drugs for a treatment of a rare disease the government might not cover it. Then again going private might be 250k so its not really an option for most people anyway.

 

[Estebonrober]

I have repeatedly been able to see a doctor for myself or kids the same day or next. Urgent care May be 45 minutes if there are more serious cases being seen. Specialists though.....that can be a 2 month wait.

I am the one who preps what specialists do. Two months is about average. Unless you have something "emergent", and that depends "who" and what is going on.

 

[Lemon Merchant]

It can be a four month wait to see me, assuming that you aren't an emergent case. And in contrast to Canada's excellent free health care system, my services are not always free.

 

[Timsup2nothin]

The answer is yes, but it will require some mindset changing. A significant portion of USians operate from "if I don't have to pay for it I am obligated to gorge on as much as I can get." There will be millions of people griping about the wait while they are congesting the system getting services they have no real need for.

 

[Disgustipated]

short answer is yes. We are the richest nation on Earth, of course we can afford it.

The question is: do people want to pay for it?

The biggest problem will be the doctor shortage, and huge waiting lines for everything.

 

[Cutlass]

It can be a four month wait to see me, assuming that you aren't an emergent case. And in contrast to Canada's excellent free health care system, my services are not always free.

So if I had been at your neighborhood liquor store, I would have had to wait four months to drop in on you?

 

[Bootstoots]

It can be a four month wait to see me, assuming that you aren't an emergent case. And in contrast to Canada's excellent free health care system, my services are not always free.

Is there a large funding shortfall for mental health care versus the rest of health care, or something similar?

 

[Valka D'Ur]

Is there a large funding shortfall for mental health care versus the rest of health care, or something similar?

Unfortunately, some politicians seem to think that only visible injuries and diseases with visible symptoms and consequences need funding. So yeah, there are regions of the country where funding for mental health care is inadequate.

Language issues come into it, too. There was a hullabaloo when Justin Trudeau did a series of town halls and when he was at one in Quebec, a woman asked him in English about getting greater access to mental health services in English. Trudeau promptly said, "We're in Quebec, so I'm going to reply in French." The woman asked in English because she's more comfortable in that language, and some of the people on whose behalf she was asking don't speak French at all.

Given that Margaret Trudeau suffers from bipolar disorder, he should have known better.

 

[Lemon Merchant]

So if I had been at your neighborhood liquor store, I would have had to wait four months to drop in on you?

Nah, three months. You're a priority case.

Is there a large funding shortfall for mental health care versus the rest of health care, or something similar?

The problem is that there are not enough doctors and psychologists to go around. Not to mention that mental health is chronically underfunded. So much so that there is a fee to see psychologists in many cases (It depends on the financial status of the patient.), a psychiatrist is free, but they generally don't do cognitive therapy and other things. They are so backlogged that their primary activity is diagnosis and prescribing meds.