This is the Government that You Want to Run Health-care?

[Rolfe]

You know, I'm still a bit confused about the figures being bandied around here. We seem to have agreed that:

1. The US spends 6.6% of GDP on state-funded heathcare.
2. That provision covers only 37 million people, or 12.3% of the population.

That leaves 87.7% of the population being covered by private health spending.

Now I also thought we'd established that total healthcare spending in the USA was about 15% of GDP.

Does this not therefore suggest that 87.7% of the population, that is 263 million people, is being cared for privately by spending only 8.4% of GDP?

Taken at face value, this would suggest that per skull, state-funded care costs over five-and-a-half times as much as private care.

To confuse matters even more, we have also discovered that health insurance companies cream off about 25% of the premiums they collect in profits and overheads, utilising only about 75% of their income to purchase healthcare for their clients.

I'm fairly sure there is some confusion in the figures here, as this seems downright impossible to me. I suspect it may be something to do with how the population is assigned between the groups. Or else it may be that I have formulated the question incorrectly. I would be grateful if someone who has studied the figures could put me right on this.

Rolfe.

 

[Darat]

I didn't think the USA figures included items such as people's medical insurance premiums just what the cost of the actual medical care is?

ETA:

This article (I have no idea of the provenance of the site) seems to break it down in a sensible manner: http://www.nchc.org/facts/cost.shtml

By several measures, health care spending continues to rise at the fastest rate in our history.

In 2007, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation.1 Total spending was $2.3 TRILLION in 2007, or $7600 per person.1 Total health care spending represented 16 percent of the gross domestic product (GDP).

...snip...

In 2007, employer health insurance premiums increased by 6.1 percent - two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400.2

...snip...

 

[balrog666]

You know, I'm still a bit confused about the figures being bandied around here. We seem to have agreed that:

1. The US spends 6.6% of GDP on state-funded heathcare.
2. That provision covers only 37 million people, or 12.3% of the population.

That leaves 87.7% of the population being covered by private health spending.

Now I also thought we'd established that total healthcare spending in the USA was about 15% of GDP.

Does this not therefore suggest that 87.7% of the population, that is 263 million people, is being cared for privately by spending only 8.4% of GDP?

Taken at face value, this would suggest that per skull, state-funded care costs over five-and-a-half times as much as private care.

To confuse matters even more, we have also discovered that health insurance companies cream off about 25% of the premiums they collect in profits and overheads, utilising only about 75% of their income to purchase healthcare for their clients.

I'm fairly sure there is some confusion in the figures here, as this seems downright impossible to me. I suspect it may be something to do with how the population is assigned between the groups. Or else it may be that I have formulated the question incorrectly. I would be grateful if someone who has studied the figures could put me right on this.

Rolfe.

I didn't come up with the 6.6% of GDP figure but I can guess that it is *ALL* spending on health care in the US, public and private, certainly federal spending is easy to check.
And Medicare covers some ~43 million, Medicaid some ~48 million.
Some ~25+ million are estimated to be eligible for VA coverage but it tends to be a last resort use.
Some 2-3 million are served by the Indian HCS (also a last resort).
More are covered under state and local hospitals and services.


I find it rather silly to assume that upon nationalization of health care services, the best doctors and hospitals will suddenly be able to (and happy to) handle three times their current patient load, especially in geographic areas they do not now serve, while all those crappy, overloaded, and overbureaucratized services will just fade away into the dust. I strongly suspect that nationalized health care will almost certainly start with the expansion of the current government-run systems, entrenching the bloated and incompetent bureaucracy even further into the system.

 

[Rolfe]

No, we're pretty clear that the 6.6% refers to state-funded healthcare.

As Darat confirmed in the previous post, total healthcare spending in the USA is pretty much what I had thought, 16% of GDP.

It may be that the state-funded health care covers a larger proportion of the population than we had assumed. In addition, it may be that I have a false assumption in there somewhere, I'm not certain I've got my brain round it.

It seems to me that the medical insurance industry is part of healthcare. If these figures only include what is actually spent on healthcare directly, and exclude the 25% of the premiums which are supporting the insurance companies, then the figures are an underestimate. All of a medical insurance premium, I would contend, is spending on healthcare.

Rolfe.

 

[jimbob]

Here is where I got the 6.6% figure (for 2004)

Medicaid costs a larger percentage of GDP than the NHS does the British taxpayer.
(44.7% of 14.7%=6.6%) was public, as opposed to the UK's (83.4% of 7.7%=6.3%) of GDP Source:

OECD Health Data 2007 - Frequently Requested Data

 

[balrog666]

Here is where I got the 6.6% figure (for 2004)

Thanks. Budget numbers for FY2007 appear to be 15.3 and 5.4%, respectively, so they are not out of line (source here: US Budget FY2007) although that latter number includes the CDC, the FDA, the NIH, etc as well as direct spending.

 

[jimbob]

Bump for Jerome...

The details please.

Will a general hospital in a large prosperous city magically be built on land that is cheap? If not how will the capital cost of a general hospital be reduced?

Will a 5-hour surgery not require a surgeon, anaesthetist, and supporting nurses? Will surgery currently requiring 5-hours in theatre, suddenly need less time?

Will the surgeon and anaesthetist spend a greatrer proportion of their working time in theatre? (Actually my rough calculation, completely unrealistically assumed that they spent 100% of their time in theatre). If this time is to be maximised by the free-market, how?

Aside: Does anyone have any figures for what proportion of a general surgeon's work is actually in theatre?​

Will the general surgeon, and anaesthetist accept lower wages, when their skills are still in demand?

Will the capital cost of the theatre be reduced? If so, how? Will it be depreciated over a longer time?

Why would the cost of medical equipment be reduced?

I have already asked these questions, or simlar ones, and your answers seem to say that you accept my calculations but in later posts deny their validity, why:

Originally Posted by JEROME DA GNOME
Quote:

Originally Posted by jimbob
Any specific examples?

The current problems in the American health-care system.

Quote:

Quote:
In a deregulated market, will economies of scale suddenly vanish?

Nope.

Quote:

Quote:
Will the capital cost and depreciation of medical equipmens suddenly reduse?

Nope.

Quote:

Quote:
Will medical treatment and diagnosis suddenly not need highly qualified workers? Will highly qualified workers, in a field where there is demand for their services suddenly not command high wages?

Nope and nope.

Quote:

Quote:
Will large hospitals not be needed, or will the capital cost of the hospital also not need to be covered? Will the land value of new hospitals vanish.

Nope and nope.

Quote:

Quote:
Without regulation, how do you protect against cartels?

Why should I protect against cartels?

Where are the costs going to be reduced. With specific examples (other than the free market pixie).

ETA: Here are my detailed calculations, hidden for brevity,

Please tell me which parts are not estimating the lowest plausible cost:

But they wouldn't make any money in selling inherently expensive treatment at below cost.

According to this the median net worth of a renting household was $4k in 2004 (if I am reading the data correctly)

How could a household with a net worth of that actually pay any more than $4k for anything? Especially as they are likely to be poor credit risks, so borrowiong the money would be difficult.

Can we get the coronary healthcare cost below $4k?

5-hour bypass surgery: General surgeon with less than 1-year experience, $170k, Anaesthetist , less than 1-year experience, median salary $145k.

Both work 60 hour weeks for 50 weeks a year. This means that their combined equivalent hourly rate is $105/hour.

Now they are not performing surgery all of that time, so the actual money that the they are paid as an hourly rate whilst in theatre has to be higher.

As well as the two highly-skilled doctors, you need support staff, (in one photo, the team seemed to be four people), so that makes two other wages that need paying directly during the surgery.

You also need to pay for the use of the theatre, and expensive equipment, say $3million, depreciated over 5-years, when the equipment is in yse 52 weeks per year, gives a theatre cost of $11.5k/week. Now the theatre can't be in use all this time, there has to be preparation, so (generously) we could also assume a 60-hour week for the theatre, which gives $190/hour just for the theatre. Actually it will cost a lot more than this, but I am making a conservative point.

So far just taking the cost of the theatre depreciation and the salaries of the surgeon and anaesthetist, both at the bottom of their respective pay scales, and both working 60-hr weeks in theatre, we get to $295/hour, or $14745 for the five-hour surgery.

You could probably double this for more realistic utilisation rates.

You now need to add in the cost of the other two team members, and of the provision of facilities, and of the proportion of the hospital capital cost that is being depreciated (say over 30 years), and the cost of the bed and accomodation over (three days) stay inhospital.

It soon costs more than the $4k that these people have.


Rolfe works in a free-market system providing medical care to animals, so I will ask him this next question:

If someone's pet needs treatment that costs more than they can afford, do you (as the representative of the free market pixie) reduce the price of the treatment, or does the animal not get any treatment?

 

[JEROME DA GNOME]

Bump for Jerome...

The details please.

Will a general hospital in a large prosperous city magically be built on land that is cheap? If not how will the capital cost of a general hospital be reduced?

Will a 5-hour surgery not require a surgeon, anaesthetist, and supporting nurses? Will surgery currently requiring 5-hours in theatre, suddenly need less time?

Will the surgeon and anaesthetist spend a greatrer proportion of their working time in theatre? (Actually my rough calculation, completely unrealistically assumed that they spent 100% of their time in theatre). If this time is to be maximised by the free-market, how?

Aside: Does anyone have any figures for what proportion of a general surgeon's work is actually in theatre?

Will the general surgeon, and anaesthetist accept lower wages, when their skills are still in demand?

Will the capital cost of the theatre be reduced? If so, how? Will it be depreciated over a longer time?

Why would the cost of medical equipment be reduced?

I have already asked these questions, or simlar ones, and your answers seem to say that you accept my calculations but in later posts deny their validity, why:




Where are the costs going to be reduced. With specific examples (other than the free market pixie).

ETA: Here are my detailed calculations, hidden for brevity,

Please tell me which parts are not estimating the lowest plausible cost:

As I have said the costs for health-care will be reduced when the government stops funding it.

Look to education to see how costs rise when money is spent by government.

 

[jimbob]

By how much; didn't you agree with my calculations about the cost of hospitals, wages etc...

If you didn't agree with my calculations, could you show where the difference is.

Maybe general surgeons will be willing to work for only $40/hour?

Maybe the land cost of hospitals will vanish?

Maybe not.

Do you want me to spell out all my calculations again?

ETA:

The cost doesn't need to simply be reduced, but for your claim to work private, unsubsidised healthcare has to become cheap enough for someone on $7/hour.

 

[Architect]

As I have said the costs for health-care will be reduced when the government stops funding it.

Is this more unsubstantiated spreculation or do you have some real evidence to back it up for a change?

Look to education to see how costs rise when money is spent by government.

Are you seriously suggesting that privately owned schools are more cost effective than the public sector? Evidence??

 

[JEROME DA GNOME]

Is this more unsubstantiated spreculation or do you have some real evidence to back it up for a change?



Are you seriously suggesting that privately owned schools are more cost effective than the public sector? Evidence??

Do you really need to be spoon fed information?

Do some research.

 

[Architect]

Do you really need to be spoon fed information?

Do some research.

I can see that you're struggling with the concept of scepticism, or critical thinking, which seems deeply unfortunate given that you have chosen to inhabit a site focussing on just this area.

A sceptic is one who questions the reliability of certain kinds of claims by subjecting them to a systematic investigation based on testable hypotheses, analysis of evidence, and critical thinking.

You may wish to avail yourself of a definition of these terms.

Now, let's look again at this issue. YOU have made a statement which YOU have apparently been unable to substantiate or provide substantive (hell, any) evidence for. Now YOU expect US to do you research for you.

Really, you'll love Loose Change.

 

[Blue Mountain]

Do you really need to be spoon fed information?

Do some research.

You're making the assertion; you back it up with evidence.

Our evidence is that the UK and Canada pay half what the US does for health care and get better outcomes. For a little bit more than what the US taxpayer is paying to supply healthcare to about 30% of its population, the Canadian and UK taxpayers are covering the entire population.

Or are you just a troll?

 

[Architect]

Odds-on says "troll". Or whining. One of the two, anyway.

Civility, folks. Please be civil.

Replying to this modbox in thread will be off topic  Posted By: LibraryLady

 

[JEROME DA GNOME]

You're making the assertion; you back it up with evidence.

Our evidence is that the UK and Canada pay half what the US does for health care and get better outcomes. For a little bit more than what the US taxpayer is paying to supply healthcare to about 30% of its population, the Canadian and UK taxpayers are covering the entire population.

Provide the evidence that Canada provides better health-care.

Provide evidence that the UK provides better health-care.

I have already evidenced that they do not. That information was just waved away.

This is why I am no longer doing other's research for them.

 

[Architect]

I have already evidenced that they do not. That information was just waved away.

Simply stating, without substantiation, that something is the case does not constitute evidence. In fact on this thread very critical information reegarding expenditure and coverage have been put to you, and you have failed to respond save for attempting to divert the subject onto some sort of defence/colonial topic.

What's wrong? Can't substantantiate your own arguments and opinions? That doesn't bode well, does it?

 

[JEROME DA GNOME]

Simply stating, without substantiation, that something is the case does not constitute evidence. In fact on this thread very critical information reegarding expenditure and coverage have been put to you, and you have failed to respond save for attempting to divert the subject onto some sort of defence/colonial topic.

What's wrong? Can't substantantiate your own arguments and opinions? That doesn't bode well, does it?

You can example to proper way to write on this forum.

Start here:

Provide the evidence that Canada provides better health-care.

Provide evidence that the UK provides better health-care.

 

[jimbob]

Provide the evidence that Canada provides better health-care.

Provide evidence that the UK provides better health-care.

I have already evidenced that they do not. That information was just waved away.

This is why I am no longer doing other's research for them.

OK, lets take Canada compared to the US:
US:

Infant mortality rate:
total: 6.37 deaths/1,000 live births
male: 7.02 deaths/1,000 live births
female: 5.68 deaths/1,000 live births (2007 est.)

Life expectancy at birth:
total population: 78 years
male: 75.15 years
female: 80.97 years (2007 est.)

Canada:

Infant mortality rate:
total: 4.63 deaths/1,000 live births
male: 5.08 deaths/1,000 live births
female: 4.17 deaths/1,000 live births (2007 est.)

Life expectancy at birth:
total population: 80.34 years
male: 76.98 years
female: 83.86 years (2007 est.)

Or the UK:

UK:

Infant mortality rate:
total: 5.01 deaths/1,000 live births
male: 5.58 deaths/1,000 live births
female: 4.4 deaths/1,000 live births (2007 est.)

Life expectancy at birth:
total population: 78.7 years
male: 76.23 years
female: 81.3 years (2007 est.)

If life expectancy isn't a measure of health, what is a better proxy?

I would prefer to see the life expectancies of the the population divided into quartiles/deciles based on wealth, that would show many demographic differenced.

I don't think anybody is claiming that the US provides inadequate healthcare for the wealthy, expensive maybe, but not inadequate.

What I am claiming is that it provides inadequate healthcare for a significant proportion of the population, and that it does this whilst the government spends more on healthcare than the UK, which does provide universal healthcare.

 

[Architect]

First of all, JimBob seems to have done a perfectly acceptable job in supporting the case for - at the very least - comparable levels of healthcare in Canada and Europe. I'll happily leave that to him.

Secondly, you now need to substantiate your assertion that we've only done so on the back of purloined wealth from former colonies. Which should be particularly difficult for you in the case of Canada, I should think.

 

[jimbob]

Jerome, can't you at least post back to your original opost claiming evidence, or is it of the level of the "free market pixie" with no supporting evidence for the statement.