Universal Health Care in the US. Yea or Nea?

[kellyb]

It's an interesting idea. But the fact remains that America already spends way over the odds on inadequate healthcare. They don't need to spend more. They just need to spend it on healthcare, not overheads.

Rolfe.

Well, it's not just a matter of overhead, I don't think.
Some of the excess cost is because the US gov doesn't put price caps on drugs here, so pharmaceutical companies can charge whatever they want here. Pharma says the profit it makes off Americans is what fuels new drug developments. Most of the R&D costs are acquired by price-gouging US citizens.

Also, here, (from what I understand, I might not be getting this quite right) the high-risk professions (like OBGYN) pay their malpractice insurance in their own groups, instead of the risk being diluted by the low-risk professions as it is in the NHS. So that fuels the CYA excessive medicine and extra costs so the doc can afford the malpractice insurance.

There are a few other factors at play, too. It's really a mess and I don't think anyone really completely understands what's happening.

 

[kellyb]

I am not talking of spending more, instead of companies paying for private insurance they would pay taxes. And a significantly smaller amount than thay currently pay in insurance.

A whole lot of small businesses don't even offer insurance, and taxing them more would drive them under. Even more small and medium sized businesses only pay a fraction of the insurance costs for a family. So I don't think it would work out like you're thinking.

 

[Toke]

So I don't think it would work out like you're thinking.

I don´t know how many companies pay health insurance or how much of it.
But getting it through taxes is cheaper than through private insurance, so raising taxes for both companies and employees would be a bargain. Let the accountants figure out how to distribute the raise.

 

[Kestrel]

I don´t know how many companies pay health insurance or how much of it.
But getting it through taxes is cheaper than through private insurance, so raising taxes for both companies and employees would be a bargain. Let the accountants figure out how to distribute the raise.

The mantra is that private solutions are always cheaper and more efficient.

Reality is somewhat different. Senior citizens in this country get health care via the Medicare program. As an option, they can sign up for a privately run HMO plan. The companies that offer these plans don't accept anyone who is not healthy. Each person using the HMO plans costs the taxpayers about 15% more than the traditional Medicare patient.

 

[Rolfe]

Would you mind explaining that? I don't even know what HMO stands for.

KellyB said in another thread that health insurance for her family takes 50% of their income. This is surely unsupportable. If it's 50% of a low income then maybe it's not a huge price for the insurance, but it must be leaving the family on the breadline.

I've been trying to work out what I actually pay for the NHS. As far as I can figure it, it's about £300 a month in my taxes (£3,600 a year). Probably about a third of the total tax take. Or, if I add that notional £300 back into my take-home pay, then it comes to just over 10% of my monthly take-home pay (or 8.5% of my gross salary). (It might be less than this, as some of the assumptions I'm making are a bit shaky. It's certainly not more.)

The huge difference here is that my contribution is calculated not on my perceived risk (as my motoring insurance is, for example), but on what my income is. So, a low-risk person on a high income is going to be paying quite a lot (and actually, that's the category I'm in, despite what seems to be quite a modest contribution in US terms), while a high-risk person on a low income is going to be paying only a little.

"Oh, how unfair!" I hear the Americans shout. The low-risk person should be paying the small premium and the high-risk the high premium!

But think about it. This is a whole-life thing. I was covered by the NHS when I was a child, and earning nothing (and I can tell you, my father was earning the backside of nothing too). Ditto when I was a student. Ditto when I was just starting out and on a low income. And when I retire and my income goes down, I'll still be covered. If I should have the misfortune to be ill or injured so that I'm unable to work, the NHS will still cover me. No difference. No variation in the care I'm entitled to. And all the time, I pay just that 10% or thereabouts of my income (well, less on a very low income, because of tax allowances).

I don't just look on what I pay now as my contribution to the overall good of the society I live in at the moment, I look on it as my payback for what I've had in the past, and my contribution to what I may need in the future. And under this system nobody can look at my health record and deny me cover, and nobody can insist that I pay a premium I can't afford. I pay in when I can afford it, and it's there for me even when I can't. And if I don't ever need it? Well, hey, who wants to be ill?

I struggle daily to understand why so many Americans don't like this idea. To me, it is the bargain of the century.

Rolfe.

 

[Blue Mountain]

Would you mind explaining that? I don't even know what HMO stands for.

An HMO is a Health Maintenance Organization^WP:

A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract. The Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options. Unlike traditional indemnity insurance, an HMO covers only care rendered by those doctors and other professionals who have agreed to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers.

I struggle daily to understand why so many Americans don't like this idea. To me, it is the bargain of the century.

In his 1982 book Why We Act Like Canadians (subtitled Letters to an American Friend), noted Canadian author and historian Pierre Burton mused on the differences between Canadian and American views of government. Canadians, Burton wrote, have a tendency to trust their government as a whole but hold the sitting Prime Minister and his ministers in low regard. Americans, on the other hand, love their democracy, holding the office of the President (if not its current holder) in high esteem, while at the same time being distrustful of government as a whole.

 

[Blue Mountain]

I've been trying to work out what I actually pay for the NHS. As far as I can figure it, it's about £300 a month in my taxes (£3,600 a year). Probably about a third of the total tax take. Or, if I add that notional £300 back into my take-home pay, then it comes to just over 10% of my monthly take-home pay (or 8.5% of my gross salary). (It might be less than this, as some of the assumptions I'm making are a bit shaky. It's certainly not more.)

I've tried to do similar calculations myself. Where I ran into problems was trying to figure out what my contribution to government coffers is. In addition to income tax, I'm paying other taxes to the federal government, primarily GST (VAT) and gasoline.

And the government has sources of revenue other than personal taxation. There are taxes on business. What proportion of that do I end up paying indirectly? I expect there are some industries for which that number isn't all that high because I don't have any direct or even indirect interaction with that sector. Others such as high tech are probably more noticeable, because I like my gadgets.

And the government gets revenue from royalties on resource extraction, tolls on canal operations, the occasional sale of assets, etc. Overall the calculation isn't that straightforward.

 

[Rolfe]

Yes. It was a wild guess. I don't think it's an underestimate though.

I would add that, whatever it is, I still think it's a good deal. I still have plenty left after tax. And if the government is a bit short, there's a Trident submarine or two they could economise on....

Rolfe.

 

[ServiceSoon]

I pay 8.27% of my monthly salary for health care to cover myself, while my employer probably pays another 8.27%.

 

[Rolfe]

And on top of that, you're paying about the same as we are (I mean what we pay for the NHS) for your share of the cost of Medicare/Medicaid - possibly a little more.

Rolfe.

 

[Kestrel]

I don't just look on what I pay now as my contribution to the overall good of the society I live in at the moment, I look on it as my payback for what I've had in the past, and my contribution to what I may need in the future. And under this system nobody can look at my health record and deny me cover, and nobody can insist that I pay a premium I can't afford. I pay in when I can afford it, and it's there for me even when I can't. And if I don't ever need it? Well, hey, who wants to be ill?

I struggle daily to understand why so many Americans don't like this idea. To me, it is the bargain of the century.

Rolfe.

Have you ever seen the propaganda spread in the US about the health care system in countries with socialized medicine like the UK?

 

[Rolfe]

I've come across some of it in threads such as this, and links people have posted. It's unbelievable.

Almost as unbelievable as the lies and slander and misrepresentation, is the wilful determination of some US posters to reject and ignore the truth when it is told to them severally and together by a high percentage of the Europeans on the forum.

Rolfe.

 

[quixotecoyote]

I've come across some of it in threads such as this, and links people have posted. It's unbelievable.

Almost as unbelievable as the lies and slander and misrepresentation, is the wilful determination of some US posters to reject and ignore the truth when it is told to them severally and together by a high percentage of the Europeans on the forum.

Rolfe.

Your equine transportation appears to be undergoing a severe increase in elevation. Just thought you might want to know.

 

[Corsair 115]

I've tried to do similar calculations myself. Where I ran into problems was trying to figure out what my contribution to government coffers is. In addition to income tax, I'm paying other taxes to the federal government, primarily GST (VAT) and gasoline.

It gets even more difficult when you consider that there are tax credits you can get that are intended to offset some of those tax costs. For example, depending on one's level of income, you can get quarterly GST tax credit cheques from the government. There are lots of other deductions and credits that come into play as well.

 

[Rolfe]

And someone just pointed out that the taxes on both alcohol and tobacco are high, and that tobacco taxes in particular are justified as helping support the NHS. I drink little and smoke not at all. I know the cost of the NHS in Scotland is about £10 billion, because that was stated when the Scottish budget was published. But I can only relate that to a subset of taxes (that amount devolved to the Scottish government).

I'm sure the information is there somewhere (total cost of the NHS in Britain as opposed to total tax take from the population), but I don't know where to find it. (All I know is about 7.7% of GDP, as opposed to about 15% of GDP for the USA spent on healthcare in total, and that's not quite what we're discussing).

It's still a damn good bargain.

Rolfe.

 

[Ivor the Engineer]

The NHS costs about £100 billion per year, which translates to about 9.4% of GDP.

http://news.bbc.co.uk/1/hi/health/1935730.stm

http://www.independent.co.uk/news/uk/politics/nhs-budget-growth-to-slow-to-4-396421.html

 

[Rolfe]

Seems to vary depending on the source of the statistics. Some may be more up to date than others. Ivor, that first link of yours is predictions from 7 years ago. The second is a newspaper article two years old, and I see nothing about GDP in it.

This is using 2005 statistics, but at least it's not a newspaper article.

Rolfe.

 

[applecorped]

From the document:


"Most of the funding for the healthcare system comes from county, municipal, and parish taxes.
These local income taxes, which are set by the municipal and county governments, tend to be
proportional to income, with an average rate of 31.65% in 1998. All in all, county taxes funded
66% of Swedish healthcare spending in 1999, and 85% of all county expenses came from
healthcare expenditures (León and Rico 2002).

Grants from the central government to the counties/municipalities, financed through a
progressive national income tax and regressive indirect taxes, account for 7-11% of health
expenditures. The remainder of healthcare spending is financed by patient fees (2%) and
mandatory contributions by employers and employees (21-25%); such contributions took the
form of an 8.5% payroll tax in 2000. The overall financing scheme of Sweden’s health system
skews regressive due to the proportional local taxes and high co-payments (León and Rico
2002)."

 

[Ivor the Engineer]

http://www.publications.parliament.uk/pa/cm200708/cmhansrd/cm080901/text/80901w0085.htm

Andrew Gwynne: To ask the Secretary of State for Health when he plans to issue primary care trust allocations for (a) 2009-10 and (b) 2010-11. [219876]

Mr. Bradshaw: The 2009-10 and 2010-11 primary care trust revenue allocations will be announced in the autumn alongside the NHS Operating Framework for 2009-10.

Mr. Donohoe: To ask the Secretary of State for Health what the NHS budget will be in 2009-10. [220560]

Mr. Bradshaw: The total NHS plan expenditure for 2009-10 is £102,642 million. This is as set out in the NHS Departmental Report 2008 (Figure Al).

 

[Rolfe]

Is that all of the NHS, including Scotland, Wales and Northern Ireland?

How does it relate to GDP?

We probably don't know GDP for 2009-10 yet, so if you could find a recent time period we have full data for, that would be good.

Or we could go on discussing using the published statistics, which give comparable figures for the different countries we're discussing, without having to dredge them up one at a time. Since actually the details don't affect the argument a great deal.

Rolfe.