Health care - administrative incompetence

[Agatha]

This is getting beyond ludicrous - comparing the price of Macs in the USA & UK has nowt to do with either the cost of the NHS or the cost of the USA health system.

Nor does misunderstanding the results of the salary calculator ("our" salary implies xjx has added his and his wife's salary together, which will give misleading results), and in any case the salary calculator doesn't take account of Tax Credit payments, whereas the salary calculator US site does take account of dependant deductions. Nor does it take account, as Tatyana says, of our generous paid annual leave, or sick leave.

And as for misunderstanding VAT and thinking it gets added to the ticket price - my mind is boggled.

Still, it saves xjx from actually responding to the important points about the % of GDP that we pay to fund our entire NHS vs the % of GDP that Americans pay to fund a system most of them cannot use.

It also, sadly, seems to stop him from replying to my oft repeated but hitherto ignored questions about long term chronic illness.

 

[Gandalfs Beard]

I'm still wondering how the US model of Health Insurance amounts to so-called "Free Markets."


GB

 

[Emet]

This is getting beyond ludicrous - comparing the price of Macs in the USA & UK has nowt to do with either the cost of the NHS or the cost of the USA health system.

Ya think?

Number Of Uninsured Americans Soars To Over 50 Million
Updated: 12-28-10 09:43 AM

As the Great Recession has sown unemployment and downgraded work even for those people who have held on to their jobs, the number of Americans lacking healthcare has swelled beyond 50 million, according to a sobering new report from the Kaiser Foundation.

Among the report's most troubling findings: The number of Americans without any health care coverage grew by more than four million in 2009. That left almost one-fifth of non-elderly people uninsured. Among those between 19 and 29 years old, nearly one-third lacked coverage.
(...)
As those lacking health insurance grow in number, so do those missing out on necessary medical attention. About one-in-four uninsured adults have forgone care in the past year because of costs, compared to only 4 percent of those who have private coverage, according to the report.
(...)
Those lacking health coverage are vulnerable to what has become a commonplace financial calamity: confronting a medical emergency, and having to pay for care entirely out of pocket. This year, 27% of uninsured adults used up most or all of their savings paying medical bills, according to the study. Half of these uninsured households had total assets of $600 or less.
(...)
The soaring number of people falling through the cracks and going without health insurance is in large part the result of the recession, which has eliminated millions of jobs, along with employer-sponsored coverage. Roughly half of all working age Americans with insurance have it through their employer.
(...)
Yet even if the economy soon adds more jobs and lowers the ranks of the unemployed, the scarcity of health coverage is likely to endure, argues one of the study's authors, Carl Van Horn, Professor of Public Policy at Rutgers University and Director of the John J. Heldrich Center for Workforce Development. Long before the recession, he noted, having a job conveyed no guarantee of coverage.

"Just recovery of jobs isn't sufficent to address the issue," he said. "A lot of the jobs that people are getting are part-time jobs and/or don't have healthcare benefits attached to them."
(...)
"We have an employer-based healthcare system," Van Horn said. "And if your lose your job, unless you're old or very poor, you have no health care insurance."

http://www.huffingtonpost.com/2010/12/27/uninsured-americans-50-million_n_801695.html

 

[Tatyana]

This is pretty interesting.

I must admit, the sales tax in the US seriously annoys, me.

I would approach the till with exact change, only to find I had to cough up more money.

There were times that the tax on a soft drink and Subway would amount to 30%.

It was annoying.


This was in Cali, do they have higher sales tax than most?




http://www.nationmaster.com/graph/tax_tot_tax_wed_sin_wor-total-tax-wedge-single-worker


DEFINITION: The percentage of gross earnings given up in tax, including any social security contributions. Calculated for a single worker without children, earning 100 % of the average wage. Data for 2001, and only for selected OECD countries.


1 Belgium: 55.6%
# 2 Hungary: 52.6%
# 3 Germany: 50.7%
# 4 Sweden: 48.6%
# 5 France: 48.3%
# 6 Italy: 46.2%
# 7 Finland: 45.9%
# 8 Austria: 44.7%
# 9 Denmark: 44.2%
# 10 Turkey: 43.2%
# 11 Czech Republic: 43%
# 12 Poland: 42.9%
# 13 Netherlands: 42.3%
# 14 Slovakia: 42%
# 15 Spain: 37.9%
# 16 Norway: 37%
# 17 Greece: 36%
# 18 Luxembourg: 33.9%
# 19 Portugal: 32.5%
# 20 Canada: 30.2%
# 21 United States: 30%
# 22 United Kingdom: 29.7%
# 23 Switzerland: 29.5%
# 24 Ireland: 25.8%
# 25 Iceland: 25.7%
# 26 Japan: 24.2%
# 27 Australia: 23.1%
# 28 New Zealand: 19.6%
# 29 Mexico: 15.6%

 

[Tatyana]

Close to the same property taxes as well

1 United Kingdom: 11.9%
# 2 Japan: 10.3%
# 3 United States: 10.1%
# 4 Canada: 9.7%
# 5 Australia: 8.9%
# 6 Switzerland: 8.1%
# 7 France: 6.8%
# 8 Ireland: 5.6%
= 9 New Zealand: 5.4%
= 9 Netherlands: 5.4%
# 11 Italy: 4.3%
# 12 Sweden: 3.4%
= 13 Belgium: 3.3%
= 13 Denmark: 3.3%
# 15 Finland: 2.5%
# 16 Norway: 2.4%
# 17 Germany: 2.3%
# 18 Austria: 1.3%

 

[Uncayimmy]

This is pretty interesting.

I must admit, the sales tax in the US seriously annoys, me.

I would approach the till with exact change, only to find I had to cough up more money.

As I understand it, there are laws prohibiting including the sales tax in the listed price in some areas (not positive). If you want to include the sales tax in the price, you have put "Tax Included" or something similar. On the receipt, however, the sale tax needs to be broken out separately. In certain circumstances you can deduct sales tax from your federal income tax, which is probably at least part of the reason for this.

Here's a breakdown for Washington's (state, not DC) price advertising laws:
http://dor.wa.gov/Content/GetAFormOrPublication/PublicationBySubject/TaxTopics/TaxIncluded.aspx

Another issue is that sales tax is local. If (say) Wal-Mart wants to sell a TV for $499, they would have to print out separate advertising for all the places in which it operates. Some states have no sales tax. In those that have sales tax, sometimes cities have additional tax.

Thus the listing of the price makes sense. The method of taxation is another matter entirely.

 

[Emet]

This is pretty interesting.

I must admit, the sales tax in the US seriously annoys, me.

I would approach the till with exact change, only to find I had to cough up more money.

There were times that the tax on a soft drink and Subway would amount to 30%.

It was annoying.


This was in Cali, do they have higher sales tax than most?

Here's the Wiki page on sales tax.

State income taxes are a whole 'nother subject. I once resided in a state with no income tax. Aside from my professional licensing fee, the state instituted a "privilege tax" for most, if not all folks who carried a license to practice their profession/trade.

Had to make up the lost revenue some way...

 

[xjx388]

I don't know which model macbook you are comparing (the top search result on Amazon.co.uk is this one at £789 ($1212) but you may have misunderstood one thing; the price ticket we see in every shop already has VAT included, so you'd be in error if you added a further 20%.

1. Sorry for the misunderstanding. I'm stupid when it comes to how other countries do things. I assume and make an ass out of ME. That's why I like forums: I learn.

2. The point remains that goods are more expensive in the UK which affects buying power.

 

[Agatha]

1. You would not believe the amount of research I've done just for this thread on the US healthcare system and tax regimes.

2. On some things maybe, on other things maybe not.

3. Um, long term chronic illness? Hello?

 

[Rolfe]

Maybe our spending on healthcare is high. But in the UK, our take home pay (according to thesalarycalculator.co.uk) would be ~$14,000 less than it is here.

"Our" take-home pay. So you're inflating this by referring to two salaries - one of them likely to be unusually high, being as your wife's a doctor and you believe doctors should be paid on a par with pop stars.

Your own take-home pay, now?

Then I would pay 20% (in January) VAT on my purchases of most items, which are already more expensive in the UK then the USA (for example in the UK a MacBook costs $1316 +20%, Texas $999 +8.25%).

You seem to have failed to realise that in Britain the price quoted to a private customer is the price paid. No hidden taxes.

The actual UK price of a MacBook, I just looked it up, with today's conversion figure, is $1,307. The actual Texas price you quote is $1,081. That's a difference of $225. On an item manufactured by a US company and in a market where the US is historically cheaper.

Not nearly the difference you suggested, and a cherry-picked example which is probably not representative.

No matter how you slice it, I have more money in my pocket in the US than I would in the UK AND I have control over my own healthcare costs (which amount to about $5000 per year, all told).

You quoted a salary difference based on both your wife's and your joint income. You are quoting health insurance costs for yourself alone. Dishonest, much? How about giving us figures which are actually comparable?

And while we're at it, would someone care to comment on the probability of someone getting good healthcare coverage for $5,000 all told? Sounds very low compared to what other Americans say they have to pay.

Oh I forgot. You have only "catastrophic" coverage. You save "a large amount" every month to cover possible other healthcare costs. So you're not comparing like with like, again. How much more does the necessity to save all that money reduce your disposable income by?

It comes down, as we said in the beginning, to cultural differences. UK=Government take care of us, USA=We'll take care of ourselves for the most part.

We take care of ourselves for the most part. We choose, however, to pool the risk of 100% of the population for healthcare purposes, and not to exclude anyone. We task the government with administering this.

It works well. You should try it some time.

Nope, I have about $9000+ more in my pocket per year in the US than I would in the UK.

No, I don't think you do. Dishonest figures as noted above.

The worst that could happen right now is that my every person in my family has severe medical needs in any given year. In that highly unlikely scenario, then maybe I would have less in my pocket. However, I take that extra $9000 or so (and then some) and sock it away for just such unlikely scenarios. Or to travel the world if I want to. Or spoil my kids. Or renovate my house. My choice.

Or, or, or. You see, that's the difference. It's not an "or" with us. We can do what we like with our savings, without any worry about healthcare costs arising for ourselves or our dependants.

See this is what I have a problem with. You can choose not to work and society is expected to pick up the tab. Preposterous.

Seems to me I've heard American posters complaining about the same thing. Medicaid and all that.

See this is what I have a problem with. A society that is so uncaring that it makes no provision to help people who have fallen on hard times, and in particular leaves them stuck with multiple thousands of dollars of liability for healthcare costs.

Preposterous. Except neither of our countries actually does this, systematically and completely.

Rolfe.

 

[Uncayimmy]

1. Sorry for the misunderstanding. I'm stupid when it comes to how other countries do things. I assume and make an ass out of ME. That's why I like forums: I learn.

It's better to learn before making claims.

2. The point remains that goods are more expensive in the UK which affects buying power.

Right. And since they pay nothing for health care, they have a lot more disposable income to buy a Mac. Where are you going with this? You don't seem to know how to compare buying power between two countries. It's exceedingly complex, and starting with the price of an niche market, imported electronic device when you don't even know how prices are listed in the UK is a terrible start.

I think you should just drop this tangent. It's little more than a desperate attempt to justify your ideology via barely related issues.

 

[Fiona]

I wonder how far the fact of having doctor in the family increases one's comfort with only having "catastrophic" health insurance? Would it make a difference if there was not a doctor (and his or her doctor pals)?

 

[Wildy]

Right. And since they pay nothing for health care, they have a lot more disposable income to buy a Mac. Where are you going with this?

Clearly it's that British people should stop buying MacBooks and instead put that money into the NHS.

 

[Darat]

...snip...

2. The point remains that goods are more expensive in the UK which affects buying power.

No the point is that some goods are more expensive because it's a free market!

By the way if in future you want a much better example of such pricing disparity use the price of Adobe software; Adobe have been ripping off, sorry charging what the market will bear, the UK for a long time.

 

[jimbob]

2. JimBob has attempted to question you on the maths of the issue several times, see (for example) post 207. You've yet to provide a meaningful and comprehensive response.

His numbers are 1. Made up and 2. Based on delivery in the current system.

My estimates for the fundamental costs are conservative estimates. I also did ask where my assumptions or calculations were incorrect, because I have freely admitted to not being an expert in this industry. However, I am an engineer in another capital-intensive industry, and have to factor in the expected return on capital, effects on capacity, and depreciation/amortisation of equipment when comparing technologies.

This is how the free market works in such industries, which I contend is similar in those respects to healthcare. If investors think that they could get a better return in capital by sticking their money in the bank, or buying government bonds, then the required capital for any medical equipment won't get invested.


Please could you give me better numbers then.

In answer to point #2 that the numbers are based on the current system. How will this affect any of these numbers? Especially if you seem to be arguing for an increase in medical salaries elsewhere in this thread.

My questions are highlighted in this

How so? In a free market, if enough people choose not to buy commodity x because it's too expensive, then the price of commodity x has to come down.

ETA2: added in post to which I was mainly responding:

How, exactly, would you have had me budget for 1.2 million dollars in healthcare costs for cancer over the past 7 years (a significant amount of which wasn't covered under insurance?)

In our current system, I wouldn't. 1.2 million is a crap-ton of money and there's no way it should cost so much. You indicated that the insurance didn't cover much of that figure. Are you saying that your out-of-pocket is 1.2 mil or that the total bill was 1.2 mil, the insurance paid a chunk and you are left with a chunk? If so, what was your chunk?

It's hard to argue when the argument becomes personalized in this way. I'm not trying to offend you and I apologize if I did so, sincerely.

I did some calculations earlier, and I'd like you to answer where they are wrong:

Individuals can soon run up costs that are excessive. That is why we need some pooling of risk to as "insurance". You need some administrative overhead, and I'd contend that the US has a wasteful system.

You are wrong that the poor are not an attractive market.

Walmart has done pretty well suppling to the poor.

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.

Would 5-hour surgery suddenly require different numbers of staff? Would the salaries suddenly reduce. Note also that I chose the median salaries of inexperienced medical staff, so this is almost certainly a gross under estimate.

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.

I have no idea how long surgeons can work for, but for intricate, physically demanding work where mistakes are unacceptable, this is also far too long, so this cost multiplier is also far too low

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.

Now, I couldn't find any information for the capital cost of the theatres but given the cost of medical equipment, and facilities for such a room, I would think this is possibly conservative (I do admit that this is cost that I have least confidence in).

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 in hospital.

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

Unless you are referring to capitalism, for the "current system" that could be changed, these costs are basic costs before any of the overhead to pay for the administration, advertising, and the various profit margins that are needed to actually provide a return on investment.

Where has any poster said anything about limiting the income of medics? In other threads at least (and possibly in this one) it has been pointed out that many NHS consultants also have private practices, in addition to their primary NHS practices, and often use the same NHS facilities for the private practice - which benefits the NHS by paying for the resources.

Earlier on I asked if my calculations for the costs for surgery was incorrect. We could probably see what sort of costs Ducky's treatment entails, and it would be pretty expensive. I doubt he would be a profitable prospect for any insurer anyway.

Do you disagree with my calculations. $1.2 million doesn't seem surprising at all. But I am only an engineer in a capital-intensive industry.

Why should insurers be forced to take on unprofitable customers? Why should people find medical insurance prohibitive simply due to an accident of medical history?

The answer is universal healthcare.

 

[Rolfe]

I wonder how far the fact of having doctor in the family increases one's comfort with only having "catastrophic" health insurance? Would it make a difference if there was not a doctor (and his or her doctor pals)?

You know, that's a point. I don't have an insurance policy on my cat, because I'm a vet and I know I'm unlikely to need another one unless something goes "cat"astrophically wrong. I know I have enough savings to cover paying my friend Noel for whatever bionic implant might be needed.

I wouldn't use myself as an example when it comes to funding veterinary care, that's for sure.

Rolfe.

 

[Emet]

1. You would not believe the amount of research I've done just for this thread on the US healthcare system and tax regimes.

2. On some things maybe, on other things maybe not.

3. Um, long term chronic illness? Hello?

Hello, Agatha.

Here's an interesting article:

The report pointed to five key findings about the interaction of health care systems and chronic illness sufferers and the resultant financial burdens that may cause these individuals, at times, to be unable to access care. The report’s findings specifically related to people who have private insurance.

1) High cost-sharing, caps on benefits and lifetime maximums leave cancer patients vulnerable to high out-of-pocket health care costs. Some people in the report had more than $100,000 in medical bills, despite having an insurance policy throughout their treatment.

2) People who depend on their employer for health insurance may not be protected from catastrophically high health care costs if they become too sick to work.

3) Cancer patients and survivors are often unable to find adequate and affordable coverage in the individual market. Even when they are in remission or have received an upbeat prognosis from their physicians, cancer victims still endure hardship in finding coverage and pay higher premiums for individual coverage due to medical underwriting.

4) While high-risk pools are designed to help cancer patients and others who are uninsurable, they are not available to all cancer patients and some find the premiums difficult to afford. Not all states offer coverage through high-risk pools.

5) Waiting periods, strict restrictions on eligibility, or delayed application for public programs can leave cancer patients who are too ill to work without an affordable insurance option.

“Cancer patients too often find out that their insurance doesn't protect them when they need care the most. High out-of-pocket costs coupled with the high cost of insurance premiums can force cancer patients to incur huge debt, and to delay or forgo life-saving treatments.”
John R. Seffrin, Ph.D., national chief executive officer of the American Cancer Society

http://www.analysisonline.org/site/aoh_display.asp?sec_id=140002434&aoh_id=415

 

[Darat]

xjx388 - it's a fast moving thread so you probably missed some posts - but could you answer two questions that seem outstanding?

The first is mine:

xjx388 - do you believe that everyone in your country should have access to a good level of healthcare?

The second is this one:

xjx388, do you ever intend to address the issue of people with chronic illness?

...snip...

 

[jimbob]

So start easy: What is your income tax percentage, what is your VAT percentage and at what rate is your national insurance tax?

You having "enough left to do what you want" is not specific enough in a discussion of the advantages and disadvantages of NHC.

Perhaps it is purposely confusing because if you really knew how much you were actually paying you'd move to the U.S.

Do you know of any stats regarding how many people have the additional private insurance?

check out my sig for the expendeture in 2007 for private and state-funded healthcare (the link will let you see the entire excel document from the OECD)

OECD healthcare statistics

http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_1,00.html
2007 Data (latest available)
UK 8.4% of GDP of which 81.7% is state expenditure = 6.86% of GDP from taxes
US 16% of GDP of which 45.4% is state expenditure = 7.264% of GDP from taxes

 

[Ducky]

Hello, Agatha.

Here's an interesting article:




http://www.analysisonline.org/site/aoh_display.asp?sec_id=140002434&aoh_id=415

One by one, let me share my experience with these:

1) High cost-sharing, caps on benefits and lifetime maximums leave cancer patients vulnerable to high out-of-pocket health care costs. Some people in the report had more than $100,000 in medical bills, despite having an insurance policy throughout their treatment.

Absolutely accurate for me. While I have not yet been told I hit a lifetime cap/maximum, when this happens (and I assume it will until something drastically changes) I'll be even deeper in than I am now.

2) People who depend on their employer for health insurance may not be protected from catastrophically high health care costs if they become too sick to work.

Yes. When I was starting my business I had a day job for the insurance. When I was diagnosed I had begun full time to work on my business and was between coverage. Due to this, I faced a host of problems being covered and getting care I could afford.

3) Cancer patients and survivors are often unable to find adequate and affordable coverage in the individual market. Even when they are in remission or have received an upbeat prognosis from their physicians, cancer victims still endure hardship in finding coverage and pay higher premiums for individual coverage due to medical underwriting.

Absolutely true. Were I to get my own policy now it would be completely unaffordable. I should point out I make well above the poverty line, and it is still unaffordable.

4) While high-risk pools are designed to help cancer patients and others who are uninsurable, they are not available to all cancer patients and some find the premiums difficult to afford. Not all states offer coverage through high-risk pools.

100% accurate. I don't have a lot to add, that's pretty specific and self-explanatory.

5) Waiting periods, strict restrictions on eligibility, or delayed application for public programs can leave cancer patients who are too ill to work without an affordable insurance option.

One better: I turned to MinnCare, a public service for those without insurance who need it. I was told to qualify for coverage to get the surgery to fix my spine I had to make less than 500 dollars a month. That doesn't even cover rent, but I shut down my business and under advice from the social worker did not file for unemployment in order to qualify. When I did that, and was forced to rely on credit for the qualifying period and I found myself in massive debt from it. 6 months later when that coverage was changed (based on need of cost, emergency operation v. continued care) MinnCare has a program worked out with private insurance companies. When I was handed over to a major Private insurer in Minnesota, that insurer promptly dropped any payments on any services because several years prior I had been covered with them under another primary care physician. Because of this, 100% of my radiation treatments and PT recovery regimen was not covered. My debt has spiraled well into six figures since then, even after getting on insurance through my work's group policy.

But hey, I should have gone without because I couldn't afford it, right xjx388? Obviously I'm one of those welfare cheats you describe.

ETA: Side note: at the time this happened I was called a welfare cheat by someone whose views mirrored xjx388. Apparently I am somehow a welfare cheat for needed gov't assistance for health care and yet NOT filing for unemployment.