Healthcare in United States

@Agauger I tried to message you privately on this but you are not taking messages. I wanted to get your input regarding healthcare in 2019. Did you sign up for Medicare? What is your view of how healthcare is done in the US? I am retired but I don’t get healthcare paid for by my former employers. But I (and my wife) are not old enough for Medicare, so our only way to get health insurance is through Obamacare. What is your view on access to healthcare in the United States? @swamidass please add your views here as it is really a social issue that PS should address.

@Patrick, did I hear correctly that the USA is the only member nation of the OECD which doesn’t provide some sort of universal health care?

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Yes, and it is really having an impact in the US now. Life expectancy in the US is down for several years now. We spend more per person on healthcare and are less healthy.

I did not sign up for Medicare. I am sorry for your predicament. Healthcare is expensive, and any major medical event ca bankrupt a family even with insurance. There are a lot of problems and I don’t have a solution.
Socialized medicine means much higher taxes and restriction to access and sometimes long waits for care.

But we are lucky to have the problem. There could be no insurance or medical care at all.


Well we live in 2018 America where access to healthcare should be afforded to everyone as a human right.
Yet we have a system that makes basic healthcare a rich/poor issue. I can afford any healthcare insurance that I want. But I can’t get it because 1) am not 65 to qualify for medicare, 2) too rich for medicaid or any other programs, and 3) I am retired so I can no longer get medical insurance from my employer as I did for decades. So what to do? @Agauger I am interested why you didn’t sign up for Medicare? That is actually the insurance that I am hoping to get in five years when I turn 65. I couldn’t understand why Bernie Sander’s plan of “medicare for all” wasn’t taken seriously.

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I doubt you would go for the extreme conservative/libertarian position that I gravitate towards that insurance IS part of the problem because it cuts out the directness of payment and the problem actually started with doctor licensing?

Your friend Jay Richards might! His book Money, Greed and God changed my life!


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Have you read any Milton Friedman, Henry Hazzlit, Fredrich Hayek, Mises, or Rothbard? I think they could definitely explain to you why Bernie Sanders plan wasn’t taken seriously.

Because it doesn’t make any economic sense.

Hi - I’m an Australian who has been watching US healthcare for a while.

Frankly, I think the rest of the developed world sees US healthcare as barbaric. Every other developed country has made healthcare universal, affordable and effective by centralising it.

Yes, this means higher taxes to the government but much lower insurance premiums and pharmaceutical costs for each person, so the overall cost per person is much smaller. For example, in 2016 total health spending per person was $4,708 in Australia but $9,892 in the US. Centralised healthcare would save everyone in the US money - businesses and individuals - mainly because a centralised purchaser of healthcare services has vastly more bargaining power than thousands of independent insurance companies.

Not to mention in Australia there are simply no such things as pre-approval, deductibles, or denial of claims. You just show your national Medicare card and you get treated anywhere for nothing or a small fee. Pharmaceuticals are also heavily subsidised and usually cost a person around $10-$30 regardless of the actual cost of the drug (some of which are very expensive).

I believe the only reason the US has not moved to a centralised healthcare model is the lobbying power of the medical, health insurance and pharmaceutical industries, who spend tens of millions campaigning against “socialised” medicine … the better to protect their pocket-books.


Thanks. I don’t hold a position because I don’t know enough about any relevant subject to have a clue. :slightly_smiling_face:


@CLAVDIVS fortunately or unfortunately it is always suspect to make such strong judgements across cultural lines. There are some specific challenges here that make a European style healthcare system all but impossible. This not entirely for barbaric or backwards reasons.

Medicare and Social Security doesn’t make economic sense either. But before Medicare and Social Security poverty among senior citizens was the norm.

Does public education system make any economic sense? How about the GI bill, Child vaccines, the interstate highway system, government funded medical research, the EPA, food stamps?

The other side of the story is someone in the U.S. (not just a rich person) can have a diagnostic such as an MRI in a matter of days and surgery, say, a hip replacement, in a matter of days or weeks. No waiting for perhaps years to be treated when you are suffering from a debilitating condition. There could be changes to make the system more efficient. But copying the 20th century model of centralizing everything would lead to health care rationing and a lower standard of care over time.

Here is the reality of the situation now in the United States. There is no waiting nor rationing for any medical procedure. For example, there is an MRI center a mile from my house. It has the latest MRI equipment and is ready to do MRIs upon appointment. If I called today, I can easily get an appointment for an MRI in a few days at a time convenient for me. Getting a prescription for an MRI is really easy also.

So here is the problem.

If I don’t have insurance, I call up to make an appointment and when asked tell them I don’t have insurance but I will pay for the MRI myself. Since I don’t have a negotiated rate with the MRI center, my price for the MRI is $20,000.

But I do have insurance (a crappy Bronze plan that I pay $1500 a month for that has an incredible $13,000 deductible before it pays one dime) . I call up to make an appoint and tell them my insurance information. Since I have a huge deductible, the insurance company will pay $0 for the MRI but they have a negotiated price of $285 for the MRI so I will only have to paid $285 for the MRI.

Why do I have to pay for insurance for no coverage when the MRI center is doing MRIs for $285 a pop? Why can’t I just pay for the MRI myself? And how do they justify the $20,000 price for an MRI?

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33 posts were split to a new topic: The Case Against Seatbelts

Hi Intjer

All healthcare systems have rationing.

In Australia and most of the developed world, health services are rationed based on medical need as determined by doctors.

In the US, health services are rationed by health insurers who are perversely incentivised to deny as many services as possible in order to maximise their profit. And as @Patrick pointed out, if you don’t have insurance then you are SOL.

The evidence is clear that the US has the worst health outcomes in the developed world in spite of spending roughly twice as much per capita as every other country. So it appears that centralising healthcare leads to a higher standard of care, not a lower one.


Hi Joshua

May I say how much I have enjoyed reading the conversations on this site once I discovered it a couple of weeks ago. It makes a refreshing change to see such relatively respectful dialog in the area of origins.

My characterisation of US healthcare as barbaric was on the grounds that it appears to be needlessly cruel on a personal level, and detrimental at the national economic level.

However I am willing to hear more about the unique challenges the US faces, that may not be faced by all the other western democracies.


Hi Mark

You’re correct that medical services not covered by insurance tend to get cheaper as the technology becomes mainstream. These are not essential life-saving services, and market forces seem to be at work.

Health insurers are also peversely incentivised to support sky-high prices for covered medical services – they add a percentage then pass on the cost to their policy holders, so the higher the price, the higher their profit.

I couldn’t agree more that the US is turning into a plutocracy with collusion between government and capitalists, and this is at the root of your healthcare issues. However, the ballot is still mightier than the wallet – you can still vote in a government that will give you a proper health system.


Like @CLAVDIVS I come from a nation where centralized “free” health care is a no-brainer. In fact I spent my entire career working for it, and it had many strengths, and some weaknesses. The worst weaknesses come from politicization - every time a new government came in they tried to improve the largely unimproveable by an adventurous new reorganisation, when it would be have been better for the professionals to find how to work round even the least well-planned system.

So the greatest interest for me in this discussion is to see how the politicization works in America, as always along polarized party lines, and therefore along social, educational and religious lines because every damned thing is over there. Maybe that’s why it’s thought helpful to get someone you disagree with to come down on one side or the other, whether or not they have any particular dog in the health-care fight: once you can label them on one issue, you can damn them on everything. Fortunately the rest of the world knows life isn’t that simple.

A current discussion here is relevant to political, social and religious lines. Our end-of-life care is, reportedly, light-years ahaed of the rest of Europe, and that is because of the hospice movement, and that is because one Christian doctor, Dame Cicely Saunders (whom I was privileged to invite to speak twice at Westminster Hospital), revolutionized the whole concept of care of the dying.

Local hospices, and later children’s hospices, subsequentluy sprung up all over the country, very often on the initiative of church groups and individual Christian physicians, and they both initiated, and integrated with, home care services like McMillan Nursing, and then with the National Health Service providers, who were able to call on them for expertise and service - thus unblocking hospital beds. It is all run on voluntary contributions from local communities - including, of course, the religious organisations. Their value in making death a positive physical, social and spiritual journey is universally acknowledged.

Now, inevitably with that history, geographical coverage remains uneven, and so enthusiasts call for hospices to be made part of National Health provision… but of course, that would then place them under political control, and especially financial constraints, as it has always sounded better to be advancing cancer treatment than comforting the dying (which is, of course, why Dame Cicely was an unusual doctor in the 1960s).

Politicians, too, then inevitably will see some problem in hospices providing spiritual counsel at secular expense, and the local FFRF equivalent would, without doubt, try to censure the hospices both for allowing religion into state healthcare, and exploiting the dying to boot … though they would almost certainly be more amenable to finding some activist claiming their dying mother was forced to see a priest, rather than speaking to those thousands thankful for support on the edge of eternity, since they have such limited funds.


On a personal note, I work at a medical school and receive first class health care. I took a big hit with Obamacare because my health care plan fell under “Cadillac” plans, which forced my rates to go up (or my employer would pay penalties).
Did that hurt? Yes. Do I think it was necessary, and for the greater good? Also yes.


Like Obama himself said in ‘Colbert Report’, everyone likes Obamacare, some people just don’t like the ‘Obama’ part.