> Should this also be the case for food, housing, and cell phones? If not, why?
Because the heart transplant for your child, or elderly care of your mom, or your cancer treatment is not like a cell phone. Or is it? It is for me at least. Is that something that needs to be explained?
Single payer systems are not hypothetical utopia / sci-fi scenarios. This is already happening in many countries where people are happier and live longer.
Do you have any examples where healthcare regulated like cell phones with a good outcome?
Surely if it is such a great system, someone would have stumbled on it.
I have examples of where it is regulated like the cell phone and it doesn't work -- pretty much any third world country where regulatory agencies are practically not functional. There you go to to the doctor to get a shot of antibiotic, instead you get a shot of saline. Because antiobiotic shots cost money. Etc.
Because those are things that are an actual market. Health care often times isn't. You can choose what grocery store you go to, what apartment you rent, what cell phone you buy. Usually, unless your planning sucked, you have days/weeks/months to figure out what is good value, and compare prices, that kinda thing.
Health care, on the other hand, can be, and at least in my case, usually is, a monopoly. I've got 1 large company that runs most of the doctors offices and all of the hospitals in the area, so they don't have many competitors. Also, for emergency stuff, you don't have a chance to even think about shopping around. Broke a bone? Yeah, sounds like a great time to pull out the phone and shop around for doctors that would be able to set it for cheaper.
If you had a gunshot wound that needed treating, and you arrive at the hospital to find today only they are charging 1 million dollars for bullet removal (what a coincidence), but the hospital one state over was doing bullet removals for only 100,000$ - are you in a position to negotiate? Is there any reason at all that this hospital would lower its price to match its competition? (as would happen in a competitive market)
Now flip it and say instead of a gunshot you broke your cellphone. You arrive at best buy and they say today only the iphone costs 1 million dollars, but a store one state over has it for 600 - are you in a position to negotiate? Is there any reason at all best buy would lower its price to match the competition? In fact, this happens every day at most every major retailer.
In the US we ascribe much higher value to freedom of choice & markets, etc. We have elected to take the good (driving a disproportionate share of medical progress) with the bad (twice the cost for worse outcomes).
As a counterpoint, I'm from the US and I completely disagree with this. I never ascribed any such value to the "free market", especially when it comes to health care.
And what will happen is you will not get much health care. Certainly much less than you got in 2005, for much more than you paid in 2005.
Insurers routinely pay out over %100 of premiums in claims. Meanwhile government programs with benefits- like welfare- blow %75 of their budget on overhead and only pay out %25.
Economics is like physics. You can wish it wasn't so. You can look at optical illusions, but the reality is always there.
How much healthcare do you get in the US for $2928/year? That's how much the UK National Health Service cost the UK government per person in the 2013/2014 reporting period, for a comprehensive universal healthcare system with no deductibles, no co-pays other than a minor prescription charge (7 pounds, unless you're exempt due to low income), and which is consistently ranked higher than US healthcare by the WHO.
If we can cut that by 75% since government programs are apparently so wasteful, I'm assuming US insurers should be able to offer some insanely great programs in the ~$3000/year bracke, since the UK apparently ought to be able to get away with providing this level of service for $750/year.
The problem is that the USA is funding a disproportionate share of the medical advances. So while it may seem absurd that we spend double for worse outcomes, I'm not sure it's so simple.
While that is true, it is quite clear that it is not what drives healthcare costs.
Firstly, industry only accounts for less than 60% of research in the medical field in the US to begin with. The rest is made up by donations, grants from various organizations, and about 28% from the NIH that are not part of the healthcare spending.
When you look at the R&D expenses borne by industry you get things like Pfizer, which in recent years have spent about 17% of revenues on R&D. Typically less than their profit.
Given that Pfizer gets a substantial proportion of their revenues internationally (in 2009 this was ~56%), despite massive restrictions on advertizing, while their US sales costs are substantially higher than elsewhere (e.g. in many European countries, ads for prescription medicines is outright illegal), most of their available cashflow after cost of sales/marketing is accounted for does not come from the US, and is unaffected by US healthcare costs.
If this split holds across the industry, then US healthcare sources accounts for 30% of US healthcare medical research funding.
> And what will happen is you will not get much health care. Certainly much less than you got in 2005, for much more than you paid in 2005.
Other countries that have single-payer universal coverage have much better care, and absurdly better quality-of-outcome-per-dollar-spent than the US.
Also, I'm nth-ing dmitriy_ko's request for a citation... along with a request for a quote on the actual overhead-vs-payout ratio of private-sector "health insurance" companies. (Make sure to parse those reports very finely... as we've certainly learned from the creative ways that the Intelligence Community has lied to Congress, the DoJ, and the American public, there are many ways to make a statement that is strictly true, but so misleading that it might as well be a bald-faced lie.)
Your 100% vs 25% is for completely different metrics.
Insurers will pay out over 100% of premiums for some small percentage of people, but will pay out less than 100% of what they take in premiums overall, or else they go out of business.
Insurers seem to make enough money to pay a huge staff and process a lot of paperwork, but you also have to consider the higher costs of health care due to the health providers also needing more staff to do "coding" (looking up codes which precisely classify medical services administered, there are many thousands) and other paperwork (and IT systems etc) needed to get paid by insurance companies.
It is hard to believe because it isn't true. In the U.S., the government-run health care systems are the most efficient systems, far better than the private insurers.
I would be quite interested to see your data. A quick google search indicated to me that the vast majority of insurers pay out less than the ACA-required 80-85% of premiums and therefore were required to pay a rebate to their customers under the new law. Certainly 80% < "over 100%". They call this the Medical Loss Ratio (MLR), which I find to be an amusing term. It is interesting to note that it is considered bad for the MLR to be too high, because this indicates poor control over expenses.
It would also be interesting to see your data on government payout ratios as well. Government employment is at the same time notoriously stingy but also forgiving. It's well known that civil servants are difficult to fire even when they aren't performing their duties. I could believe that the remora effect of underperforming laggards could push overhead costs up somewhat but the statistics you suggest seem quite excessive.
I can't vouch for this website's data or slant [1], which suggests that Medicare's administrative costs are around 3% of premiums, while private insurance administrative costs approach 17%. Medicare is reported to be a good example of a system with excessive MLR which apparently leads to high rates of fraud. Sort of like not giving the IRS enough money to audit people, reducing the impetus to pay legally-owed taxes. In these cases it is better to marginally increase overhead.
Yeah, that's bullshit. The oft-quoted figure of 3% for Medicare may not take into account the premium collection that the IRS handles, but with outside agencies it's still 6-8%.[0]
"The bottom line: Government spends about 70% of tax dollars to get 30% of tax dollars to the poor. The private sector does the opposite, spending about 30% or less to get 70% of aid to the poor."
Two of those three works cited to arrive at the "~70%" figure are ~thirty years old. It's not looking good for the author. Let's look at the paper by Edwards that's only ~9 years old...
Edwards's first citation for his "~70%" figure is one of those two thirty-year old studies. His second is one is a paper by Tanner from 1996. So, let's look at that one...
Sadly, the Tanner work is a dead-tree book, page 136 isn't available in the Google Books preview, and Mr. Edwards doesn't bother to mention the source of Tanner's numbers.
So. Two out of three sources for that "Government welfare programs spend 70% of every dollar on overhead" claim are ~thirty years old. One of those sources can't be easily verified. It's not looking good for the basis of that claim.
But, let's be charitable. Let's presume that the claims of the twenty-year-old paper were based on then-recent information that was correctly interpreted and is still valid, twenty years later... [0]
Remember that Tanner is talking about all US government welfare programs. We're talking -specifically- about Medicare. As mentioned here [2] the worst case overhead for Medicare is 8%. That's a far cry from the 75% figure cited by MCRed, and far better than the 25%->35% overhead figure cited by Mr. Edwards for private-sector charities.
Medicare is really well run and gives really good outcomes per dollar spent. It's a shining example of a long-standing, effective, well-run government program. Sure, if you look, you can find horror stories of bureaucratic failures and mismanagement... but the same is very true (and happens far more frequently) when dealing with private sector "health insurance" companies.
[0] Some reasonable contemporary scholars found much to complain about in the work. A choice quote from one criticism in 1997: "Tanner uses the familiar tactic of dividing this spending by the number of poor people ... [t]he intended inference is either that a lot of the money goes inappropriately to people who are not poor or that the bureaucracy siphons off most of the funds. Neither is correct. Most of the resources do go to the intended beneficiaries, but are not counted; about 80 percent of welfare spending takes the form of in-kind transfers, and poverty is defined in terms of cash incomes only. Administrative costs of most government welfare programs are under 12 percent." [1]
Nah. Every citizen should have good health insurance that requires no out-of-pocket expenditures.
There should be one plan, available to every citizen. There should be one payer, the Federal Government.
Anything else is a recipe for price-gouging and ballooning costs.