Comparative taxes and healthcare costs

[Starlight]

The OECD has a useful little table taxation data for all the OECD countries. It measures total taxes (federal + state + local) as a percentage of the GDP of the country. i.e. of all the money that the country makes per year, what proportion of it does the government collect in taxes?

2012 is the most recent year they have full data for. Here's the English-speaking world plus a few others:
United States - 24.4%
Australia - 27.3%
Ireland - 27.3%
Canada - 30.7%
New Zealand - 33.0%
United Kingdom - 33.0%
OECD Average - 33.7%
Germany - 36.5%
Sweden - 42.3%
Denmark - 47.2%

Of those nations in my list, the US has lowest taxes, and in fact, in the entire OECD only Chile and Mexico have lower (perhaps not nations it's ideal to copy).

Denmark, on the other hand, which has the highest taxes of any OECD nation, is the world's happiest country, is ranked the best country in which to do business, and is the world's least corrupt country. Likewise Sweden, Germany, Norway, Iceland, Finland etc, all are some of the world's happiest and most successful countries, and they have taxes above the OECD average.

So having really high taxes is demonstrably not disastrous. In fact, people who study the subject have found that happiness appears to correlate with higher taxes (not only do the poor get happier when the taxes on the rich go up and more benefits are given to them, but the rich get happier too, because they benefit from living in a society with more government services and less poverty and crime).

The data is pretty clear: The US could increase its taxes by half, no problem. In fact, it could double them, no problem. Doubling taxes would bring the US on to pretty much par with Denmark.

What could the US government do with all that extra money? Basically everything good any American could ever think of, because that is a looooot of money. Free healthcare for all, expand social security, free college, paying off the debt, infrastructure improvements. You name it, that money would pay for it, easily.

So when members of the Tea Party insist that taxes in America are 'too high' and that it's absolutely imperative that taxes are cut, I'm like...
(I am, however, open to the argument that the taxes are wrongly distributed at present in the US, and that the ultra-rich pay far far too little and everyone else pays too much)


However. That said, we're not quite comparing apples and apples here, because Americans pay for healthcare outside of their taxes. Americans spend $8,500 per person on healthcare per year, which is 15.8% of GDP. Whereas all the other nations pay for healthcare through their taxes. So the cost to the average taxpayer of taxes plus healthcare is 40.2%. So that's actually comparable to other countries at the higher end of the tax-spectrum. But taxes + healthcare being at 40.2% should be buying America amazingly good government services, and it clearly isn't. So why not? Where's the money going?

The answer is private healthcare. That 15.8% of GDP that the US is spending on healthcare is a massive rip-off. Other OECD countries are paying only a third to a half of that for their healthcare. My country spends around 5.5% of GDP on healthcare. That's one third of what the US is paying. So the US is currently wasting roughly 1.7 trillion per year due to its inefficient healthcare system.

The problem with the US healthcare system is rather obvious: It's privatized. Almost every other OECD country runs a government single-payer system equivalent to "medicare for all", and as a result gets 2 to 3-fold cost reductions. Why? Well the entire medical insurance industry becomes unnecessary for starters. When you guys add the health-insurance middle-man your premiums are going towards paying the salaries of every single employee in those organisations, plus their profit margins, plus the bonuses for their CEOs. And when you have privately run hospitals you're likewise paying for their profit margins and bonuses. And when you let the pharmaceutical companies charge whatever they feel like for their drugs, they become the most profitable industry in the US, and exploit you no end.

Thus, if the US were to move to a single-payer medicare-for-all system, then forecasts suggest that its healthcare costs for the next decade would drop from $42 trillion to $15 trillion. Want to pay off an $18 trillion national debt? No problem. You can do that, and have $9 trillion left over to spend as you please. That's even enough for another War on Terror if you really really want. And do keep in mind how much wars cost before starting them. Bush W racked up about $5 trillion worth of debt for wars that he paid for with the credit-card, and if you start factoring in the life-long healthcare costs for veterans that estimate sky-rockets.


So in the context of various people on TV and elsewhere whining about Bernie Sanders' extravagant spending intentions, it's worth bearing in mind that Sanders' proposal of medicare-for-all would save $27 trillion over ten years, which could easily pay off all the national debt and pay for a wishlist as long as your arm of everything a socialist utopia could ever dream of having. If it all went straight into decreased taxes, then essentially the total that individual taxpaying Americans pay per year for taxes + healthcare, could go down by around 20%.

[Mountain Man]

Sorry, Dimbulb, but it doesn't work that way. We were already promised lower healthcare costs when Obamacare was shoved down our throats, but instead costs have skyrocketed, quality has plummeted, doctors have been quitting in droves (not to mention the hundreds of thousands of doctors who have opted out of the exchanges because of the miniscule payouts), and the new razor thin networks are limiting patient choice and in some cases making it impossible for patients to receive necessary care. And all this is from merely a partial government take over of healthcare. You really think things will improve with a full take over?

As for privatized healthcare, dollar for dollar, it has historically proven to be vastly superior to any socialist program like England's NHS.

[QuantaFille]

The quality of care in a privatised system will always be better, regardless of the cost. Ideally, the cost would be lower but we'd still have a privatised system. If healthcare providers didn't charge so much, we wouldn't even need insurance. If the problem is the middleman, simply get rid of the middleman. (I'm currently trying to get my health insurance company to pay for an ambulance, of all things. If such a thing were affordable I would have paid for it months ago with no problem and not had to deal with an insurance company at all.) When you have a single provider (the government), there is no competition and therefore no incentive to do better than everyone else and attract customers. I've seen the UK's NHS and it leaves a lot to be desired. They need some competition to shake things up a bit. The one thing I have heard almost universally regarding national healthcare, is that it usually takes FOREVER to get an appointment to see a doctor. (Insert joke here about Canada's 10-month waiting list for the maternity ward.) That doesn't sound like quality healthcare in the slightest.

[Mountain Man]

The problem with the health insurance system is that first of all, it morphed into a catch-all payment plan instead of the way every other insurance works where it's only used for big emergency expenses (car accident, house fire, etc.), and secondly, for whatever reason, Congress had the brilliant idea of preventing insurers from competing across state lines which created in-state monopolies and increases prices. Look at it this way: if car insurance paid for routine maintenance like oil changes then Quik Lube would start charging $100 for it.

I think a more sensible plan than gutting the system like Obamacare did would have included, among other provisions, lifting the restrictions preventing insurers from competing across state lines, limiting insurance payouts to catastrophic expenses only in order to force the cost of "routine maintenance" down, and putting a cap on malpractice suits so that they no longer functioned like a "get rich quick" scheme for the plaintiff.

In other words, leave the system largely intact while eliminating the things that are driving costs up.

[Mountain Man]

I've seen the UK's NHS and it leaves a lot to be desired.

Apparently there is a limited amount of money for things like medication, and once the monthly pool runs dry, the government tells the patients to take a hike. Thing is, this pool of money covers everything from antibiotics to life-saving medication, and with so many people mooching off the system, money quickly runs out, so you can imagine how that works out for people who need an expensive medication just to stay alive. My wife regularly sees her friends on Facebook begging others not to take undue advantage of the system because they're having so much trouble getting the medicine they desperately need. Unfortunately, if something isn't done to stop Obamacare, we'll be there within a decade.

[mikewhitney]

Another general problem is that the US Government does not have constitutional authority to collect a direct tax on the general population in the USA. Nor is it authorized to require participation in a medical program.

[Starlight]

The quality of care in a privatised system will always be better, regardless of the cost.

I'm currently trying to get my health insurance company to pay for an ambulance, of all things.

The entire rest of the developed world is like at the amount of time Americans waste interacting with their health insurance companies. If anything my numbers drastically underestimate the inefficiency of using health-insurance companies because it doesn't factor in:
- The time, effort and stress you spend dealing with them
- The cost of lawsuits against them when they refuse to pay out for things they should
- The costs to all involved when a person chooses to remain working at a job they don't like because "it has a good health plan". (This completely blows the mind of anyone here who finds out that that's a thing. The general response is: . Likewise when people here find out that medical bills are a common cause of bankruptcy in the US)

When you have a single provider (the government), there is no competition and therefore no incentive to do better than everyone else and attract customers.

The idea of 'competition' in health markets makes little sense. Sick people don't have time to shop around, and they don't really have the ability to know if the doctors at one hospital are truly 'better' than another.

The government has a constant incentive to improve services because voters are continuously using them. I read an interesting article recently, observing that Americans typically don't understand how efficient the government services of other developed countries tend to be, because in other developed countries all political parties have improving the efficiency of government services as one of their main goals, whereas in America the Republicans are simply trying to eradicate government services and the Democrats are trying to increase the budget for them and there's relatively little attention paid by either group to actually making them more efficient. In general in most developed countries, government services tend to be more efficient than private industry, because the government service isn't running at a profit (so the money that would have been wasted in profits goes into the services), by and large doesn't need very big if any marketing and sales departments, doesn't need to give their CEOs massive bonuses, and spends pretty close to 100% of its energy on actually just getting things done.

I've seen the UK's NHS and it leaves a lot to be desired.

Your account of it differs to everyone else I've ever heard mention it. It ranks as the number 1 healthcare system in the developed world pretty much in all categories.

The one thing I have heard almost universally regarding national healthcare, is that it usually takes FOREVER to get an appointment to see a doctor.

To some extent that is just US right-wing propaganda. It's based on a kernel of truth that waiting times for non-urgent conditions can be quite long if the current government has chosen to cut back on healthcare funding. To give some examples:
-A friend of mine had a heart rhythm problem detected. They immediately scheduled a heart-operation for her the next day, and installed a pacemaker.
-Over the past 10 years I've needed to see two different specialists about non-urgent things, the wait-time was about 6 weeks in each case. But once I was 'in' the system, the specialists freely scheduled weekly or two-weekly appointments with me as necessary.
-My grandfather needed a knee replacement and was on a 2-year waiting list for that. The family felt that it was a lot more urgent than that as it was affecting his quality of life greatly, and paid some money for him to see a private specialist who reviewed the situation, and who intervened to get him moved up the waiting list and have the operation done within a month (the operation itself being done by the public hospital for free).
-An American friend here was out hiking and had a rock fall on his foot that broke and chipped the bone. As soon as he got to a medical facility they operated to insert a metal rod to help it heal, and after about 6 weeks took it out again. (His response was "I have travel insurance, do I need to contact them for this medical payment?" And they were like "It's all free")

You can decide for yourself whether those count as "FOREVER" or not. Length of waiting times is basically a function of urgency and how much the government has been funding or cutting healthcare. We've had a right-wing government who's been cutting healthcare for the last 7 years. Things are now all but running on fumes and shoestrings, and we spend the lowest amount of any of the 11 OECD nations listed here on healthcare. But we still have the 2nd best healthcare outcomes after the UK, because the system is efficient and streamlined. The richest 1-5% of people here do generally choose to get private health insurance so that they can skip the waiting periods and go straight to private hospitals immediately if they feel their non-urgent condition is more urgent than the waiting period the public system is trying to make them wait.

It's not like we don't have a private healthcare system here: We do. We have private hospitals and private insurance for those that want them, in addition to the public hospitals. So everyone here knows what a privatized healthcare system looks like and how it would run. It's not like it's a case of "if only they knew how great a private system was compared to their public one". No, we have both. And literally 100% of people here think the public system is a great idea. We have 7 political parties, and never in my lifetime have I heard a single politician or single person suggest it would be a good idea to get rid of public healthcare and just have a fully privatized system. Everyone would just fall over laughing if that was suggested. Stupidest idea ever, because literally everyone can see what a great job the public healthcare system does.

[Starlight]

Sorry, Dimbulb, but it doesn't work that way. We were already promised lower healthcare costs when Obamacare was shoved down our throats, but instead costs have skyrocketed, quality has plummeted, doctors have been quitting in droves (not to mention the hundreds of thousands of doctors who have opted out of the exchanges because of the miniscule payouts), and the new razor thin networks are limiting patient choice and in some cases making it impossible for patients to receive necessary care. And all this is from merely a partial government take over of healthcare. You really think things will improve with a full take over?

As for privatized healthcare, dollar for dollar, it has historically proven to be vastly superior to any socialist program like England's NHS.

As per usual you demonstrate your utterly credulous belief in the propaganda and lies you've been fed by the insane and lying right-wing media bubble you inhabit.

As I've told you in the past, I am not interested in even looking at your bonkers Breitbart and similar sources because experience shows they are almost 100% always wrong and lying.

You did, however, cite the Washington Post, which as I've said in the past is the furthest to the right that I'm prepared to take seriously. Let's have a look at that one:

doctors have been quitting in droves

You appear to be lying about the article's contents. The article never once mentions doctors quitting or resigning, and instead discusses the fact that an aging population will need more doctors:

"An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,"
...
The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease

Where the article does mention Obamacare, it says that Obamacare will increase the number of doctors needed slightly, but not by much:


The mind boggles at how you got "doctors quitting in droves" out of that article. Here's a recent article from a non-crazy source discussing the fact that the number of doctors in the US has gone up by nearly 100,000 in the last 6 months, and those doctors who are quitting are retiring because they are old.

[QuantaFille]

Competition is a good thing. If we had hospitals tripping over themselves to be the most affordable hospital in town with the best doctors and the best success rates, they will attract patients. Like Mountain Man said, insurance should only be for catastrophic things, not everyday stuff. I should be able to see a doctor for my yearly checkup without having to take out a loan or go through my insurance at all. My medication should not be an astronomical amount, either. I shouldn't need insurance for these things. But hospitals know they can charge a patient $15 for a bandaid during a procedure and either the insurance will pay for it, or the patient will because, what else could they do? Go to a hospital that charges fair prices? There are none. Insurance has driven up prices, and the government forcing everyone to purchase health insurance under threat of penalty fines isn't helping - it's making things worse.

The entire rest of the developed world is like at the amount of time Americans waste interacting with their health insurance companies. If anything my numbers drastically underestimate the inefficiency of using health-insurance companies because it doesn't factor in:
- The time, effort and stress you spend dealing with them
- The cost of lawsuits against them when they refuse to pay out for things they should
- The costs to all involved when a person chooses to remain working at a job they don't like because "it has a good health plan". (This completely blows the mind of anyone here who finds out that that's a thing. The general response is: . Likewise when people here find out that medical bills are a common cause of bankruptcy in the US)

The health insurance companies are part of the problem. We need a serious overhaul of the insurance system we have now instead of merely instituting penalties for people who don't have it and calling it "universal healthcare".

The idea of 'competition' in health markets makes little sense. Sick people don't have time to shop around, and they don't really have the ability to know if the doctors at one hospital are truly 'better' than another.

We do, actually. I don't know who told you we don't, but they're wrong. In the past when I have had medical conditions that I knew I needed to see a doctor about, I went online and read patient's reviews on various healthcare providers in my area and selected the one who had the best reviews. Like shopping on Amazon - always read the reviews first. You can see each doctor's qualifications, see what insurance plans they accept, what their patients think of them, whether they are usually running on time, etc..
When I needed the ambulance earlier this year, the one closest to me is the one that responded. I was unconcious and couldn't ask for an in-network ambulance. (The ambulance driver did ask me what hospital I wanted to go to, however.) That is the one situation where you can't shop around before selecting your care provider. This is why the concept of emergency services being "in network" and "out of network" is crazy to me. For everything besides emergencies, you need to shop around. Would you go to an auto mechanic without looking them up online first to see what their customers think? No? So why would you go to whatever doctor the government tells you to go to? That's just silly. Is your car more important than your own body?

The government has a constant incentive to improve services because voters are continuously using them. I read an interesting article recently, observing that Americans typically don't understand how efficient the government services of other developed countries tend to be, because in other developed countries all political parties have improving the efficiency of government services as one of their main goals, whereas in America the Republicans are simply trying to eradicate government services and the Democrats are trying to increase the budget for them and there's relatively little attention paid by either group to actually making them more efficient. In general in most developed countries, government services tend to be more efficient than private industry, because the government service isn't running at a profit (so the money that would have been wasted in profits goes into the services), by and large doesn't need very big if any marketing and sales departments, doesn't need to give their CEOs massive bonuses, and spends pretty close to 100% of its energy on actually just getting things done.

You have an awful lot of unwarranted faith in humanity if you trust a politician who says "I will do X if you elect me".
Are you familiar with the American public school system? It is run by the government. People pay for it with their taxes. The government (presumably) has incentive to make it efficient. Yet, somehow, students at most private schools have better grades than the ones at the public schools. The private schools have to compete to attract students. The public schools don't compete with anyone since most people can't afford private schools AND you have to go to the campus you're assigned to (with a few exeptions, in my district). The lack of competition will always drag down the quality of the service being provided. I have seen it firsthand.

Your account of it differs to everyone else I've ever heard mention it. It ranks as the number 1 healthcare system in the developed world pretty much in all categories.

Then we're doomed. Waiting months to see a doctor is not acceptable, let alone as awesome as you make it sound.

To some extent that is just US right-wing propaganda. It's based on a kernel of truth that waiting times for non-urgent conditions can be quite long if the current government has chosen to cut back on healthcare funding.

Funny thing is, I have NEVER heard it FROM any Americans, let alone "US right wing propagand[ists]". I've only heard it from people who are actually from the countries whose healthcare system was the topic of discussion when I heard it.

To give some examples:
-A friend of mine had a heart rhythm problem detected. They immediately scheduled a heart-operation for her the next day, and installed a pacemaker.
-Over the past 10 years I've needed to see two different specialists about non-urgent things, the wait-time was about 6 weeks in each case. But once I was 'in' the system, the specialists freely scheduled weekly or two-weekly appointments with me as necessary.

And I have always been able to get same-day or next-day appointments with my PCP/GP, even for non-urgent things. At least, until ObamaCare shut down her practice.

-My grandfather needed a knee replacement and was on a 2-year waiting list for that. The family felt that it was a lot more urgent than that as it was affecting his quality of life greatly, and paid some money for him to see a private specialist who reviewed the situation, and who intervened to get him moved up the waiting list and have the operation done within a month (the operation itself being done by the public hospital for free).

A two-year waiting list. That means he bypassed a lot of other people who still had to wait two years for their surgery. What an awesome system that lets people wait so long. It must be all those funding cuts that the American right wants us to think is causing the long wait times. For some reason.[/sarcasm]
If doctors and hospitals were in competition, the one with the best doctors and can get him in the fastest and at the best price, wins. As it is, they rely on the government giving them money and they have to do with it what they can. If they don't get much money, tough. If they were able to charge free-market rates, they would make more money as they attracted more patients and wouldn't have to rely on the government doling out funds. They could get people in and out faster, and make more money besides. Quality would soar because the hospital with the lowest quality goes out of business if they don't step up their game.

-An American friend here was out hiking and had a rock fall on his foot that broke and chipped the bone. As soon as he got to a medical facility they operated to insert a metal rod to help it heal, and after about 6 weeks took it out again. (His response was "I have travel insurance, do I need to contact them for this medical payment?" And they were like "It's all free")

When I looked into whether I was covered by the UK NHS, there were still a lot of things I would have had to pay for. And technically speaking, it's not "free". Someone had to pay for it, just not the patient (at least, not right at that moment).

You can decide for yourself whether those count as "FOREVER" or not.

You have to admit, a two year waiting list is pretty ridiculous. And in the case of the emergency experienced by your American friend, situations like that generally call for same-day treatment. In emergency situations, wait times are generally measured in hours or minutes rather than weeks or months and you didn't mention how long he waited.

Length of waiting times is basically a function of urgency and how much the government has been funding or cutting healthcare. We've had a right-wing government who's been cutting healthcare for the last 7 years. Things are now all but running on fumes and shoestrings, and we spend the lowest amount of any of the 11 OECD nations listed here on healthcare. But we still have the 2nd best healthcare outcomes after the UK, because the system is efficient and streamlined. The richest 1-5% of people here do generally choose to get private health insurance so that they can skip the waiting periods and go straight to private hospitals immediately if they feel their non-urgent condition is more urgent than the waiting period the public system is trying to make them wait.

Make up your mind. Are there long waiting lists, or no?
First you say that the long wait times are because the right-wing government is cutting funding, and then you say that in spite of those funding cuts you're still the 2nd most awesome because your system is "efficient and streamlined". Waiting two years for surgery - ANY surgery - is neither efficient nor streamlined.
You also claimed that the rumours of long wait times are just lies and propaganda from the American right, and the next you're explaining how a few people are getting around the long wait times by paying extra money. Say what?

It's not like we don't have a private healthcare system here: We do. We have private hospitals and private insurance for those that want them, in addition to the public hospitals. So everyone here knows what a privatized healthcare system looks like and how it would run. It's not like it's a case of "if only they knew how great a private system was compared to their public one". No, we have both. And literally 100% of people here think the public system is a great idea.

No, they see what THAT private system looks like and how THAT private system runs. The fact that only 1-5% of people can afford it is absurd to me. I'm not sure of the numbers but a whole lot more than 1-5% of Americans can afford health insurance. It's quickly becoming more and more expensive and out of the reach of many people, but even now a whole lot more than 1-5% can afford it. If your private system is that expensive, no wonder most people think the public system is better.

We have 7 political parties, and never in my lifetime have I heard a single politician or single person suggest it would be a good idea to get rid of public healthcare and just have a fully privatized system. Everyone would just fall over laughing if that was suggested. Stupidest idea ever, because literally everyone can see what a great job the public healthcare system does.

Because they all have swallowed whatever propaganda that told them that the public system is better. That 10-month waiting list for a bed in the maternity ward is the most awesome thing ever, those stupid Americans don't know what they're missing out on!

[Starlight]

You have an awful lot of unwarranted faith in humanity if you trust a politician who says "I will do X if you elect me".

No, I was just describing past experience.

Are you familiar with the American public school system? It is run by the government. People pay for it with their taxes. The government (presumably) has incentive to make it efficient. Yet, somehow, students at most private schools have better grades than the ones at the public schools. The private schools have to compete to attract students. The public schools don't compete with anyone since most people can't afford private schools AND you have to go to the campus you're assigned to (with a few exeptions, in my district). The lack of competition will always drag down the quality of the service being provided. I have seen it firsthand.

Right, we have a similar thing here. 99% of schools are publicly run. And the rich 1%-ers are prepared to pay $$$ for their little darlings to have the absolute best education any amount of money can buy, so they send their kids to a private school that costs a heap more and buys the very best teachers by paying them more money.

It works the same way in our health sector. We have quality good care provided for free to everyone (through taxes). And if someone wants to pay out a huge amount of money to get care that is above-and-beyond that quality, they can do so through the private system.

And I have always been able to get same-day or next-day appointments with my PCP/GP, even for non-urgent things.

So have I. I wasn't talking about GPs, I was talking about hospital specialists. Of course you always can see a GP within a couple of days, that's just basic.

A two-year waiting list. That means he bypassed a lot of other people who still had to wait two years for their surgery. What an awesome system that lets people wait so long. It must be all those funding cuts

Yes. There is a cycle in the politics of healthcare in most Western nations that goes:
People: "The waiting lists are too long!"
Government: "Okay, we'll spend more money to shorten them" ~does so and fixes problem~
People: "Okay, good. We're happy now."
<several years pass>
Government: ~gradually siphons money out of the healthcare budget to spend on other things~
<several years later>
People: "The waiting lists are too long!"
<repeat>

Depending on where you are in the cycle (depending on whether the government is left or right wing, and how long it was since the last "waiting lists are too long" outcry) will determine how long the waiting lists are.

You have to admit, a two year waiting list is pretty ridiculous.

I agree, and that's one reason why I don't vote for right-wing governments as they underfund public services.

And in the case of the emergency experienced by your American friend, situations like that generally call for same-day treatment. In emergency situations, wait times are generally measured in hours or minutes rather than weeks or months and you didn't mention how long he waited.

His foot was broken and bleeding. Treatment would have been immediate.

Make up your mind. Are there long waiting lists, or no?

It varies. In general no. But for non-urgent operations the wait times can get high if the system is being poorly funded.

Waiting two years for surgery - ANY surgery - is neither efficient nor streamlined.

I was describing the cost-effectiveness of it by those words. The healthcare system does a truly impressive job of churning out a maximum of treatment for a minimum of money.

No, they see what THAT private system looks like and how THAT private system runs. The fact that only 1-5% of people can afford it is absurd to me.

When the free system does a really good job, only the ultra-rich think it's worth forking out $$$ for a better version of the free thing. That's the case with both education and health.

If your private system is that expensive, no wonder most people think the public system is better.

It's the other way around: The private system is more expensive because the public system is better. The fact that there is a free public system means the only niche in the market for the private system to compete in is extremely-high-quality extremely-fast-turnaround-time extremely-expensive. It's like public vs private schooling - if you have a public school system that is free, then the only market left for private schooling is a more-expensive better-quality market niche.

I've only heard it from people who are actually from the countries whose healthcare system was the topic of discussion when I heard it.

People in all countries like to complain about things. I've heard Americans whine about a huge long list of things that they find problematic about their healthcare system:
- price
- insurance companies not paying out
- policies that are convoluted and have exceptions
- hospitals that accept their insurance vs not
- bankruptcy from medical bills
- being stuck in a bad job simply for healthcare coverage
- pretty sure I'm forgetting a few things here

Everyone else in the Western world hears that and on each and every one of those things thinks "why do you guys have such a retarded system? All those issues simply don't exist with government run healthcare. We spend zero time worrying about any of that."

So given all those are non-issues in most Western systems, what do people of those countries spend their time complaining about?
- Waiting lists.
- That's it. That's seriously it. There's nothing else.

So when your average Westerner feels like ranting about the health system they have to rant about waiting lists because there are literally pretty much never any other issues. And a person who's super-concerned about waiting lists is totally free to use the private health system if they want to do so.

Nothing stops America from continuing to run a private system along side the public one. If you think the private system can out-compete the public system then feel free to let it try. The results will be similar to public vs private schools. 90% of people will be satisfied with the public option, and the rich few will decide that spending more of their own money for ultra-high-quality is worth it.

[QuantaFille]

Right, we have a similar thing here. 99% of schools are publicly run. And the rich 1%-ers are prepared to pay $$$ for their little darlings to have the absolute best education any amount of money can buy, so they send their kids to a private school that costs a heap more and buys the very best teachers by paying them more money.

It works the same way in our health sector. We have quality good care provided for free to everyone (through taxes). And if someone wants to pay out a huge amount of money to get care that is above-and-beyond that quality, they can do so through the private system.

The point I am getting at, is that the reason the private system is so much better, is because of the competition between each other within that system. You scoffed at the very idea. There is more than one private school in any given city. They know that parents who want to enroll their children in a private school have a choice, and that they will choose the most attractive school, so the schools know they have to work hard to BE that school. The hospitals and doctors can do the same thing, if allowed to instead of getting whatever patients the insurance companies and/or the government lets them have. Let ALL healthcare providers compete in a privatised system with minimal insurance interference, and see what kind of quality service we get.

So have I. I wasn't talking about GPs, I was talking about hospital specialists. Of course you always can see a GP within a couple of days, that's just basic.

I can get into a specialist's office a whole lot quicker than 6 weeks, too. I think the last time I had to see one, I was in the office in probably three weeks. I could have gotten in sooner if I had picked a different doctor.

Yes. There is a cycle in the politics of healthcare in most Western nations that goes:
People: "The waiting lists are too long!"
Government: "Okay, we'll spend more money to shorten them" ~does so and fixes problem~
People: "Okay, good. We're happy now."
<several years pass>
Government: ~gradually siphons money out of the healthcare budget to spend on other things~
<several years later>
People: "The waiting lists are too long!"
<repeat>

Depending on where you are in the cycle (depending on whether the government is left or right wing, and how long it was since the last "waiting lists are too long" outcry) will determine how long the waiting lists are.

So, it's NOT just propaganda from the American right. Why did you imply that it was?

I agree, and that's one reason why I don't vote for right-wing governments as they underfund public services.

They couldn't POSSIBLY be trying to implement something that works better.

I was describing the cost-effectiveness of it by those words. The healthcare system does a truly impressive job of churning out a maximum of treatment for a minimum of money.

Ultimately, you still get what you pay for, unless the money goes through the government's hands first in which case "efficient" means they only spent some of it on useless unrelated crap, instead of most of it. None of it would get spent on useless crap if it went directly to the provider instead of through a middleman.

When the free system does a really good job, only the ultra-rich think it's worth forking out $$$ for a better version of the free thing. That's the case with both education and health.

The fact that a better version exists at all is kinda my whole point, here. You're admitting that the government run system is not the best. Imagine the better system, at a low cost! That's what I'm suggesting, here. And no healthcare is free, remember. You pay for it one way or another.

It's the other way around: The private system is more expensive because the public system is better. The fact that there is a free public system means the only niche in the market for the private system to compete in is extremely-high-quality extremely-fast-turnaround-time extremely-expensive. It's like public vs private schooling - if you have a public school system that is free, then the only market left for private schooling is a more-expensive better-quality market niche.

Yes. That's called "competition". When you know what you are competing against, you know where you need to improve to attract customers. It's just that the government run "competitor" can't be bothered to give half a crap so they don't compete back - so the private run equivalent wins by default.

People in all countries like to complain about things. I've heard Americans whine about a huge long list of things that they find problematic about their healthcare system:
- price
- insurance companies not paying out
- policies that are convoluted and have exceptions
- hospitals that accept their insurance vs not
- bankruptcy from medical bills
- being stuck in a bad job simply for healthcare coverage
- pretty sure I'm forgetting a few things here

Everyone else in the Western world hears that and on each and every one of those things thinks "why do you guys have such a retarded system? All those issues simply don't exist with government run healthcare. We spend zero time worrying about any of that."

So given all those are non-issues in most Western systems, what do people of those countries spend their time complaining about?
- Waiting lists.
- That's it. That's seriously it. There's nothing else.

That is incorrect. I have heard numerous complaints from Brits about how expensive the NHS is. They aren't stupid. They know it's paid for out of their tax money and that taxes are very high. I probably hear that complaint even more than I do about the waiting lists. And the rest of the Americans' complaints are due to the insurance companies mucking things up. We should be dealing directly with the healthcare providers, who are in competition with each other, and only invoke the insurance companies for catastrophic things. We should also be free to chose whatever affordable healthcare insurance plan we want, instead of only being able to afford whatever our employer is willing to pay half of. I would NOT have chosen my current insurance provider if I had been given a choice. All of the plans I looked into that I would have had to get on my own were WAY outside the range of what I am able to pay for.

So when your average Westerner feels like ranting about the health system they have to rant about waiting lists because there are literally pretty much never any other issues. And a person who's super-concerned about waiting lists is totally free to use the private health system if they want to do so.

Only there's that pesky insurance-companies-making-everything-too-expensive thing. Pretty much forces most people into using the crappy "free" system, whether they want to or not. Which they still have to pay for, don't forget. It's not free.

Nothing stops America from continuing to run a private system along side the public one. If you think the private system can out-compete the public system then feel free to let it try. The results will be similar to public vs private schools. 90% of people will be satisfied with the public option, and the rich few will decide that spending more of their own money for ultra-high-quality is worth it.

The thing is, they either AREN'T satisfied with it but can't afford better, or they honestly don't know any better. Either way, private care will still be too expensive for what it is. Let everyone have access to the ultra-high-quality care, and let them be able to afford it. Why is that such an awful idea to you? If all of the public schools were privatised, do you know what would happen to the quality of education? It would go up. People could spend what they save on taxes on the school of their choice. The crappy schools would go out of business instead of being propped up by the government. New schools would open that offered better programs than their competitors, at a better price so it wouldn't cost as much as the typical private school does now. Everyone wins.

[Mountain Man]

As per usual you demonstrate your utterly credulous belief in the propaganda and lies you've been fed by the insane and lying right-wing media bubble you inhabit.

As I've told you in the past, I am not interested in even looking at your bonkers Breitbart and similar sources because experience shows they are almost 100% always wrong and lying.

You did, however, cite the Washington Post, which as I've said in the past is the furthest to the right that I'm prepared to take seriously. Let's have a look at that one:
You appear to be lying about the article's contents. The article never once mentions doctors quitting or resigning, and instead discusses the fact that an aging population will need more doctors:

"An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,"
...
The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease

Where the article does mention Obamacare, it says that Obamacare will increase the number of doctors needed slightly, but not by much:


The mind boggles at how you got "doctors quitting in droves" out of that article. Here's a recent article from a non-crazy source discussing the fact that the number of doctors in the US has gone up by nearly 100,000 in the last 6 months, and those doctors who are quitting are retiring because they are old.

Typical Dimbulb: cherry pick one of my half dozen sources that you feel confident taking issue with and act like you've refuted my entire argument. Even if I conceded that one point, all the other devastating affects of Obamacare remain.

And I'm not conceding that point.

Yes, the doctor shortage is caused partially by retiring doctors, but what you're not saying - and I'm sure it just slipped your mind; no, really - is that those doctors are retiring early because of Obamacare.

http://blog.heartland.org/2015/08/ph...e-and-nursing/

And the shortage is only going to get worse over the next decade.

http://www.forbes.com/sites/brucejap...90000-by-2025/

[Mountain Man]

Speaking of wait times, having lived in the US my whole life, the idea of having to wait for medical care is absurd to me. I'm used to a system where you're immediately scheduled for treatment and can get same-day or next-day non-emergency care, immediate treatment for emergency care, and where non-emergency surgery happens within a week. When people talk about how great socialized medicine is in one breath and then mention long wait times in the next (two-year waiting list for knee surgery!), I just scratch my head.

[Truthseeker]

I am a little surprised nobody mentioned medical tourism abroad for U.S. citizens. Often an American saved $$$ for treatment that compared well with U.S. standards when he or she came back home. The cost of staying in a hotel, if necessary, is included.