r/FluentInFinance • u/The-Lucky-Investor • 13d ago

“Medicare for All” would save the U.S $5.1 Trillion over 10 years Discussion/ Debate

https://www.commondreams.org/news/2018/11/30/easy-pay-something-costs-less-new-study-shows-medicare-all-would-save-us-51-trillion
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u/BigPlantsGuy 12d ago edited 12d ago

Health is inherently political. Why do americans have worse health than our peers? Politics.

Same reason half the country prefers wasting trillions on inaccessible, subpar private healthcare instead of universal healthcare: politics.

Why is our food less healthy than our peers? Politics

Why are our cities less walkable leading to car dependence? Politics

Why do millions more americans have access to healthcare than before obama? Politics.

Why were millions almost stripped of health insurance during the pandemic? Politics?

Why did red states refuse medicaid expansion, refuse money for healthy school lunches, and explicitly ban various forms of healthcare? Politics

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u/Old_Height_8351 12d ago

US healthcare certainly isn’t subpar. Likely the best in the world when the outcome variables are controlled for acuity. Yes it is very expensive though.

I agree on the food part mostly. It is still your choice to eat unhealthy foods at the end of the day.

Our healthcare is very accessible. You can get appointments in a matter of days or a few weeks for the vast majority of services, or you can go to urgent care or an emergency department and get care in minutes/hours.

I don’t think politics has anything to do with how walkable our cities are. Americans like having large houses and yards so they want to live in a suburbs. People that live in big cities can walk to the places they need for the most part.

Nobody was stripped of their health insurance so I don’t understand your point there. Even if people don’t have insurance, under EMTALA you can’t be refused to emergency care. This is how migrants use the healthcare system essentially. They are told to show up at an ED for their care because they can’t be refused. This is obviously a bad system for care but you still have the option

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u/BigPlantsGuy 12d ago edited 12d ago

US healthcare is so far from best in the world. We pay more for worse outcomes. Sure if you are a millionaires you can get good healthcare. That’s true everywhere.

To my knowledge, the US is the only wealthy country in the world where people ration insulin or go into debt for healthcare.

The only rich country where people diagnosed with diseases opt to not get treated because they cannot afford it

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u/Old_Height_8351 12d ago

The “worse outcomes” is a typical talking point I see that doesn’t have much rigor if you dissect it.

If you travel to most other countries, you don’t see as many obese, wheelchair-bound people. Most countries are healthier and that’s why they don’t spend as much healthcare and that’s why their outcomes look better. Americans don’t take care of themselves well, so we have so much cancer and heart disease. Our healthcare system is of much higher quality than almost every country, just go to a hospital or physician abroad and you’ll see that immediately

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u/BigPlantsGuy 12d ago

Much rigor? What data do you need to see?

Life expectancy? Maternal mortality rate? Disease prevention? Affordability? Obesity rate? Heart disease? Diabetes? STDs? Aids? Addictions?

All bad

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u/Old_Height_8351 12d ago

All bad because why? Because people here don’t live healthy lives. That has nothing to do with the healthcare system. I would say you have a point if healthcare spent more time on actually doing disease prevention like teaching people how to exercise and eat healthy. But they’re too busy dealing with people that are continually sick and on meds for years at a time.

Most of the things you listed make my point. They’re all higher in the US because people don’t care about health so they have worse outcomes independent of the healthcare system

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u/BigPlantsGuy 12d ago

It has everything to do with our healthcare system. You cannot separate it, it is all related

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u/Old_Height_8351 12d ago

How does getting an STD, being obese, or having an addiction have to do with the healthcare system?

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u/BigPlantsGuy 12d ago

It’s all part of the healthcare system. Prevention is the most important part of healthcare

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u/Old_Height_8351 12d ago

I agree with you there. Problem is that you should be learning about health in school. You wouldn’t come to a hospital to learn about these things in a good system. You’re too late at that point

Schools should do serious health education and that would be helpful

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u/BigPlantsGuy 12d ago

As in like using tax dollars to have healthcare professionals teach kids about health?

That sounds like a very political choice

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u/Old_Height_8351 12d ago

We already allocate tax dollars to it, not sure there’s much politics in being healthy. We just don’t do it effectively. Might cost a little more, might not. There are a lot of factors for health and it’s an individual choice. Thats what makes it so hard. Most people are just lazy. Simple as that. It’s really not hard to be healthy for most people

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u/BigPlantsGuy 12d ago

Are you joking? We have been talking for half an hour about the politics of being healthy.

Why are democratic states so much healthier than republican states on a consistent basis?

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u/GeekShallInherit 12d ago

The “worse outcomes” is a typical talking point I see that doesn’t have much rigor if you dissect it.

Except US outcomes are terrible, and behind all its peers.

https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003013#sec018

And medically avoidable deaths are higher as well.

https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-2017-international-comparison-reflects-flaws-and?redirect_source=/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017

you don’t see as many obese, wheelchair-bound people.

Many US peers aren't far behind on obesity. Of the other two top health risks, smoking and alcohol, the US is average or better than average vs. its peers. At any rate the outcomes I've cited above are already adjusted for various demographic and health risks, and we can spot check to see if there's any remaining correlation between obesity and the outcomes. There is not.

https://i.imgur.com/ZOkB9ps.png

Most countries are healthier and that’s why they don’t spend as much healthcare

No, it isn't.

Our healthcare system is of much higher quality than almost every country

Citation needed.

US Healthcare ranked 29th on health outcomes by Lancet HAQ Index

11th (of 11) by Commonwealth Fund

59th by the Prosperity Index

30th by CEOWorld

37th by the World Health Organization

The US has the worst rate of death by medically preventable causes among peer countries. A 31% higher disease adjusted life years average. Higher rates of medical and lab errors. A lower rate of being able to make a same or next day appointment with their doctor than average.

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-percent-used-emergency-department-for-condition-that-could-have-been-treated-by-a-regular-doctor-2016

52nd in the world in doctors per capita.

https://www.nationmaster.com/country-info/stats/Health/Physicians/Per-1,000-people

Higher infant mortality levels. Yes, even when you adjust for differences in methodology.

https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-s-compare-countries/

Fewer acute care beds. A lower number of psychiatrists. Etc.

https://www.healthsystemtracker.org/chart-collection/u-s-health-care-resources-compare-countries/#item-availability-medical-technology-not-always-equate-higher-utilization

Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries

These findings imply that even if all US citizens experienced the same health outcomes enjoyed by privileged White US citizens, US health indicators would still lag behind those in many other countries.

When asked about their healthcare system as a whole the US system ranked dead last of 11 countries, with only 19.5% of people saying the system works relatively well and only needs minor changes. The average in the other countries is 46.9% saying the same. Canada ranked 9th with 34.5% saying the system works relatively well. The UK ranks fifth, with 44.5%. Australia ranked 6th at 44.4%. The best was Germany at 59.8%.

On rating the overall quality of care in the US, Americans again ranked dead last, with only 25.6% ranking it excellent or very good. The average was 50.8%. Canada ranked 9th with 45.1%. The UK ranked 2nd, at 63.4%. Australia was 3rd at 59.4%. The best was Switzerland at 65.5%.

https://www.cihi.ca/en/commonwealth-fund-survey-2016

The US has 43 hospitals in the top 200 globally; one for every 7,633,477 people in the US. That's good enough for a ranking of 20th on the list of top 200 hospitals per capita, and significantly lower than the average of one for every 3,830,114 for other countries in the top 25 on spending with populations above 5 million. The best is Switzerland at one for every 1.2 million people. In fact the US only beats one country on this list; the UK at one for every 9.5 million people.

If you want to do the full list of 2,000 instead it's 334, or one for every 982,753 people; good enough for 21st. Again far below the average in peer countries of 527,236. The best is Austria, at one for every 306,106 people.

https://www.newsweek.com/best-hospitals-2021

OECD Countries Health Care Spending and Rankings

Country Govt. / Mandatory (PPP) Voluntary (PPP) Total (PPP) % GDP Lancet HAQ Ranking WHO Ranking Prosperity Ranking CEO World Ranking Commonwealth Fund Ranking
1. United States $7,274 $3,798 $11,072 16.90% 29 37 59 30 11
2. Switzerland $4,988 $2,744 $7,732 12.20% 7 20 3 18 2
3. Norway $5,673 $974 $6,647 10.20% 2 11 5 15 7
4. Germany $5,648 $998 $6,646 11.20% 18 25 12 17 5
5. Austria $4,402 $1,449 $5,851 10.30% 13 9 10 4
6. Sweden $4,928 $854 $5,782 11.00% 8 23 15 28 3
7. Netherlands $4,767 $998 $5,765 9.90% 3 17 8 11 5
8. Denmark $4,663 $905 $5,568 10.50% 17 34 8 5
9. Luxembourg $4,697 $861 $5,558 5.40% 4 16 19
10. Belgium $4,125 $1,303 $5,428 10.40% 15 21 24 9
11. Canada $3,815 $1,603 $5,418 10.70% 14 30 25 23 10
12. France $4,501 $875 $5,376 11.20% 20 1 16 8 9
13. Ireland $3,919 $1,357 $5,276 7.10% 11 19 20 80
14. Australia $3,919 $1,268 $5,187 9.30% 5 32 18 10 4
15. Japan $4,064 $759 $4,823 10.90% 12 10 2 3
16. Iceland $3,988 $823 $4,811 8.30% 1 15 7 41
17. United Kingdom $3,620 $1,033 $4,653 9.80% 23 18 23 13 1
18. Finland $3,536 $1,042 $4,578 9.10% 6 31 26 12
19. Malta $2,789 $1,540 $4,329 9.30% 27 5 14
OECD Average $4,224 8.80%
20. New Zealand $3,343 $861 $4,204 9.30% 16 41 22 16 7
21. Italy $2,706 $943 $3,649 8.80% 9 2 17 37
22. Spain $2,560 $1,056 $3,616 8.90% 19 7 13 7
23. Czech Republic $2,854 $572 $3,426 7.50% 28 48 28 14
24. South Korea $2,057 $1,327 $3,384 8.10% 25 58 4 2
25. Portugal $2,069 $1,310 $3,379 9.10% 32 29 30 22
26. Slovenia $2,314 $910 $3,224 7.90% 21 38 24 47
27. Israel $1,898 $1,034 $2,932 7.50% 35 28 11 21

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u/Old_Height_8351 12d ago

Thanks again for all the sources. I think the first article was linked in error. It has to do with the cost savings of a single payor system.

If you look at the data in the second article, specifically the healthcare outcomes in exhibit 2 you may draw a different conclusion about quality. We actually do very well in several of the outcomes, and several others were very close to other top countries.

There are too many things cited to comment on so I’ll leave it at this: you’ve changed my mind on several things with the cited sources. Thank you for that. I still have some questions about some of the articles but I simply don’t have the time to read all these and digest them

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u/GeekShallInherit 12d ago

I think the first article was linked in error. It has to do with the cost savings of a single payor system.

It was in error, but it wasn't supposed to have anything to do with cost savings, it was to do with outcomes, which was presented again later, but here it is again for good measure.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30994-2/fulltext

specifically the healthcare outcomes in exhibit 2 you may draw a different conclusion about quality. We actually do very well in several of the outcomes, and several others were very close to other top countries.

We're spending half a million dollars more than our peers. Doing OK on a few metrics, while worse overall, is a travesty however you measure it.