Tax money already finding health care in the US

[TheNorwegian]

Please, help me understand this. I am not trying to pick a fight, but genuinely want to understand: Some health care in the US is funded with tax dollars, like Medicaid. According to this article the total amount in 2015 that went through the federal budget was $938 billion. This is roughly 3.000 per capita in tax money for "socialized" health care

Policy Basics: Where Do Our Federal Tax Dollars Go?

When I look at the statistics for health costs per capita, $3000 per capita is almost the same as the total cost per capita in Finland. However, in Finland that expense covers everybody. So, tax payers in the US are already paying almost the same amount of tax for health purposes as people in Finland do - but for this money they do not get universal coverage.

List of countries by total health expenditure per capita - Wikipedia

Have I understood this correctly? Also, I wonder if the states or towns have some costs for health care funded by tax dollars - or is it 'only' federal dollars that go to this?

If I understand this correctly, then it is not a question of willingness to pay taxes or not - because US citizens already pay almost the same amounts in tax for health services as the Europeans do. Then I suppose it must be a question of costs (?)

 

[inquiring mind]

This is just my opinion, but as cost of health services remain the same or even increase, and the portion paid by public tax dollars continues to be limited or even reduced, and more people are added to Medicaid (non-payers)... the private portion (personal co-pays of those who "have to pay") will continue increasing until it’s unbearable. It just appears the government is trying to stop its bleeding, while avoiding a battle with the healthcare industry over cost regulation, and the average paying citizen is paying more and more private out of pocket costs (for everyone’s health care).

In a sense, through lack of knowledge and understanding of the situation, those who "have to pay" are covering the cost of the increasing number of Medicaid recipients without the government having to bring it to the political forefront or come up with a workable solution (oh they claim they’re working on it, but nothing ever seems to happen other than premiums go up). In my opinion, Obamacare was an attempt to put more of the younger generation on high deductible (out of pocket – private) coverage to help disperse and slow the private portion increase on those who "must pay", but apparently that’s not working. All that most of us on the aging side, “who have to pay”, really know is that “our” healthcare costs continue going up.

There’s a “hard truth” we’re going to have to come to terms with: if our social programs for those who “don’t pay” continue to provide as comfortable a lifestyle as possible, and the healthcare for all who “can’t pay” is provided, then those who “have to pay” will continue to see huge increases whether it be in public tax dollars or out of pocket at the doctor’s office or hospital. It sure doesn’t appear healthcare costs will be lowered any time soon, unless the Trump administration can pull it off. So, when you’re crying “open borders” and “send us your poor and needy”… you better know where you stand and how much you can afford to give. This is just my opinion and my assumptions, I don’t have any social or healthcare industry knowledge or the numbers to back them up. Maybe someone who does will respond with any corrections and more detailed information.

 

[variant]

If I understand this correctly, then it is not a question of willingness to pay taxes or not - because US citizens already pay almost the same amounts in tax for health services as the Europeans do. Then I suppose it must be a question of costs (?)

No you are grasping the problem correctly.

The issue isn't how we pay for healthcare but how much. We pay more in public healthcare spending than most other countries on earth per person and only cover the poor and the elderly with it. Then we spend that much money again on private care for everyone else, so the per person charge is much higher.

The MAIN issue is that the United States government does little to reduce or control the price of healthcare. Where a European style socialized medicine run by the state will ruthlessly use it's leverage to hammer down costs, we do as little as possible by putting some caps on medicare reimbursements for treatments.

Our healthcare would in any case cost more than most places, but then we go and find ways to make sure it is more expensive.

There are trade offs with any system but we seem to have found the worst of all possible ways to do things.

 

[TheNorwegian]

The MAIN issue is that the United States government does little to reduce or control the price of healthcare. Where a European style socialized medicine run by the state will ruthlessly use it's leverage to hammer down costs, we do as little as possible by putting some caps on medicare reimbursements for treatments.
.

So, this is one of the relatively few instances where free competition leads to a worse price for the consumer? The US refuses to use its potentially big power as buyer of medicines and health care in the way that European nations do. This sounds like a "fundamentalist" view of Capitalism, saying "we want Capitalism because we believe that is best - so please don't confuse us with facts..."

 

[variant]

So, this is one of the relatively few instances where free competition leads to a worse price for the consumer?

Well the competition isn't exactly free or fair. Hospitals don't really advertise their rates. Most people will pay whatever it takes to save their life. In an emergency people don't really shop around. The options are limited for say chemotherapy. Competition could help treat some of the long term problems like diabetes but a lot of the costs are actually hidden from most people (the 70% of us who get our insurance through our employer) by the system where their employer is footing most of the bill and then getting a tax break for it.

The problem is that after 50 years of doing it this way people are starting to feel real pain as employers drop coverage (due to cost) and they are left adrift in a market that, if you didn't already have coverage and you have a healthcare problem, you are really and sincerely have few options.

The US refuses to use its potentially big power as buyer of medicines and health care in the way that European nations do. This sounds like a "fundamentalist" view of Capitalism, saying "we want Capitalism because we believe that is best - so please don't confuse us with facts..."

It simply is capitalism. Capitalism misapplied to a problem it was never well equipped to solve. Capitalism for water delivery (water bottles instead of a piping system) or capitalism applied to roads (toll roads) or capitalism applied to defense (mercenarys), or the great example of the roman fire department (we'll negotiate our rates while your house is still burning).

Capitalism isn't the only thing to blame though, bad policy, and corruption has also been to blame.

The problem is difficult because there are a lot of people making a lot of money on this. The US healthcare market is worth 3.2 Trillion dollars and we probably pay up to double what we would otherwise, so we're talking about 1 to 1.7 Trillion dollars in waste.

That kind of money floating around bribing politicians with money = speech type rules on political/corporate PR is hard to overcome.

 

[JackRT]

Comparative outcomes -------- Canada / US :
per capita medical spending --- $4500 / $8500
percent of GDP ---------------------11.2 / 17.7
public share –---------------------- 70% / 48%,
doctors per 1000 -------------------- 2.4 / 2.5
nurses per 1000 ----------------------9.3 / 11.1
life expectancy ----------------------- 81 / 79
smoking rate --------------------- 15.7% / 14.8%
obesity rate -----------------------25.4% / 36.5%.
As you can readily see, Canada achieves comparable or superior outcomes at close to half the expense and every citizen regardless of status or income has equal access.

 

[inquiring mind]

Comparative outcomes -------- Canada / US :
per capita medical spending --- $4500 / $8500
percent of GDP ---------------------11.2 / 17.7
public share –---------------------- 70% / 48%,
doctors per 1000 -------------------- 2.4 / 2.5
nurses per 1000 ----------------------9.3 / 11.1
life expectancy ----------------------- 81 / 79
smoking rate --------------------- 15.7% / 14.8%
obesity rate -----------------------25.4% / 36.5%.
As you can readily see, Canada achieves comparable or superior outcomes at close to half the expense and every citizen regardless of status or income has equal access.

I’m not being a wise guy... this is a straight-up question. I hear this all the time, but I don’t know, are there a lot of Canadians who come to the U.S. for treatment? If that is true, wouldn’t it skew those comparative numbers in some way, or not?

 

[JackRT]

I’m not being a wise guy... this is a straight-up question. I hear this all the time, but I don’t know, are there a lot of Canadians who come to the U.S. for treatment? If that is true, wouldn’t it skew those comparative numbers in some way, or not?

The number of Canadians who seek treatment in the USA is negligibly small. They usually involve rich people who are not willing to wait while others more ill are treated or treatments that are so rare that there is no one qualified in Canada to treat it. On the other hand quite a few Americans have made use of "medical tourism" to get treatment in China or India at a fraction of the US cost.

 

[Dave Ellis]

I’m not being a wise guy... this is a straight-up question. I hear this all the time, but I don’t know, are there a lot of Canadians who come to the U.S. for treatment? If that is true, wouldn’t it skew those comparative numbers in some way, or not?

This is a long standing myth. In reality there are very few Canadians that go to the United States for treatment, I had a debate with someone on facebook on this one a couple months ago, if I remember correctly it was roughly 100 patients a year. However, there were a comparable number of Americans who came to Canada for treatment. There were slightly more Canadians went south, but it was literally about a dozen patients difference.

However, there are thousands of Americans that live close to the border that come to Canada for prescription medication, as its typically anywhere between 30-70% cheaper here on average depending on the drug.

 

[ExodusMe]

Here is a good exposition on the healthcare problem.

Canadians come to U.S. because of waiting lists. If you live in Canada and can foot the bill and don't want to wait for healthcare, then you come to the U.S.

Hard Truths about Health Care

 

[JackRT]

Canadians will sometimes go to the USA for health care usually for one of two reasons:
1. they are unwilling to wait their turn --- in other words they think they are better than someone who needs the treatment more than they do and they have the money to buy that preferential treatment.
2. the treatment might not be available in Canada because the condition is rare or the treatment is experimental
The number of Canadians who do so is vanishingly small and is balanced by Americans who seek treatment in Canada or get their prescriptions filled here at a much lower cost. Sarah Palin used to do that.

 

[Dave Ellis]

Here is a good exposition on the healthcare problem.

Canadians come to U.S. because of waiting lists. If you live in Canada and can foot the bill and don't want to wait for healthcare, then you come to the U.S.

Hard Truths about Health Care

Less than 1% of Canadian health care patients travel abroad for health care (that includes to every country in the world, not just the U.S.). In reality, very, very few Canadians go to the United States for health care.

Emergency procedures will get treated just as fast here as they are in the U.S, for example this past Sunday a friend of mine fell and dislocated her left hand middle finger at the knuckle. Originally we thought it was a break. From the time she arrived at the hospital they had the scans finished, diagnosis, reset the finger, wrapped it up and she was out the door and on the way home in two hours after arrival.

About 15 years ago, my dad had a heart attack and required a quad bypass. They had to put him on blood thinners and whatnot and do the appropriate scans, however he was also taken care of in a comparable amount of time to what you'd expect in the United States. That being said, we paid no money for the medical procedures, whereas in the states we'd have probably lost our house and had bills in the hundreds of thousands of dollars (my dad is diabetic, so it would be unlikely he'd have been able to get good private coverage, unless he had something through work).

Where you'll have longer waits is if you're doing "scheduled surgery", for example a knee or hip replacement or non-urgent procedures. Getting your knee replaced is something that has to be done, however if you get it done April 10, or April 30, it's not really the end of the world. I'd also like to bet that if you offered the procedure to Americans for free if they waited a couple extra weeks, they'd happily take you up on the offer.

Back in the '90s there was actually a fairly major problem with Americans coming north with fake health cards and getting treated in Canadian hospitals for free. The problem only went away when they started having Photo ID on the health cards and things became more computerized so it was easier to check if the card was legit.

It's still very common for Americans close to the border to come north to buy their prescription medication because it's usually anywhere between 30-70% cheaper here.

In reality, there's very little good to defend in the U.S. health system. You guys spend more than twice what we do on health care per capita, and tens of millions of your citizens can't even use it.

 

[ExodusMe]

Canadians will sometimes go to the USA for health care usually for one of two reasons:
1. they are unwilling to wait their turn --- in other words they think they are better than someone who needs the treatment more than they do and they have the money to buy that preferential treatment.
2. the treatment might not be available in Canada because the condition is rare or the treatment is experimental
The number of Canadians who do so is vanishingly small and is balanced by Americans who seek treatment in Canada or get their prescriptions filled here at a much lower cost. Sarah Palin used to do that.

Your reason for #1 is slightly funny because you have turned a person seeking healthcare into a self-righteous monster.

 

[ExodusMe]

Less than 1% of Canadian health care patients travel abroad for health care (that includes to every country in the world, not just the U.S.). In reality, very, very few Canadians go to the United States for health care.

As if who goes where for treatment means anything? The healthcare system as a whole needs to be judged based on more than just whether a few people skipped the border to get healthcare...

Emergency procedures will get treated just as fast here as they are in the U.S, for example this past Sunday a friend of mine fell and dislocated her left hand middle finger at the knuckle. Originally we thought it was a break. From the time she arrived at the hospital they had the scans finished, diagnosis, reset the finger, wrapped it up and she was out the door and on the way home in two hours after arrival.

About 15 years ago, my dad had a heart attack and required a quad bypass. They had to put him on blood thinners and whatnot and do the appropriate scans, however he was also taken care of in a comparable amount of time to what you'd expect in the United States. That being said, we paid no money for the medical procedures, whereas in the states we'd have probably lost our house and had bills in the hundreds of thousands of dollars (my dad is diabetic, so it would be unlikely he'd have been able to get good private coverage, unless he had something through work).

Not sure of your dad's situation, but my wife had private coverage when she had cancer that had to be removed near her heart. We paid ~3K of a $160K bill. I also know of diabetics who have private health coverage. My point is that citing case studies does nothing to further some point about whether the Canadian system is better or not (if that is your point, because you haven't made it clear).

Where you'll have longer waits is if you're doing "scheduled surgery", for example a knee or hip replacement or non-urgent procedures. Getting your knee replaced is something that has to be done, however if you get it done April 10, or April 30, it's not really the end of the world. I'd also like to bet that if you offered the procedure to Americans for free if they waited a couple extra weeks, they'd happily take you up on the offer.

Back in the '90s there was actually a fairly major problem with Americans coming north with fake health cards and getting treated in Canadian hospitals for free. The problem only went away when they started having Photo ID on the health cards and things became more computerized so it was easier to check if the card was legit.

It's still very common for Americans close to the border to come north to buy their prescription medication because it's usually anywhere between 30-70% cheaper here.

In reality, there's very little good to defend in the U.S. health system. You guys spend more than twice what we do on health care per capita, and tens of millions of your citizens can't even use it.

Not sure what your point is here. Our issue of rising cost is due to subsidization, because American's don't have to foot the bill, so we go to the doctor for everything. The American healthcare system has always been subsidized by the government. I don't like our healthcare system either.

With that said, I am from Washington state. My grandpa crosses the border to buy prescription drugs. He is in his 80's. If it is cheaper for the individual, why not? The issue faced with the Canadian government is the same (but not as large as the US). The debt & cost associated with subsidizing medical care with little benefit to the average person. If you look at charts that depict the per capita spend & length of life there are countries that spend 1/100th of what the US & Canada does with the same death rate.

My ancestors emigrated from Europe to Canada and then US. My great grandfather who died at the age of 96 lived in Canada near Vancouver in Richmond. I have also heard my share of horror stories about Canadian healthcare and the wages paid to nurses, etc... You lose all your good doctors to America because we pay them more. Your system is not what we should be aiming for.

 

[Dave Ellis]

As if who goes where for treatment means anything? The healthcare system as a whole needs to be judged based on more than just whether a few people skipped the border to get healthcare...

The point you raised was Canadians often come to the states for treatment, in reality the stats show that's false. Virtually all Canadians stay here for treatment.

Not sure of your dad's situation, but my wife had private coverage when she had cancer that had to be removed near her heart. We paid ~3K of a $160K bill. I also know of diabetics who have private health coverage. My point is that citing case studies does nothing to further some point about whether the Canadian system is better or not (if that is your point, because you haven't made it clear).

Paying 3,000 for that procedure is still more than you should have to pay. And what about people that don't have coverage and would get a $160,000 bill in the mail? Things like that do happen in the States.

Not sure what your point is here. Our issue of rising cost is due to subsidization, because American's don't have to foot the bill, so we go to the doctor for everything. The American healthcare system has always been subsidized by the government. I don't like our healthcare system either.

I think the key problem is that the American system treats health as a commodity. The Canadian, along with basically every other first world country treats health as a human right.

With that said, I am from Washington state. My grandpa crosses the border to buy prescription drugs. He is in his 80's. If it is cheaper for the individual, why not?

Makes sense to me as well, however don't you see the problem with the drugs being so much cheaper here when they're often produced in your own country?

The issue faced with the Canadian government is the same (but not as large as the US). The debt & cost associated with subsidizing medical care with little benefit to the average person. If you look at charts that depict the per capita spend & length of life there are countries that spend 1/100th of what the US & Canada does with the same death rate.

The same death rate? That's a nonsense argument for health care, people are still going to die. The question is are they dying at age 82, or age 75? What's the quality of life? Do they have access to the treatment they need?

My ancestors emigrated from Europe to Canada and then US. My great grandfather who died at the age of 96 lived in Canada near Vancouver in Richmond. I have also heard my share of horror stories about Canadian healthcare and the wages paid to nurses, etc... You lose all your good doctors to America because we pay them more. Your system is not what we should be aiming for.

That's actually a myth, there was a problem with doctors heading to the states in the early-mid 90s, however it hasn't really been an issue since then. In fact, since 2003 there's been more doctors coming to Canada than are leaving.

https://www.washingtonpost.com/blog.../03/AGVdAuHH_blog.html?utm_term=.59b0e78479cc

 

[ExodusMe]

The point you raised was Canadians often come to the states for treatment, in reality the stats show that's false. Virtually all Canadians stay here for treatment.

No, I stated why Canadians' come to the U.S. for healthcare. My statement did not include any indication whether it was good or not.

Paying 3,000 for that procedure is still more than you should have to pay. And what about people that don't have coverage and would get a $160,000 bill in the mail? Things like that do happen in the States.

I was ecstatic to only pay $3K. Insurance is meant to spread risk in case something happens. If you choose not to have health insurance, then you assume the risk yourself. Isn't it sad that the mentality is some type of victim blaming because you chose not to get insurance and then you got sick, then you had to pay a big bill? Everyone should have health insurance, but I am not going to make them.

Freedom is great - it just comes with risks.

I think the key problem is that the American system treats health as a commodity. The Canadian, along with basically every other first world country treats health as a human right.

Health is a commodity, whether you agree with it or not. Worse, it is a finite commodity (taken from national review article). There is only a finite supply of doctors, nurses, hospitals, etc.. etc.. etc...

Do you not understand that?

Makes sense to me as well, however don't you see the problem with the drugs being so much cheaper here when they're often produced in your own country?

It is no different than a mega-rich person going to China to take advantage of cheaper labor and then importing goods to make money. If a US citizen wants to reap the benefits of a country they don't belong to for their own personal gain and there is no law to prevent them, then I don't see it as my place to tell them what to do.

The same death rate? That's a nonsense argument for health care, people are still going to die. The question is are they dying at age 82, or age 75? What's the quality of life? Do they have access to the treatment they need?

I misspoke. I meant the length of life as stated at the beginning of the quotation. Point still stands. Current statistics show that the amount Canada & US spend has no benefit as other countries spend significantly less with the same length of life.

That's actually a myth, there was a problem with doctors heading to the states in the early-mid 90s, however it hasn't really been an issue since then. In fact, since 2003 there's been more doctors coming to Canada than are leaving.

The economics to your rebuttal just doesn't make sense. Sure they might be heading there after Obamacare, but doctors in the US make significantly more than Canadians.

Further, the article you posted says that ~200 doctors/year leave Canada for US which equates to one half of a percent. My point was that the best doctors leave Canada for the US. It doesn't matter to me how many. We have better doctors than you because our system affords it. I don't like our system. I don't advocate our system, but when you claim "all Canadian's get equal care". That may be true to an extent. When it comes to "all Canadian's get equal care in comparison to other countries" that is not true.

 

[JackRT]

Your reason for #1 is slightly funny because you have turned a person seeking healthcare into a self-righteous monster.

Only if they are using their wealth to advantage over another person for medical treatment. Most of us in Canada regard access to medical treatment as a human right and not a privilege of wealth.

 

[ExodusMe]

Side thought; individuals who discredit free market systems, because they are based on money and the purchasing of healthcare often take the position of healthcare being a 'human right'. They usually use this position to justify consumers of healthcare not needing to pay for it. The logical conclusion to this is that doctors or other healthcare professionals should not receive a wage for their service, BUT if this point is pushed you will realize that their position is not that doctors, etc.. shouldn't get a wage, but that someone else besides the consumer should pay the wage.

The hypocrisy ensues. Socialists are nothing more than able working beggars on the street corner.

With that said, we should start a thread to discuss whether healthcare is a human right.

 

[ExodusMe]

This is a timely article. Check it out
On Health Care, Most People Don’t Know What They’re Talking About

 

[Hank77]

The economics to your rebuttal just doesn't make sense. Sure they might be heading there after Obamacare, but doctors in the US make significantly more than Canadians.

How much does a Surgeon - Cardiothoracic in Houston, TX make? The median annual Surgeon - Cardiothoracic salary in Houston, TX is $441,741, as of March 31, 2017, with a range usually between $354,097-$553,750 not including bonus and benefit information and other factors that impact base pay.

How much does a Surgeon - Cardiothoracic in Ontario, CA make? The median annual Surgeon - Cardiothoracic salary in Ontario, CA is $454,312, as of March 31, 2017, with a range usually between $364,175-$569,509 not including bonus and benefit information and other factors that impact base pay.

Surgeon - Cardiothoracic Salaries in Ontario, CA by education, experience, Location and more - Salary.com

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