What are we really spending on medical care in the US?

[Openmind]

I thought the implication was obvious. If tuition is heavily subsidized in France (I say almost all of it) then the cost of medical care in France should include the cost of tuition. Their 11% of GDP is a gross understatement of the real cost.

Okay, so the cost of tuition (approximate, obviously, as it varies per university, and the same applies here!) is about $60,000 per year for an average (2009 number of graduating medical student) 170,000 per year, for a length of 9 years (which includes what we call "undergraduate studies!). This would be about $90 Billions to produce those 170,000 doctors in subsidized French school.

But, if you count that, 311,000,000 US population ( rounded up to the lowest), and a difference of per capita cost of $2,700 per YEAR, and estimating that these physicians will practice medicine for 35 years. . .this means that the cost to the American public in terms of additional cost of health care is close to $30 TRILLIONS!

I guess. . .economic efficiency is not our forte, is it?

Ok so they pay more than just tuition. But my sources have indicated that the money they pay to the university, i.e. tuition consiste almst entirely of the small application fee. Regardless of whether they pay 1% of the tuition or 2% or even 3%, the remainder paid by the gov is still money that is not counted in the cost of health care in France when comparisons are made. I have provided a source and you are your own source.

We just calculated that (although approximately!) right?

Ok then, well all the money that American doctors must borrow will be included in their salaries and is thus counted in our estimate of how much health care costs in the US. In France not all of it is counted.

Well, in the above calculations, we didn't count "personal living expenses" for either the French or the American doctors. The French doctors also have to get loans to "live" while they are pursueing their medical studies. . . and they feel they are renumerated appropriately to recup those loans!

You may think that to be an advantage but the top doctors in France who wrote the petition to the gov disagree with you.

Obviously there will always be people who don't like quotas!
I don't really either! But IF I have to choose between a REAL quota based on INTELLECTUAL/MENTAL ability to succeed in the full course of study, and to succeed in the long time career, or an "artificial" quota set by the impossibility of some students, no matter how smart, or motivated they are, to even access medical school. . .guess which one I find the most acceptable?

Quotas represent government coercion. In the US we have a system whereby bright but poor students earn scholarships either from the gov or from private foundations.

And ECONOMIC quotas (i.e., ability to have wealthy parents, or enough ability to raise scolarships) are MARKET coercion such as, if you have wealthy parents, you're in with an average ability to complete the program, but if you are poor and your family has poor credit, you're out, even if you're close to being a genius. . .unless you get very lucky!

You are saying that they have enough physicians but the facts that I presented come straight from the horses mouth and the facts say that France has a "crippling shortage of medical staff" Either you or the best doctors in France are wrong about this.

What makes you think they don't have to pay back loans? The tuition in Medical school is not the ONLY expenses included in those loans. . .and French student have to live by their own means during the 9 to 14 years of medical school. This doesn't come for free, and some must obtain loans as well. .maybe not as big, but proportionally just as costly. . .especially since they do NOT expect to make upward of $300,000 a year as soon as they get out of school!

I stand corrected may have to pay back loans - just not for tuition which is the largest cost of medical school. The cost of those loans would be included in each doctors calculations as he or she decided to become a doctor or not and they are thus counted.

Be logical: It will cost a medical student about $15,000 to $20,000 a year to live while going to school. .multiplied by 4, that's about $60,000 to 80,000 total. That's about 50% of the average cost (cited by you) of the debt a student graduates with.

There are NO people who are not getting any treatment at all unless they make the choice to avoid getting treatment - maybe a homeless man is is afraid of hospitals. But we can't compel him to get treatment.

That is not correct. for follow up people have choices: use insurance, pay for it, or use public aid to see regular physicians outside of the ER, or even appeal to charity (and I will add now that I know of no charity organized around the idea of paying for people's medical care. Why? Because no one lacks care.

You seem to live a very sheltered life! Have you ever heard of "patients dumping?" Do you know why EMTALA law had to be implemented?
link: Emergency Medical Treatment and Active Labor Act - Wikipedia, the ...
en.wikipedia.org/.../Emergency_Medical_Treatment_and_Active_L
Do you know that the big flow of that law is that there is no money to check that it is being implemented everywhere? Therefore patients dumping continues. . . and some of the greatest offenders are some very well known, very "Christian" hospitals?

Feel free to show us an example of a person who does not have medical care in this thread. The thread has been up since Sept. 2009 and no one has given a legitimate example yet.

https://www.houseofpolitics.com/forum/showthread.php?t=8518&highlight=47+million



No I do not want to rely on public aid. It is a gov program and only offers adequate care rather than the exceptional care I want. I suppose that is why I studied hard in school, got post graduate degrees, worked hard to climb the ladder, and worked hard to never be without insurance. But everyone did not have the same opportunities that I had - many went to really bad public schools instead of a good public school like me. I blame failing public schools and say that this is the first thing that needs to be fixed.



yes, cancer survival is better in the US. As is a better outcome for just about any disease a person might get compared to other countries. The ways in which other countries offer better cures can be counted on one hand.


I don't know why anyone would want to by "medicine" with no active ingredient either but that is their choice. But I was referring to other supplements that actually work. In Europe this is a bigger market than here in part because they do not have access to as much drugs as we do.

You're wrong! They don't use as many "natural" medications as we do, because for one thing, they can go get a prescription for almost nothing anytime they need it! Prescription medication is more dependable and cheaper. . .because it is covered! Some people may make a life choice of not using prescription medications, but it has NOTHING to do with quota, or restrictions.

Is it not rationed in France? Rationing is by definition an authoritative limitation on access to a good. Maybe France does not ration medicines. Maybe the ruling government just restricts drugs, through greater regulation (your words) , by deciding who will get what when and why more than we do. Ooops, that's rationing.

There is NO rationing of drugs. . .there is just a healthy decision that says that most medications should NOT be available over the counter, but through a medical doctor. I actually wish that was as controlled here, because it would be safer, but then, in this country, too many people would have to do without any medication if they don't have affordable access to a doctor to write that prescription!

Here, the "restriction" once again, are ONLY economic decisions. . .WE can't purchase Lipitor from Canada, although it is the same medication that is sold here, because here the pharmaceutical industry can get about 5 X more for that simple, over used medication, than what it cost in Canada!

Yes, we do have "restrictions." Once again though, they are "market greed" restrictions!

 

[Dr.Who]

Do you speak French? Do you read French? If you do, I'll be happy to provide you with my source re: tuition in France!

The purpose of providing links is to make your case stronger.
This is an English speaking forum. If you want to make your case stronger you will need to provide English links.

And, by the way, with an additional $2,700 per year, per capita, paid by the US for health care, I would say that the subsidies that the French government provides for ALL educational fields (not just medical) seem like a drop of water compare to what we pay in additional health care!

Would you care to do the calculation, per year, per capita? ( US population X difference in cost of health care per capita X 40 years career of medical doctors) I think it would be something like: (311,813,034 X $2,700 X 40 = upward of $33 TRILLIONS
For comparison, France had 170,000 student in last year of medical school in 2009. So, let's say that each of those student cost the French government $60,000 that year. (170,000 X $60,000 = $10.2 Billions)

Now, which system seems to be the most economically efficient?

I like where this is going!! You are now starting to try to compare apples to apples.

Lets convert those numbers into GDP then adjust the 16% of GDP of the US and the 11% of GDP of France and see what happens. I don't think the math above is quite adequate to do the job but it can be done.

Regardless, you have now accepted that there are costs that need to be added to the French figures in order to compare them the the US figures. Medical school tuition was only ever an example of one cost. There are other costs that are hidden by governments when we try to make comparisons.

When we take the 16% for the US and the 11% for France (which are only 5% apart) then start making adjustments we should all be able to see that the two numbers just might get really close. And of course the US does have better rates of recovery for just about every disease where lifestyle is not the deciding factor and really whether or not the doctor makes you better is the most important way to measure how good a health care system is.

 

[Dr.Who]

Yet, every nation that has a "more nationalized system" i.e., universal health care, pays a lot less than we do. If such a system drives up costs, how is it that we pay significantly more than any other nation on Earth? Every one!

They don't necessarily pay less. We don't know that until we do an accurate comparison without hidden costs.

And your assessment of the French system as inadequate, cramped, etc. is simply an assumption. We pay more, so we must be getting more, correct?
It doesn't always work that way.

No we actually do get better care in the most important measure- how well the doctor makes you better. We might pay more, we might not, but I was not trying to say that we get better care BECAUSE we pay more.

 

[Dr.Who]

Okay, so the cost of tuition (approximate, obviously, as it varies per university, and the same applies here!) is about $60,000 per year for an average (2009 number of graduating medical student) 170,000 per year, for a length of 9 years (which includes what we call "undergraduate studies!). This would be about $90 Billions to produce those 170,000 doctors in subsidized French school.

But, if you count that, 311,000,000 US population ( rounded up to the lowest), and a difference of per capita cost of $2,700 per YEAR, and estimating that these physicians will practice medicine for 35 years. . .this means that the cost to the American public in terms of additional cost of health care is close to $30 TRILLIONS!

I guess. . .economic efficiency is not our forte, is it?

You have attributed the entire difference in the per capita cost to only one factor. Surely there are multiple factors that make the per capita cost here higher than there. The costs also need to be amortized when they span several years or more. Though we don't really know if the per capita cost is actually higher here than there because no one has done all the needed adjustments of which there must be hundreds.

We just calculated that (although approximately!) right?

yep

Well, in the above calculations, we didn't count "personal living expenses" for either the French or the American doctors. The French doctors also have to get loans to "live" while they are pursueing their medical studies. . . and they feel they are renumerated appropriately to recup those loans!

Yep

Obviously there will always be people who don't like quotas!
I don't really either! But IF I have to choose between a REAL quota based on INTELLECTUAL/MENTAL ability to succeed in the full course of study, and to succeed in the long time career, or an "artificial" quota set by the impossibility of some students, no matter how smart, or motivated they are, to even access medical school. . .guess which one I find the most acceptable?

You may like one system better but the system you like better is the one that restricts individual rights more and THIS country was founded on the idea that the role of government is to protect individual rights not on the idea that gov was founded to pay for one persons education at the expense of another person -here we call that redistribution and it is not a role given to government anywhere in the Constitution.

“I cannot undertake to lay my finger on that article of the Constitution which granted a right to Congress of expending, on objects of benevolence [such as a doctors or a plumbers education], the money of their constituents.” James Madison.

And ECONOMIC quotas (i.e., ability to have wealthy parents, or enough ability to raise scolarships) are MARKET coercion such as, if you have wealthy parents, you're in with an average ability to complete the program, but if you are poor and your family has poor credit, you're out, even if you're close to being a genius. . .unless you get very lucky!

France has market forces, i.e. "coercion", yes? And France also has gov quotas which is coercion, yes? So France has two kinds of coercion. I would prefer just one type of coercion and additionally for it to be the one "coercion" that leaves me free.

There is NO rationing of drugs. . .there is just a healthy decision that says that most medications should NOT be available over the counter, but through a medical doctor. I actually wish that was as controlled here, because it would be safer,

Gov limits on a resource meets the definition of rationing perfectly.

but then, in this country, too many people would have to do without any medication if they don't have affordable access to a doctor to write that prescription!

Who does not have access to a doctor?

Here, the "restriction" once again, are ONLY economic decisions. . .WE can't purchase Lipitor from Canada, although it is the same medication that is sold here, because here the pharmaceutical industry can get about 5 X more for that simple, over used medication, than what it cost in Canada!

It was congress that made that law, right? And you would give more control to that congress?

Yes, we do have "restrictions." Once again though, they are "market greed" restrictions!

Restrictions that come from nature or markets, etc, are not within the jurisdiction of congress given by our constitution to address. Congress is not intended to manage every force of nature or markets. But if it is greed as you say and if greed is an injustice then congress has the obligation to make laws against any act that qualifies. Here we are a republic with a gov that is charged with the duty to protect our rights. Taking taxes to give doctors an education or to pay medical staff to treat illness is not a protection of a right but an abridgment of a right. Those who want things to be otherwise should follow the proper channels and amend the constitution or move to a socialistic country.

 

[dahermit]

(except for lifestyle issues because we are fat slobs.)

Coming from a "Christian" and a "Psychologist".

 

[ThisTooShallPass]

The hybrid system doesn't work because, as I stated before, the HIGH premiums are paid to private industry who covers ONLY basically healthy populations of relatively young adults, while the others (all those that are either too sick, too old, or too disabled to "qualify" for private health care. . .because it would lower the huge profits!) have to either do without care (unless it is an emergency, and then they can be "stabilized" before being sent home!), or received care from the government program at a cost that they can afford.

Now, if more people were able to opt out of the private health care industry and move to the medicare program, the pool of people would not only be much bigger, but also the average age would be lower, and the "average" risk would be lower.

My point is that Medicare works only because the costs associated with it are transferred to those with private insurance -- which is why their premiums are so high in the first place.

As fewer people enroll in private insurance and more in Medicare, the imbalance is greater; the privately insured must pay higher and higher costs. Eventually you get to the point where the privately insured cannot shoulder the costs any longer and physicians must begin turning away Medicare patients.

We're at that point now, incidentally.

By the way, you are partially right that people who do not have health care insurance at all are being paid for by ALL of us, through rising the price of each service. . .however, if you took away people on medicare, medicaid, and non-insured people from the pool of "clients" for health care, the private industry would NOT be able to continue paying for all the hospitals, all the technology, all the equipment, and the private health care industry's accessibility to health care would also be seriously compromise or sky rocket

Well, yeah. Our health care system is designed for its current capacity. If you took away several tens of millions of people from that system, we'd have a few too many hospitals, ambulances, doctors, nurses, etc. If you shrink demand, supply must fall to match it, or else prices fall.

But we're not talking about abolishing Medicare. I'm simply saying we need to outlaw medical price discrimination. The cost of treating a Medicare patient for condition X should be the same as treating a privately insured or uninsured patient for the same condition. This means the Medicare reimbursement schedule will have to go up and Medicare will become more expensive; that maybe also means fewer treatments will be able to be covered by Medicare. Government should be honest about the costs of its programs, and if those costs are too high to guarantee a free hip replacement for every senior in America, then so be it.

 

[Dr.Who]

Coming from a "Christian" and a "Psychologist".

The sentiment is true (do you doubt it) and singles no person out for ridicule. Yet it succinctly describes what we all know. I could have said we are the most obese country on the planet (fat) and we fail to look after our own health even though we have the most resources to do it (slobs). But that is way too wordy.

 

[Openmind]

The sentiment is true (do you doubt it) and singles no person out for ridicule. Yet it succinctly describes what we all know. I could have said we are the most obese country on the planet (fat) and we fail to look after our own health even though we have the most resources to do it (slobs). But that is way too wordy.

Are you REALLY a psychologist???
What kind? Counseling, licenced, Ph.D?

Psychologist is such big term. ..inquiring minds want to know!

 

[Openmind]

The purpose of providing links is to make your case stronger.
This is an English speaking forum. If you want to make your case stronger you will need to provide English links.

I like where this is going!! You are now starting to try to compare apples to apples.

Lets convert those numbers into GDP then adjust the 16% of GDP of the US and the 11% of GDP of France and see what happens. I don't think the math above is quite adequate to do the job but it can be done.

Okay, I'll play along with your game. . .If you accept as "adequate" the $10.2 billion a year it costs France to subsidies those 170,000 medical students, and you compare that number to the French GDP of $2.65 trillions (for 2009 also), you get to a 0.3 % of the GDP. . .a lot less than the 5% GDP difference in cost of health care in those two country.

Regardless, you have now accepted that there are costs that need to be added to the French figures in order to compare them the the US figures. Medical school tuition was only ever an example of one cost. There are other costs that are hidden by governments when we try to make comparisons.

When we take the 16% for the US and the 11% for France (which are only 5% apart) then start making adjustments we should all be able to see that the two numbers just might get really close. And of course the US does have better rates of recovery for just about every disease where lifestyle is not the deciding factor and really whether or not the doctor makes you better is the most important way to measure how good a health care system is.

Sorry! I don't think so. . .I do not believe that the 0.3% added to the 11.3% of GDP for France will ever reached the 16% of GDP that health care costs in the US! That would be a LOT Of "add ons!"
I think you may want to look at the bulk of that difference in the pockets of the big business health care industry's CEO's!

 

[Dr.Who]

Are you REALLY a psychologist???
What kind? Counseling, licenced, Ph.D?

Psychologist is such big term. ..inquiring minds want to know!

Clinical, early retired.

 

[Openmind]

Clinical, early retired.

Masters or Ph.D?

What was your field of work? Counseling? Business? Mental Health? Teaching? Child development?

I've always been interested in what I "missed" by not pursuing my graduate studies in the field of psychology, but switching instead to (first MBA), then social work.

Do you have any publications?

 

[Dr.Who]

Okay, I'll play along with your game. . .If you accept as "adequate" the $10.2 billion a year it costs France to subsidies those 170,000 medical students, and you compare that number to the French GDP of $2.65 trillions (for 2009 also), you get to a 0.3 % of the GDP. . .a lot less than the 5% GDP difference in cost of health care in those two country.

The point all along was to give an example to show that fair comparisons were not being made. We agree on that now.

For this one example you have figured that it is .3% of the gdp. We would only need to find .3 x 15 examples to make the 5% difference. I think it is highly likely that there are 15 ways that France actually pays more than the stated amount and it is very conceivable that any or all of them could be as high as 10 billion. It could also be that Frances expenses were understated only 7.5 times instead of 15 while the US's were overstated 7.5 times.

Sorry! I don't think so. . .I do not believe that the 0.3% added to the 11.3% of GDP for France will ever reached the 16% of GDP that health care costs in the US! That would be a LOT Of "add ons!"

It would be about 15 add ons. The fact that France is running in the red is one huge add on right there. How much in the red are they?


I think you may want to look at the bulk of that difference in the pockets of the big business health care industry's CEO's!

Do you think the health insurance industry makes excessive profits? Tell us how their profits compares to a number of other industries like electronics or beverages? Does McD make a measly 2% profit on cokes and Health insurers make a monstrous 35% profit?

 

[Openmind]

Do you think the health insurance industry makes excessive profits? Tell us how their profits compares to a number of other industries like electronics or beverages? Does McD make a measly 2% profit on cokes and Health insurers make a monstrous 35% profit?

Personally, I think it is a little obscene to make profit on people's life.

So, YES, I believe the health insurance industry makes excessive profits. . .I would much prefer a fully NON profit private insurance, and see any profit automaticaly reinvested in the well being of people, rather than the "stock market!"

 

[Dr.Who]

Personally, I think it is a little obscene to make profit on people's life.


So, YES, I believe the health insurance industry makes excessive profits. . .I would much prefer a fully NON profit private insurance, and see any profit automaticaly reinvested in the well being of people, rather than the "stock market!"

That's a nice sentiment but it belies a complete misunderstanding of the concept of mutually beneficial trade.

Therefore any good that people require to sustain their lives should be exchanged without a profit? Food - no profits for you! Housing - no profits for you! No soup for you!

There is nothing evil about profits. They are not evil when they are the result of exchanging money for a movie or when exchanging money for medicine. Profit is what causes people to want to produce any good in the first place. Without profit no one will produce anything. Without the hope of large profits no one will take the risks necessary to make great accomplishments - that save lives. Every single nurse, technician, doctor must make a profit on his/her time. Anyone who wants to open a clinic must have people willing to put up the money or he won't get to start one. And if these stockholders can't be repaid (because that is what is done with the profits) then they won't back the hospital and it won't get opened. Well not unless the gov backs the hospital. But the constitution does not grant the fed the power to open hospitals. And what about research? Maybe the gov does not want to back the research into some particular disease but the stockholders do. Those who will be cured depend on those stockholders.

And who decided just what good is required for life? How will our economy operate with two sub-economies - one for life sustaining goods and one for goods which are deemed to be non-life sustaining? If healthy food is deemed to be life sustaining then what about Twinkies?

Not only is it impractical to eliminate profits for life sustaining goods but in every instance in which government has tried to eliminate profits, i,e, socialisms and communisms, the results have been disasterous to life.

The concept of people exchanging goods, yes even necessary life saving goods, is inseparably written into the constitution. The only way to eliminate profits on some goods would be to scrap the constitution and start over again.

And now just asking for clarity - Are you a communist or a socialist? Or do you just subscribe to some of their ideas?

 

[Hobo1]

Some time ago, in the distant past, I think Dr.Who made a post about the lack of choice in medical treatment. That is, "this ain't Burger King, you get it our way, or you don't get it at all."

Let's take the most simple example. You want a clinic to check your blood pressure. That's all. You don't want to spend $100 on one of the machines you can buy at the store. So you walk into a doctor's office, they say, "ever been here before?". No. Please fill out this 3 page form so we have your complete medical history. "But I just want someone to check my blood pressure". Sorry, we need the forms first, sir.

You know the rest of the drill.. make a file, talk about how your are going to pay, what kind of insurance, etc. etc. Ok, now go sit down and wait - we will call you. 45 min later, the nurse calls you in... height, weight, blah, blah. Finally she takes your blood pressure, writes it down but doesn't tell you unless you insist. She says the doctor can review this with you. If you don't bolt for the door and run out, the doctor will spend 15 minutes with you... "Your blood pressure is within the normal range, but a little higher than we like to see. Maybe you should come in and have it checked at a different time of the day so we can see a trend."

God help you if you need a prescription. ....time passes... finally you can settle up at the cashier. Price $250.

If you are like most Americans, that is all normal. You think that is the "best health care in the world" (cough).

If you have traveled or even been to a medical clinic in Tijuana (shutter the thought), you know, you can go into a clinic and a clerk may make a copy of your passport or driver's license. Then a nurse takes your blood pressure, gives you the results, asks you if there is anything else. No. Price: maybe free, maybe $10.

You multiply the US way of doing health care and the way about 80% of the world does it, and you will see why everything is so damned expensive here. If I were cynical I would say the doctors are just milking you for a profit. But I really believe we have evolved into this system thanks to our own obsession with our health. That is, we feel ignored and worried the doctor is missing something if we had a streamlined system. People go to a doctor and they want medicine! Many times it is only a placebo.

Living in Southern California I have found a few doctors and a dentist that mainly treat illegal aliens without insurance. Here is a faster, cheaper, and less intense way of going to the doctor. I wouldn't go there if I was worried about something serious, but for routine stuff it is fine. That system needs to be expanded so we have a choice about our medical treatment.