Healthcare
- Thread starter RDCR07
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In the latest episode of the United Hour Podcast, Nik (@Rood) is joined by CEO Duncan Drasdo and Financial Director Andy Green from the Manchester United Supporters Trust for a special episode on all things behind the scenes at Old Trafford including a brief history of MUST and their aims today, views on INEOS and Sir Jim Ratcliffe so far, and the Old Trafford regeneration.
Yeah that is severely distorted because most people just take the basic package health insurance cause that is all they can afford. If you want good health insurance and coverage, then you have to shell out more and $1,000 is still on the lesser side. My uncle was paying close to $2,500 a month for a family of four. He is a radiologist so thats chump change for him but still.
You're the one making sweeping claims here, I'm asking you to back them up.
Not necessarily. Plenty of big businesses that have established themselves are so big that they can generally get away with pissing off customers and giving poor customer service while still sustaining themselves. Obviously they will damage themselves to an extent through this, but not to the point where it's actually detrimental to their survival. If I live in a smallish rural town and find the customer service of my local supermarket to be a bit shite and not up to the par, then I might not be particularly happy with them but I'm going to continue shopping there irregardless because I don't have any alternative.
Some businesses manage to monopolise successfully, while others operate in a system where there can't be much competition. In a hypothetical where railways are completely private with no government involvement/interference at all, it doesn't really matter how bad their service is; if they're the only company actually running a train in the area I need to get a train from, there's not really any other alternative.
I'd say your statement is generally true for smaller businesses teetering on the edge; for big, established, multi-national companies it's not really the case though, because they've reached a point where they can treat customers like crap and get away with it.
Government-run services may sometimes be inefficient but at least if a government service is inefficient I can protest that and vote for someone else who says they'll run it more efficiently, or argue for direct changes to be made. Politicians then have to be aware of that desire for change, and ideally act according. A major private enterprise doesn't really need to do so automatically - it's good business if they do listen to customers, yeah, but if they don't then the big bosses at the top will still make a ton of money. And if that business does eventually fail, then it's not the bosses at the top that suffer... cause they're well-off and well-qualified anyway. It's the unemployed workers at the bottom who suffer.
I agree with the general premise of being harsh on those who misuse the NHS but we need to look at who is misusing. Because we can end up in a position where we're punishing poor people disproportionately when their misuse of the service may be for a number of reasons, difficult circumstances at home, not received a proper education on why the NHS is so important etc. Someone rich can afford to pay a fine...someone struggling might not be able to.
I take you word for that but find it hard to believe. I work in IT and change jobs quite often. I also get contacted a lot by recruiters and companies, and one of my first questions is send me your benefits package. Of course I haven’t seen the benefits at every company but I have seen a heck of a lot including Citi, JPM, PWC, Blue Cross, Amazon, PNC, HCA, plus numerous small companies and the hospitals my wife as worked at. So I have seen the rates that at least two million Americans pay. I can even share the actual documents for some of them if I can dig them out. *anyone interested send me a PM with your email.
It varies a lot but for single coverage anything from a few dollars to $100 a paycheck is typical, a couple is typically $120-$300 a paycheck. I will not comment on families because it’s not something I have taken any notice of recently. However adding kids is often similar to adding a spouse.
Well of course yes, individuals vary from having spouses and families. I use the HSA so my rate is only around $30 a paycheck and I get to set aside $100 a paycheck (pre-tax) to use as medical expense for the year. So $1,200 a year is just for medical which I use through a credit card. Now if I get married tomorrow, my insurance through the same company goes up to around $250-300 a paycheck. And thats just for some basic coverage package. If I something a bit more extra I have to throw in maybe an extra $100 bucks a month.
It really varies a lot. We usually pay around $150 a paycheck for the two of us. That is HSA dn the employer contributes $1,500 a year to that. Right now we are paying for the best insurance with my wife's employer because we are in different cities. That is costing $300 per paycheck but it has low copays and minimal deductibles. If I roll perm at my current employer my wife can get coverage for $50, and I can get it for $40 on our own policies.
Big businesses often have crap customer service by design. They know that they're the cheapest for the product and they know that customers value cost over service in many sectors. If you spoke to Michael O' Leary he'd say if you want great customer service and not to be pissed off, go and pay twice the price with another airline. That doesn't mean they aren't efficient though. It means that their business model is based around efficiencies in cost, rather than efficiencies in service. If you want to use an airline whose efficiencies are in providing a great service you opt for a more premium airline. Both are efficient in their own ways - you only have to look at Ryanair's profits to see how efficient they are (this isn't to say they're perfect).
In a true free economy where railways were completely private you would have a situation where we'd have many more railway lines which would compete, rather than very few lines offering poor service as they're tied to charging an agreed price. Failing this (possibly due to the high cost to enter this market, you'd have other methods of transport competing for the "business" of transportation. For example you'd have a far, far more efficient road network that would allow people to effectively drive to places instead of taking the train.
The fact that our road network isn't competing with our rail network for customers, means that both are terribly inefficient. Instead of our roads getting constant investment to keep them ahead of the game, we have years of gross under-investment as updating our road system isn't as sexy as giving the NHS another £5b. This also leads to a short term false economy situation whereby roads are regularly patched up for a cheaper cost in the short term, instead of properly resurfaced which is cheaper in the long term.
The only mode of transportation that is very efficient is air travel; which is due to the fact that this is a fully privatised industry with high levels of competition. In this sector the government is still screwing things up however by failing to allow airports to grow at a rate that allows them to compete on a global scale.
Again they treat customers like crap in order to achieve their desired efficiencies; this isn't at all a sign of them being inefficient. If you have an example of a high end product that is less price sensitive that is flourishing whilst offering terrible service, then I'd be happy to hear it. Terrible service is solely a result of customers being exceptionally price sensitive. If we all were happy to pay more for a better service, these companies would collapse in favour of other companies.
Healthcare isn't comparable to budget short haul air travel in this regard. Efficiencies aren't based around the lowest cost possible, but on the best overall service possible.
Civil servants run these operations, not government ministers. All of whom are given no incentive to change or improve so it's completely irrelevant whose stewardship they're under; they aren't going to suddenly become exceptionally conscientious without any benefit to themselves. These aren't things that can be changed by Jeremy Hunt; they can only be changed by the people in charge changing the culture. What's best for the management needs to be re-aligned to what is also best for the NHS. As it stands what's best for the management is purchasing at a 25% premium in order to receive a golf weekend every year, despite this being hugely detrimental to the NHS. How can you have a system whereby the management are punished for doing the right thing?
Unfortunately I can't see any way of changing the culture without disproportionately punishing poorer people in society. If I were in charge for example I'd charge a £100 excess across the board but give all poor families an annual tax reduction of £100, meaning they would only ever benefit from this proposal. However with our tax system the way it is a simple and effective idea like this would turn into an expensive bureaucratic nightmare.
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All well and good when the biggest consequence of poor customer service is someone getting pissed off - here we're talking about potentially life and death situations. You're basically admitting here that efficiency doesn't necessarily mean good service - your admission suggests that it's cool to shaft poor people so long as the rich guys at the top make a reasonable profit, in the knowledge that if their business does fail then they'll just hop into another big job while the actual workers are unemployed. It's quite obvious why this doesn't really work for healthcare.
@finneh
I don't have time to read your whole thing, but it's not even controversial to say that competition is harder to set up in some sectors than others. And when there isn't competition, the private sector can generate huge profits without good services. The railways are an excellent example. Not just for prohibitive start-up capital but the limited availability of suitable land, etc
And as you acknowledge, healthcare efficiency (and every other sector efficiency) means profit-making, not quality of care. That might be fine in the beer market. But in the healthcare sector, why would you want to maximise profit-making rather than healthcare outcomes?
I don't have time to read your whole thing, but it's not even controversial to say that competition is harder to set up in some sectors than others. And when there isn't competition, the private sector can generate huge profits without good services. The railways are an excellent example. Not just for prohibitive start-up capital but the limited availability of suitable land, etc
And as you acknowledge, healthcare efficiency (and every other sector efficiency) means profit-making, not quality of care. That might be fine in the beer market. But in the healthcare sector, why would you want to maximise profit-making rather than healthcare outcomes?
I like this idea - it's a nice balance between the two.
That's why I said that Healthcare isn't comparable to budget air travel. Healthcare isn't something whereby costs are the only (or even a large) consideration at the expense of all else. Healthcare would be more comparable with choosing between a £75k Porsche and a £75k Jag. Both have to be of exceptional quality and the customer service has to be fantastic, because the product is less price sensitive. If Porsche suddenly starting offering poor customer service they'd stop selling cars.
Efficiency means offering the ultimate service that the customer requires. If the customer is only interested in cost, then the ultimate efficiency is to reduce costs at the expense of everything else (Ryanair). If the customer is looking for only the best product available and does not care about the cost (e.g. the Jesus Nut in a helicopter), then the most efficient company is the most innovative one in terms of producing the best product possible. If the customer is looking for quick delivery as his sole objective, then the supplier who can produce things quickly will be the most efficient. Whereby it's a combination of requires it's the company that can offer the best overall package in terms of price, quality and delivery/service.
I did not acknowledge this at all, far from it.
In terms of sectors where there is no competition causing inefficiency I agree completely, which is where the NHS currently is. In the private sector monopolies that exploit customers in this way should be regulated far, far better by government.
Well yes - but the different is that if I'm buying a Porsche in the first place then I'm obviously incredibly rich, and can just buy another car next time. People (rich or poor) don't really get that within healthcare insofar as bad care can have long-lasting, lingering or even fatal results. Hence why a lot of the comments about improving NHS efficiency under a more free-market model miss the point entirely - businesses striving for efficiency aren't doing so for customer care, they're doing so for a greater profit. You can argue that shouldn't be the case for healthcare because customer service is obviously the main, key area here...but bosses wanting to make a profit aren't necessarily going to see it that way.
And as for the last part...again, this is something that happens regularly, within companies like Ryanair etc that you've mentioned. And yes, you can say those companies are aiming for a business model that prioritises efficiency over customer service, but for many those cheaper, less reliable businesses are the only ones they can really afford to go to. Meaning they're still fecked.
How do you lot feel about faith based Healthcare programs? Apparently one of the fastest growing segments in healthcare industry.
Paying $32k for two families of 4 including HSA contributions of $2600 per employee. $4k family deductible. Went up just under 9% this year.
That is an HMO plan. ACA plans are worse in my state.
That is an HMO plan. ACA plans are worse in my state.
That's a lot of money. I pay 4800K for a family of 3. My contribution is 500 USD and employer contribution is 1000 USD for my HSA account. I also put in a nominal 250 USD contribution for my Healthcare enabled FSA account. This includes Dental and Vision. My exposure for individual is 6000 Max out of pocket and 12000 Max out of pocket for family after which I'm 100% covered. It's an embedded plan, so as long as I treat for only one individual, then I would be exposed for 6K only.
I am in work. The majority of Americans have employee provided health care insurance. Although they maybe dissatisfied with rising premium I have rarely heard anyone complain about the actual care.
Another way of looking at it is the US spends $10,000 per capita on healthcare. Lets presume there is 20% of waste we can save by going UCH with a single payer. That still leaves $8,000 per capita or $24,000 for a family of three. Lets presume costs are split 50:50 so the employee is on the hook for $12,000. Lets say someone on $50,000 pays 6% of that, that leaves a $9,000 shortfall. Free is never free unfortunately.
Some of your assumptions in that post doesn't make any sense to me, but I'm not a healthcare policy nerd, so it could just be me.
Sanders has addressed the funding bit on his web site.
https://berniesanders.com/issues/medicare-for-all/
You say all of these things are "facts" and then only use your personal experience and personal opinion as evidence here:
Can you provide actual evidence backing up your claim that most Americans get "better" healthcare than the NHS in the UK?
Also the UK is not the only country with universal healthcare. Why compare to only the UK and not include other countries like Australia and Japan?
You seem to be struggling with the fact that you are not in a position to speak for "the majority of Americans" and that your own experiences and those of the people you know are not identical to the rest of the country.
You keep making frankly ridiculous generalisations and claims and stating things as fact and then moving the goalposts or straight up dodging questions when asked to back up your claims.
Someone with no prior knowledge reading your posts would think healthcare in the US is pretty much great with just some small tweaks required.
The other thing misleading about @Mike Schatner is when he says "Most Americans do not like the current payment system". As if the problem is just having to pay an extra tenner or something minor.
The reality is ~60% of USA bankruptcies come from medical bills (that is roughly 600,000 bankruptcies a year due to medical).
Even if this number is not exactly correct its very close and illustrates the point:
Thats more major of an issue than just "not liking the payment system".
https://www.snopes.com/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/
Because I have about 17 years experience as an adult in both the UK and US. My wife also has 17 years in the NHS and working in healthcare here. The US system is far from perfect and its failing a significant percentage of people but it is working well at healthcare delivery for the majority.
I am guessing without digging too deep into the bankruptcies a large number of those would be eliminated with an expansions to of Medicaid to cover the uninsured.
I have said multiple times the system needs changing, and I am in favor of UHC and single payer. That does not detract from the fact that the majority of Americans get very good healthcare.
I do not consider the opinion of a random person on the internet to constitute compelling evidence worth listening to. All you have done is restate your personal opinion, not provided any actual proof. And as Rado_N says, you obviously don't speak for the majority of Americans.
I am in a better position to speak about US healthcare than most people. Yes the healthcare is pretty good in the US if you have insurance. I read on another thread someone waiting for a scan under the NHS and it could take months. Pretty every ER in most places have a MRI scans available 24/7. I have lost count of the number of scans I have in the last 15 years.
Too funny....yet you are happy to consider opinions of random people on the internet with zero experience of US healthcare, taxation or America in general......makes sense
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The one thing that people don't realise is, in the UK we can go private if we want to jump the que. Thing is these private procedures, tend to cost a whole lot less because of the NHS as well. I paid more in one month while I was over in the US than I would have for 2 years worth of private insurance in the UK for the same cover. The NHS right now is on it's knees in this country and its still surviving and giving out incredible care to everyone free on point of entry. If we do go for the paid route I hope we follow the lead of the Germans instead of the horror show that was my experience of health care in the US. It's a shame as I love the USA and visit regularly for family and business, but the healthcare system over there is ridiculous.
The other thing misleading about @Mike Schatner is when he says "Most Americans do not like the current payment system". As if the problem is just having to pay an extra tenner or something minor.
The reality is ~60% of USA bankruptcies come from medical bills (that is roughly 600,000 bankruptcies a year due to medical).
Even if this number is not exactly correct its very close and illustrates the point:
Thats more major of an issue than just "not liking the payment system".
https://www.snopes.com/643000-bankruptcies-in-the-u-s-every-year-due-to-medical-bills/
Reminds me of that meme, "If Breaking Bad was set in the UK":
Man gets diagnosed with cancer > Gets free treatment > the end.
No, you just think you are.
It's been pointed out to you repeatedly by several people that you cannot speak on behalf of an entire population and it takes a rather staggering arrogance to not only think you can in the first place but to stand by it when this fact is pointed out to you.
You're all over the place and can't back up anything you say.
I agree with much of it. I think it is optimistic on the actual cost of UHC. It also relies heavily of big tax rises for people earning million. We have touched on this before. Punitive taxation although appealing to the masses often reduces the total tax revenues. Ultimately the working middle class will most likely burden more of the cost. FOlks on $75-$150k a year would see increased taxes IMO. Not necessarily bad if it offers all Americans UHC.
Are there anyone other American posters that think the healthcare is poor in the US? Not the premiums and copays or paperwork. I mean the actual health care they recieve.
I have spoken to lots of people that complain about the billing side of things but I have never heard anyone say they would prefer to be treated in the UK or Canada TBH.
We are saying exactly the same thing. The system around funding is ridiculous but the actual healthcare is very good.
Clearly if you've never heard any first hand complaints none of the 323 million people living in the US can have any complaints.
I can't be arsed talking to you about this anymore, it's bloody pointless you're so one-eyed.
Instead of just listing what you and your friends think, how about doing some actual research? Start here.
http://www.latimes.com/nation/la-na-healthcare-comparison-20170715-htmlstory.html
I am well aware of the stats and research. My wife is in healthcare. Health outcomes are also linked to lifestyle, not just healthcare. Obesity and the use of high-fructose corn syrup have devastating impacts of health and life expectancy. Having 10% of people without insurance is a major factor in life expectancy.
Doesn't detract from the fact that Americans with insurance have access to very good healthcare.
Access ffs. As if that's the same thing as being able to afford it
I do. It's not a patch on private healthcare. Plus they treat you like you're a nuisance (although that could just be the hospital I went to.)
It's certainly gone downhill since I arrived in the US in 1994.
I think my position on funding and the direction of US healthcare is not dissimilar to anyone else's oosting in this thread.
Are you saying private healthcare is good or the NHS is better.