What If The Public Option Isn’t Cheaper?
Liberal defenders of the Democratic health plan like to say that the reason the CBO estimate came in high is that the public option was not included…but what if this is predicated on a false sense of lower administrative costs brought on by misleading Medicare stats? Tom Bevan has more:
This statistic about Medicare’s low administrative costs has become one of the linchpins in the argument for a “public option” on health care. The only problem, not surprisingly, is that it’s hogwash.
The explanation is really quite simple, and it’s provided here by Robert Book of the Heritage Foundation. The statistic cited by Alter and Krugman uses “administrative costs” calculated as a percentage of total health care costs (For Medicare it’s roughly 3 percent and for private insurers its roughly 12 percent).
But here’s the catch: because Medicare is devoted to serving a population that is elderly, and therefore in need of greater levels of medical care, it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates theappearance that Medicare is a model of administrative efficiency. What Jon Alter sees as a “miracle” is really just a statistical sleight of hand.
Furthermore, Book notes that private insurers have a number of additional expenditures which fall into the category of “administrative costs” (like state health insurance premium taxes of 2-4%, marketing costs, etc) that Medicare does not have, further inflating the apparent differences in cost.
But, as you might expect, when you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans. …[B]etween 2001-2005, Medicare’s administrative costs on a per-person basis were 24.8% higher, on average, than private insurers…
Let’s repeat the key sentence there for emphasis so it doesn’t get lost in the flood:
[B]etween 2001-2005, Medicare’s administrative costs on a per-person basis were 24.8% higher, on average, than private insurers.
Wishful thinking is nothing to base a health plan on…if it comes to that prayer is a lot cheaper and as least as effective…
UPDATE 9:05 p.m.: Ruth Marcus attacks the public option from a different angle:
It’s not far-fetched to imagine that instead of having a public system that trounces private insurers on cost, the public plan will end up being a more expensive repository for the sickest enrollees, holding little attraction for those in reasonably good health and doing little, then, to hold down costs.
Let’s assume that public plan advocates are not promoting it as a stalking horse for a purely government-run health insurance system and that it is possible to design a playing field that is not so tilted in favor of the public plan that private insurers will ultimately be driven out of business. The more the playing field is leveled, the more you wonder: Where, exactly, is the advantage in a public plan?
Is the health-care industry so uniquely impervious to effective regulation that — even with insurers required to accept all applicants and not allowed to charge more for riskier enrollees — a public plan is the only way to ensure that they compete on price rather than engage in covert cherry-picking to attract customers who will cost less? This seems an odd position for those who tend to be fans of regulatory regimes.
Is the health-care industry so uniquely anti-competitive that a public program is required to drive prices down? Advocates of a public plan argue that many markets are dominated by just a few insurers, and that even those insurers don’t have enough muscle or motivation to extract lower prices from providers such as hospitals and specialists in increasingly concentrated markets.
This is a serious concern, but if hospitals have the upper hand in a particular market, how is a public plan going to drive prices down unless it exercises the kind of 800-pound gorilla bargaining power that the political system is unlikely to produce?
Is a public plan — without the need to turn a profit and with lower administrative costs — inevitably going to be more cost-effective than a private competitor? To some extent, but the difference in administrative costs between public and private plans is easy to overstate: Public plans would have to market themselves and collect premiums, just like private plans, while private plans, required to take all applicants on an equal basis, would be spared expenses they have now, such as the cost of figuring out how much to charge for patients of differing health status. The overall differential would probably be about 5 percent.
Although Marcus repeats the ‘lower administrative costs’ fallacy that Bevan effectively slams the door on, she at least recognizes that it’s built on assumptions that would not hold sway in the post-Obamacare world…
Mark,
This leaves out the obvious point that private insurers generate lower expenditures by denying care, right? Any way they can, right?
Or, consider perhaps that the relevant metric ought not to be administrative costs per patient, but administrative costs per claim. The claims are what’s really being administered, and as is noted, since Medicare is comprised of a pool of people requiring more care, they’re going to submit more claims.
As Book says:
And here:
So, while he agrees with you that the # of claims is a better metric than the amount of claims, he points out that claims processing amounts to a very small percentage of administrative overhead.
Bevan also notes this from Books, which Mark pointed out above, but bears repeating:
In fact, Book is even more emphatic on this point:
And here:
But my favorite bit is the end of the Evans piece, and while it repeats something I’ve said ad nauseum, I’ll quote it now anyway:
He’s generous here…government never produces anything that is less expensive or higher quality than the private sector.
Nothing about this is going to be cheaper. The Obama administration’s anti-Midas touch is on full display here. Like it’s predecessors, the stimulus package and the cap and trade bill, the health care plan will make things worse, not better.
I share your opinion that government never produces anything that is less expensive or of higher quality than the private sector, and I believe the proponents of health care reform, from Obama to Krugman, know that this is true. So I wonder what it is they want, really, because they are too well informed to believe possible what they publicly say they want.
Let’s see.
Recall that, of all the industrialized countries, besides the US, France is the next-most-expensive, devoting 11% of GDP on healthcare. Korea was the least expensive (6.4% of GDP).
In France 7.25% of every healthcare dollar is spent on administrative costs. In Korea, 3.87%. The most efficient countries are Norway (0.86%) and Denmark (0.99%). Canada spends 3.9% of every healthcare dollar on administrative costs.
On average, the other industrialized countries spend 9% of GDP on healthcare, and 3.8% of that on administrative costs.
We spend 15.3% of GDP on healthcare, and 11% of that on administrative costs.
This is vastly higher than other countries, where what we’re calling “the public plan” is the norm.
In fact, the above (OECD) numbers understate the disparity, by focussing on the overhead costs of (public or private) health insurers. If you add in the time spent by doctors filing paperwork, etc, the disparity (in “total” administrative costs) is far greater. See, e.g. this New England Journal of Medicine comparison of US and Canada:
You can juggle the books, all you want, in comparing Medicare with the private insurers. The conclusion you would like to draw — that the “public plan” would be no cheaper than our existing patchwork of private for-profit insurers — is simply belied by the experience of every other industrialized country in the world.
So the parts that you choose to highlight, Chris, read to me like this: Administrative costs of health insurance companies are exaggerated because I want to ignore some of them.
Right?
Jacques, you say I’m jiggling the books by quoting a report that says Medicare is not as efficient as it’s cracked up to be. How so? What specifically did the article or report quoted get wrong?…
Not you, Mark. the oh-so-clever sources you cite.
To pick one absurdist claim: it’s somehow “unfair” to count the taxes paid by private insurers as part of their administrative overhead, when Medicare doesn’t have such a burden.
That is just stupid.
In the same vein, one could argue that one shouldn’t count the dividends they pay to shareholders as part of their costs, either, as Medicare (not being a for-profit public corporation) does not have that burden.
I could go on, but being
a) somewhat jetlagged and
b) rather annoyed by the shear disingenousness of the Bevans/Book exercise
I think I’ll refrain.
As to Ruth Marcus, I’ll simply point out that, if one believes (as she, and Chris and Steve seem to) that the public plan is simply incapable of competing on quality or efficiency, then I don’t see how private insurers could possibly lose any significant number of customers to the public option.
If, on the other hand, it can deliver better care at a lower price, then I can think of no earthly reason why the private insurers shouldn’t be driven out of business by it.
Fargus,
No, you took exactly the opposite point. The point is that those claiming Medicare costs are lower are the ones who are ignoring things. Now if you want to give up on disease management and on-call nurses, I’m sure private enterprise can work something out so that you can receive worse care at a lower cost.
Jacques,
I’ll see your “every other industrialized country in the world” and raise you 230 years of American history. I’m sorry, but when I point out (rightly) that nothing our government touches ever becomes higher quality or cheaper, then you’ll have to come up with a better response than “other people do it”. That’s the argument that a teenager makes to his parents about why he should be allowed to stay out later. It fails for the teenager and it fails for you. You’re going to actually have to make an argument that when we do it it will be better or cheaper. You aren’t, because you can’t.
I’m trying to forgive you, since you claim jet lag, but that statement is incomprehensibly dumb. Since I know that you’re pretty smart, I can only assume that you weren’t thinking clearly when you wrote it.
Surely you realize that if I’m paying say $100/mo to my private insurer, that the government can come in and charge $50/mo and yet still cost more? You have heard of taxes, right? And that’s how the government wins. Their cost can be $150/person/mo and still charge me, the “customer” $50/mo. The wonderful thing is they won’t even initially have to raise my taxes by a full $100/mo to cover it, because everyone’s going to have to pay that difference, even people not choosing the public option.
Or, even better, we can keep taxes lower and just add whatever cost isn’t covered to the national debt. That seems to be the current choice of this administration, so maybe we’ll go that way.
So, I’m going to be stuck with the public option, not because it’s cheaper, but because I’ll be paying for it anyway. The Democrats on the Hill know this and admit that the public option is just the springboard to single-payer. And this is how they’ll get there.
It can’t, and there’s no real reason to suspect that it can do either. And yet you’ll still get your wish. The private insurers will be driven out of business by it.
Gotta agree with Chris (and Marcus): the public option IS, in fact, a stalking horse for single payer…
Canada had exactly the same system of private health insurance as the US, up until 1966. Switzerland had exactly the same system up until 1994. Canadian healthcare costs tracked those US up until the conversion. Now they spend 10% of GDP, compared to our 15.3%
Do you really want to claim that the US is unique among industrialized countries in being incapable of running a national health insurance program competently?
Is that, perhaps, related to our being the only holdout in converting to the metric system? Some other national peculiarity?
Surely, you realize that your “private” health insurance is already being subsidized through the deductibility of employer-sponsored health insurance?
Since there’s an extreme reluctance to raise middle-class taxes, the public option is going to be mostly financed through premiums, just like private insurance. It’s true that it won’t be exclusively financed that way (since one objective is to provide coverage for people who can’t currently afford private insurance). But, then, neither is your current private insurance.
I well-appreciate your distinction between the total cost of a health insurance program and the “price tag” seen by the consumer. That’s why I keep harping on total healthcare spending as a percentage of GDP. It doesn’t really matter to me the precise path that money takes along the way.
Except for the experience of two dozen other industrialized countries.
Great!
I wish I had your confidence.
The only evidence provided here seems to be the dogmatic assertion that the government can’t do anything well, which it’s insisted must be accepted as fact without any evidence to back it up.
And which, of course, does not apply to the military or national security matters or torture or warrantless wiretapping.
Only one comment on Jacques’ latest post.
Yes.
Fargus,
I’m not about to turn this post into a discussion on the history of U.S. government waste and inefficiency. There are countless articles, blogs, books, videos, and documentaries on the subject. Using your favorite search engine on “government waste” might be a good place to start.
Jacques,
I was wrong, I had one other comment. One could also argue whether these other nations actually run their programs competently. There’s much anecdotal evidence brought forth by right-wing radio that it does not. I haven’t really paid attention to this, since it is obviously anecdotal and is not accompanied by any “quality of service” research. Also, I’ve been focused more on avoiding increasing the cost and size of government than on that side of the argument. I’ll let others speak for themselves there. I’m sure some research has been done. I don’t know the results. But, I will accept the likelihood that it’s possible these national health programs are not run competently. It’s also possible that they are models of quality and efficiency. I don’t know, and if I thought there was any chance that America could do it without significantly increasing the cost of our healthcare, I would actually care.
See, Chris, that last comment is why I can’t take you seriously in this debate. You bring up some intelligent points that are well worth researching, and then say that you don’t have to bother researching them since your dogma clearly trumps them.
Indeed, quite a lot of research has been done.
I am unsurprised that the results have not been prominently discussed on right-wing radio.
As I said, what I am interested in is bringing the 15.3% of GDP, spent on healthcare, down to something closer to the 9% that is typically spent in other industrialized countries. I don’t particularly care about the precise conduit (public sector or private sector) through which that money flows.
If we’re going to pick on Chris for hypocrisy because his “dogma trumps the points he needs to research”, then (sorry, Jacques) how are we to treat Jacques and his assertion that he doesn’t care about the conduit (public or private) through which the money flows, following so soon after his previous comment that he wished he shared the confidence of Chris that the private insurers would be driven out of business?
This plays into a previous post suggesting that health care cost savings are the Laffer curve of the left, in that they provide a convenient intellectual underpinning for a desired political outcome (in this case, universal, single payer health care) with the giant flaw that the savings are largely hypothetical, and – though convincing to Jacques – not at all convincing to a large part of the public…
I guess I need to elaborate on my — evidently too flippant — comment, to which you refer.
The way I see it, either private insurers will adapt by supplying a product that is manifestly better than that offered by the public plan (albeit, at a higher price), or they won’t. In the former case, they will survive, perhaps even flourish; in the latter case, if Chris is right, they will be driven out of business.
Either way, we, the consumers, win.
Fargus,
Once again, you clearly misunderstand the point I’m trying to make.
I’ve been far more concerned about expense than quality. I don’t have time to research both. It’s not about dogma, it’s about practicality. Such an effort is clearly, according to 230 years of American history, impractical in America. If someone could convince me that it’s practical, then I might be more interested in whether it’s worthy.
Oh, and this point doesn’t make any sense in this discussion:
Are you suggesting that I somehow think that the private sector would be better or less expensive at torture or warrantless wiretapping than the government? Because that’s the point your debating, that I said that government never makes things cheaper or better.
And, you’re wrong about the military. While we appear to have the best military force on the planet, using Jacques’ style GDP cost comparisons, it would be hard to claim that we’re getting our money’s worth here. We could certainly be more effecient here, by huge degrees. And, while I think that the private sector would do better at creating a large fighting force, there are plenty of reasons why you’d want that sort of thing left to the government. I think we can all agree that we don’t want Microsoft creating an army large enough to overthrow the government.
Jacques,
Ok, here you can get me on dogma, because I am manifestly interested in the precise conduit. Private sector only. But, since the public sector option won’t decrease the 15.3% GDP, then maybe we’re in agreement after all.
But I can’t let this pass, because it’s naive.
Hardly. The government never has to be competitive, as the full weight of the government apparatus will always be able to trump the private sector in any field it enters. Can’t compete on price? Hide part of the price elsewhere, in taxes. Can’t compete in quality? Lower your price to the point where it doesn’t matter, or make laws and regulations forcing your product to be used. In this case it’s easy. Tell employers that they must provide healthcare insurance to 100% of employees. Then mark your price down far below the private sector. Now, some companies will be able to afford picking quality over cost. But those that are smaller or having this healthcare insurance requirement thrust upon them, will not, and will take whatever option allows them to be legal for less. There’s no way to call this a win for consumers.
Furthermore, let’s assume that this is the stepping stone for single payer. Hmmm…I thought monopolies were supposed to be bad for the consumer? But in this case, you think it will be a win?
Well, there I think you have a problem of dogma getting in the way of empirical evidence.
There is not a single industrialized country in the world (beside the US) which still provides primary health insurance via private, for-profit, insurers. They all used to do it that way but, one-by-one, they all abandoned that system (the last holdouts, to my knowledge, were the Swiss, in 1994).
As a result, they all now spend a far-smaller fraction of GDP on healthcare than we do.
Now, not all of them went to a single-payer system. Many have a system of non-profit private entities providing insurance, rather than the government.
The closest, to what you consider the only dogmatically-acceptable options, are the Swiss. There, the non-profit basic health insurance coverage is sold by (the existing) for-profit insurance companies. Why do they do this? Because, if they wish to participate in the still-lucrative market for “supplemental” insurance, they must, by law, offer the government-mandated basic package, on a non-profit basis, to all comers.
(P.S.: I was wrong. The French are not our next-most-expensive competitors. The Swiss, at 11.3% of GDP, are.)
The goverment is not a profit-maximizing entity, for which grabbing market-share from its “competitors” is essential to its raison-d’etre.
Let’s start with (Nobel Laureate) Kenneth Arrow’s classic 1963 paper. Then we can move on to discuss the hugely-expensive negative-sum game engaged in by all the private health insurers, in which they try to shift the cost of treating sick people onto their competitors (or onto the patients themselves).
My machine crashed in the middle of a long, and probably unnecessarily rude post in response to Jacques, thus saving me from having to apologize for my behavior later.
So, I will attempt a response in more gentle terms.
Jacques keeps making the same point over and over, that the U.S. has the most expensive healthcare in the world, and that countries with a public option do it far cheaper than we do.
He’s yet to respond to the point that I keep making that his arguments do not apply to the U.S. Until I see some evidence that there is some reason to believe that the U.S. government can do anything cheaper or better than the private sector, then all the evidence and empirical data is completely on my side, that this is a lost cause and the U.S. people will pay a heavy price for it.
You can accuse me of being dogmatically stubborn if you wish, but my argument is that the liberal case on this reeks of insanity. As Einstein is often quoted, “the definition of insanity is doing the same thing over and over and expecting different results.”
The government option is always worse. Whether we’re talking about healthcare, or education, or building houses, or handling mortgages, or building power plants, or even buying toilet seat covers. But liberals keep wanting to try again, somehow beliving that this time it will be different. This time government will get it right.
Wake up. Snap out of it. It’s not happening. It’s never happened. It never will.
Yes I did.
I ridiculed the notion that the US is unique among all industrialized nations in being incapable of implementing what we (for want of a more suitable shorthand) are calling the “public option” in healthcare.
I cannot think of a single distinguishing characteristic that singles out the US, among all industrialized nations, as uniquely incompetent in this regard.
If you can think of one, please put it forward, so that we can discuss it.
Your axiomatic insistence that “The government option is always worse” is empty rhetoric, desperately trying to pretend it’s an argument.
If you want to carry the discussion forward, you’ll have to come up with an actual argument, rather than merely repeating a ‘private sector good; government bad‘-type slogan.
Ahhh…I did it after all. That last comment was over the top and I should apologize.
Really, it boils down to this. Jacques and I are at an impasse.
He’s completely certain that, not most, but all of the evidence unequivocally supports his conclusion.
I am just as certain of the exact opposite.
Neither of us will recognize the points that the other is making as having any validity.
For those of you keeping score at home, that means that a) we’re both stubborn, and either b) one of us is not altogether sane, or c) we’re both wrong.
My guess is a) and c).
But, I do believe that some sort of public health care system will pass at some point in the next four years, and within about 10 years after that, I’ll be able to look back and say “I told you so.” Not that it will do any good, because at that point, the system will be firmly entrenched, and we’ll be stuck with it.
And that’s the worst problem of all with a public sector system. Once created, they’re almost impossible to get rid of. So, you better be right. It better be the answer, because whether it is or it isn’t, you’re not going to be able to turn it off afterwards.
No, Jacques, you’re the one who has failed to come up with a remotely convincing argument. I’ve asked you to several times, and you keep repeating the same argument over and over that I have rejected as irrelevant and immaterial. You’ve yet to provide any evidence whatsoever that what has happened in other countries has any bearing at all upon this discussion.
And the reason why you haven’t, is because it doesn’t.
Tricare seems to have 9.2 million satisfied enrollees… active-duty and retired military, disproportionately in the South.
Off-topic, but hey, it’s my blog: Good to see your blog back in action again, Jacques…wish I was smart enough to understand half of it.
If any of my regulars wants to know why I offer a high degree of deference to Jacques, it’s because he’s undeniably a very smart man, no matter our disagreements on some political questions and policies…
Off-topic? Seems to be the “public option” in action, for military personnel, retirees, and their families.
If the experience of other countries with the “public option” is, for some inexplicable reason, irrelevant, perhaps their experience is relevant.
I had planned to blog Strings 2009 in Rome (from which I’ve just returned). Alas, Italian efficiency intervened …
Chris, your guess isn’t really that you’re stubborn and probably wrong. If you thought you were probably wrong, you’d likely not be so stubborn. There’s nothing wrong with being stubborn. Don’t try to paper over it with false humility. It doesn’t wear well.
Jacques is holding up data points in his argument, in pointing to other industrialized nations with relevant experience in the area of health care. Those data points could be reasonably examined to see if those experiences could and should be applied to the United States. What’s unequivocally not legitimate, however, is to reject those arguments out of hand because you insist without any evidence that everything the government does is bad (and you have the temerity not just to assert it, but to demand that it be taken as the default position, assumed to be true unless someone else does your homework for you). What’s not legitimate is to equate your rejection of Jacques’ arguments based on the fact that it’s really hard to hear with your fingers shoved in your ears so hard, with Jacques’ rejection of your “argument” that whatever you say needs to be presumed to be true, and that you can’t condescend to provide any evidence to back it up.
It’s getting ridiculous.
Chris can defend himself but I will just add that I understand his point, vis-a-vis Jacques, to be that Europe and Canada are not the United States and so the assumption that our experience with national healthcare, and its attendant cost, will be the same or better is, at least, open to challenge, especially if the system we propose to install is not identical to theirs. Furthermore, that they deliver health care more cheaply, as measured against GDP, ignores the question of what they deliver (quality/quantity) compared to the US.
They’re not Australia, Japan or Korea, either.
For that matter, Sweden is not Germany, France is not Iceland, … etc.
Each of of the two-dozen countries has its own peculiarities that makes it different from the rest.
And their healthcare systems are not identical either.
Still, one ought to be able to learn something from examining their experiences, no?
I’m not ignoring that. There’s lots of comparative data, on healthcare outcomes in industrialized countries. By some measures, the US fares quite poorly, compared to the others. Overall, though, the healthcare outcomes across the industrialized world are pretty much comparable. The only discernible difference is that the rest of the industrialized world achieves those outcomes a lot more cheaply.
Really?
You don’t care whether the guy sitting next to you on the bus has antibiotic-resistant TB? You don’t care whether the kids in your child’s class are vaccinated? You don’t care whether your co-worker drops dead of a heart attack, in the middle of your joint project?
Sure you do.
To pick an analogy, you subsidize free public education, through high school, for all your neighbours. Not only that, but you mandate that their kids actually attend school.
Why?
One need only look back to what the country was like, before the advent of universal public education. Most of the population was illiterate, fit only for the most menial of occupations, and everyone was poorer, as a result. You can’t run a prosperous, modern industrial society, without an educated workforce. So you are (or ought to be) more than willing to make the public investment in human capital, which is required for you to be able to enjoy the fruits that our technological society provides.
The argument for ensuring that your fellow citizens are not too sick, to be productive members of society, runs pretty much the same way.
The sick guy on the bus next to me is no more or less likely to be so with or without a national health care program. I work for a company with good health care benefits such that there is little or no financial reason not to have coverage, and, yet there are plenty of people that get sick. Keeping them away from work when they’re sick would be a more expedient way to reduce the transmission of their various illnesses (especially the ones with elementary school aged children!).
Ok, I really had said all I cared to say on this subject, but this will, in fact, be my last post. No one has provided any useful information since Mark’s initial post, and I really don’t expect to suddenly see some now.
Fargus,
It’s not that I want you to do your own research, it’s that I don’t have an infinite amount of time to post links to the billions of articles online regarding the excesses of the Federal Government. Nor do I want this to get into a discussion of why it’s really ok (or isn’t ok) how much we spend on education, housing, social services, national defense, public transportation, energy, space exploration, agriculture, research, infrastructure, communication, legislation, the judiciary, etc. ad infinitum. I want to stick the point.
So far, none of the arguments from Jacques are relevant, let alone convincing.
TRICARE does not appear to support Jacques’ hopes of cutting down costs by any substantial margin. DoD spends about $45B/yr on healthcare, for 8 million people. That of course doesn’t include their enrollment fees, deductibles, co-pays, or additional payouts through MediCare, etc. And while the military certainly suffers from being high risk, one would hope that active duty personnel are in better shape than most of us and have less expenses related to being overweight, malnutrition, etc. We don’t have age breakdowns and breakdowns on who’s eligible for Medicare, but we can make some assumptions using U.S. averages.
If there’s 8 million people covered, about 1.25 million of them are eligible for Medicare. These people spend about 2:1 compared to non-Medicare recipients, so we can add about $7.5B the that $45B number giving us $52.5B, which again doesn’t include fees, deductibles, co-pays. Obviously this is hard to estimate, but if we conservatively say $500/pp/anum, that gives us another $4B, for a total of $56.5B for these 8M people, or slightly over $7000/pp. US avg. per capita is just under $8000/pp.
Also, what are the cost benefits of healthcare at a military facility? The doctors and nurses and administrative staff their are just paid their standard G-whatever wages, right? At least any that are government employees. These will be substantially less than the salaries of private sector hospitals, which also artificially decreases the military cost. Now, I suppose you could move all health workers into the public sector and pay all healthcare professionals G-whatever wages, but if you think that’s going to increase the quality of healthcare, keep dreamin’.
I suppose a savings of 12.5% is significant, but as I’ve said, I would expect this group of people to be in better shape, and I think I’ve been conservative on my estimates. And you expect administrative costs to increase as the the group size increases, so if the size increased by the 40x necessary to cover the entire US pop, it’s hard to believe that the cost wouldn’t rise significantly over that $7000/pp.
Random Questions:
Does the admin cost of Medicare include things like rent, land purchase, building construction, etc.? Or do those expenses come from other parts of the Federal Budget? I expect the answer is the latter.
What did these other countries spend on healthcare before they went to their socialized systems?
Why are infant mortality rates so much higher in these countries?
And, once again, should you attempt to justify public sector, please refrain from the “everybody else does it” responses. They add no value whatsoever to the discussion. If that’s all you’ve got, you’ve got nothing. If you have specific details on how, why, and how much, you’d expect to save in the U.S. on a public-sector plan, then please provide them.
I’m out.
My reading indicates
1) Tricare covers 9.2 million people, not 8 million.
2) It’s exclusive of Medicare (ie, military retirees are dropped from Tricare at age 65, when they become eligible for Medicare).
3) Tricare has no copays, deductibles, or enrollment fees.
If I’m wrong about any of these, I’ll be happy to be corrected. But, as far as I can tell, none of the things you “added” to jack up its apparent price, actually apply.
I think the fact, that active duty military (though not, necessarily, their families or retirees) are more fit than the general population, is more than made up for by their higher risk of life-threatening or debilitating injury, PTSD, …
I wouldn’t expect the administrative cost per enrollee to rise. You’re familiar with the concept of “economies of scale,” right?
You are right, though, that the doctors in Tricare earn less than their colleagues in civilian life (though more than their non-medical counterparts). So one wouldn’t expect nearly as dramatic saving from a civilian version, which would be comparable to the UK’s NHS. The latter, I’ll point out, spends $2760/person/year. (Irrelevant, I realized, because nothing done in any other country could possibly be relevant to this country.)
Anyway, the point was not to suggest Tricare as a model for revamping the entire US healthcare system. Rather, it was a rebuttal of your claim that the US government couldn’t possibly deliver quality healthcare at a reasonable price.