I'm just beside myself that people continue to argue how our horrendous system now is better than the alternatives in other countries. The data is clear. We spend double. Our life expediencies and overall health are worse. The system is broken. Having a whole bunch of insurance company employees, coders, PBMs or whatever, acting as middle men -- they're all skimming a piece of the action, and our overall health is suffering. Sorry to those who work in the field as medical coders or claims processors or whatever... but your jobs never should have existed in the first place.
I feel like we're arguing different points, and not necessarily disagreeing with each other.
Health insurance companies have a profit margin of 4-5%. That's actually significantly below the economy as a whole. So it's not like they're laughing all the way to the bank. Sure, going full-on NHS would eliminate that cost. There's also all the work that's duplicated in each company, in terms of setting reimbursement rates, actuarial stuff, etc.
Nobody's arguing that we spend double per capita as other developed countries. The problem is that a lot of people think that replacing a big group of
insurance companies with one giant
insurance company will, by itself, somehow magically reduce the per-capita cost or our health
care to be in line with that of other countries. In short, it's an effort to shift how health care is paid for, rather than addressing the actual costs. It's politically advantageous, i.e. it gets votes, and under a static analysis, it would appear to reduce costs by a noticeable percentage, but it does nothing to fix the real reason why health
care is so expensive.
Someone else in this thread has pointed out that administrative overhead is something like 33% of total cost, compared to half that in the UK. Ok, let's figure out why that is, and how we can fix it. Health insurance companies' overhead and profits certainly add some percentage to the cost as well. Malpractice insurance adds to the cost. High salaries required in order to pay for high educational costs certainly adds to the cost. The fact that the US pays far more for prescription drugs than other countries not only inflates our costs, but indirectly subsidizes the costs other countries pay.* The byzantine nature of medical billing, and all the overhead that creates, is a problem.
Stumping for single payer without addressing the underlying costs is, IMO, a lot like transferring a maxed-out CC balance without taking a look at your spending habits.
* Assuming the numbers posted earlier in this thread are correct, 10% of US healthcare spending is medication, and we pay
3x as much as the UK for the same medications. Let's assume that medications are also 10% of the UK's HC spending, and the rest of western Europe pays similar costs as the UK. If we passed a law saying pharma companies had to sell the same drugs at the same price to the whole developed world, they'd have to raise prices in the UK and drop them in the US. Let's say they cut the cost in the US by 50% (say, from $10 to $5), and raise it in the UK by 50% (from $3.33 to $5). Just that one change would mean that the US pays 1.8X per capita, rather than 2X per capita, compared to the UK.